A ‘model’ in shambles
As Gujarat struggles with the increasing number of cases, many activists and noted members of civil society have suggested that the crisis could be handled more effectively if a community-based approach was adopted with state assistance in handling treatment and vaccination rollout.
GUJARAT’S deepening COVID-19 crisis is showing no signs of improvement: neither the death rate nor the number of infections is plateauing. Gujarat’s one-time claim of being a model State stands exposed by its inability to cope with the pressure of the second wave of the pandemic. Worse is the State administration’s pathetic denial of the enormity of the crisis and its attempts at hiding the data on deaths.
Following tragic scenes such as ambulances lining up outside hospitals, patients lying in hospital corridors hooked up to oxygen tanks, several funeral pyres burning at the same time and thousands of people lining up for remdesivir injection vials, the State government appears to be finally addressing the crisis. On April 25, a 900-bed hospital set up jointly by the Defence Research Development Organisation (DRDO) and the Gujarat government started functioning in Ahmedabad. A 1,200-bed hospital is expected to be set up in Gandhinagar in the coming weeks, said an official release from the State government. Gujarat has been reluctant to enforce a complete lockdown because, among other reasons, it consists essentially of a mercantile community and another total lockdown would be a huge setback to smalland medium-scale businesses, the backbone of the
State’s economy. However, on April 28, Chief Minister Vijay Rupani, stopping short of announcing a full lockdown, imposed stricter restrictions that included a night curfew in 29 cities. He said every non-essential public space such as malls and parks would be shut until the situation improved.
On April 28, the COVID-19 dashboard on the Government of Gujarat portal on COVID-19 statistics posted the number of deaths in the State as 6,656, which marks an increase of 1,664, or 33 per cent, from the April 16 figure. With a total of 5,24,725 cases of COVID-19, Gujarat ranks 12th among the States worst affected by the pandemic. Of this total, 3,90,229, people have recovered and 1,27,840 cases remain active. Gujarat’s case fatality rate (CFR) is therefore about 1.3 per cent, hovering close to Maharashtra’s (the State reporting the highest number of deaths), which is at 1.5 per cent. The national CFR is 1.1 per cent, according the Ministry of Health and Family Welfare.
Local sources in Gujarat said that the death count was being under-reported, that the oxygen supply was low and that there was a massive medicine shortage. Sagar Rabari, leader of the Khedut Ekta Manch, an organisation that works with farmers, said: “I don’t have
words for what is happening in Gujarat. If the urban centres are struggling, the rural belt is getting wiped out owing to the poor health infrastructure. There are no RT-PCR [reverse transcription polymerase chain reaction] tests available in villages, so positive patients are roaming freely causing an increasing spread [of the disease]. When they begin to fall sick, there is no treatment centre as the primary health units are not equipped to handle COVID cases. Because the State has neglected its health facilities for the past 20 years, we are facing this tragic situation.”
Rabari said it was an absolute fact that COVID-19 deaths were not being accurately reported. Describing a sting operation by a local television channel, he said that TV reporters sat incognito at the Civil Hospital in Ahmedabad from midnight to 2 p.m. the following day and counted 67 dead bodies, which they confirmed died from the COVID-19 virus. The city reported 20 deaths that day. A matron at the Civil Hospital testified to the false death count. On condition of anonymity, she told Frontline: “I was asked to sign just three Covid-related death certificates. But I witnessed 30 deaths that day. If there are 25 deaths, they will report 15. The [hospital] administration is under severe pressure from the State to not reveal the real numbers. So, the deaths are attributed to other reasons such as cardiac arrest or hypertension.” She said the biggest challenge the hospital currently faced was the low supply of drugs and oxygen cylinders. “We have no stock or extra supplies. We just pray by evening that the cylinders are delivered and we have refills. Medication and injections are in a similar state.”
COURT’S INTERVENTION
As the State’s COVID-19 crisis spiralled out of control, the Gujarat High Court took suo motu cognisance of the exponential spike in COVID-19 cases on April 10. Chief Justice Vikram Nath asked the government to give a report on the shortages in testing facilities, beds and medical infrastructure. While hearing the case on April 28, Justices Nath and Bhargav Karia directed the State “to speed up and find other alternatives for the manufacture of oxygen for medical use”. The bench said: “The PSA [pressure swing adsorption] plants which are not functional need to be made functional at the earliest… as much as possible oxygen should be made available within the State in addition to the central allocation so that there is no shortfall of oxygen.”
In a move that exemplifies the State’s poor handling of the crisis, government hospitals were told to admit only patients brought in by the 108 ambulances. Obviously, this caused severe distress as people were coming to the hospitals in whatever transport was available to them. The government had to revoke the policy. “It was absurd. We have to save whoever comes and however they come. It should not depend on which ambulance brings them!” said the matron. A public interest litigation petition filed on this issue made the court direct State hospitals to accept all COVID patients and not discriminate on the basis of which vehicle they come in.
The matron said: “Yet, a major part of the problem has been brought on by the people themselves. In March, we saw people not wearing masks, organising big weddings, going to religious ceremonies, going to malls and behaving as though the virus had gone. All of this led to the spread.” Anand Yagnik, a lawyer and activist who has been filing petitions against the government in order to jolt them into addressing the alarming situation, said: “It is heart-wrenching to get calls from people who beseech us for help. Some of them die a few hours later, and we are left wondering what is going on.” Asked whether a lockdown needed to be imposed as had been done in some other States, Yagnik said that might be a solution, but the common man would suffer tremendously. “I work with street vendors, construction labour, auto drivers, etc. They plead with us saying please tell the government we will follow all protocols but not to impose a lockdown.”
MEVANI’S APPEAL
Jignesh Mevani, an independent Member of the Legislative Assembly and a proactive politician, filed a petition in the Gujarat High Court on April 26 asking the Chief Secretary, Gujarat, the respondent in the case, whether he could use his MLA funds to set up an oxygen plant in his constituency of Vadgam and buy necessary equipment and drugs, namely, Mevani asked whether he could spend Rs.30 lakh to set up the oxygen plant, Rs.10 lakh to acquire ventilators and a further Rs.10 lakh to purchase injections of remdesivir and tocilizumab.
Mevani says in his petition: “The applicant feels helpless and vulnerable even though he is an elected representative and he is unable to provide medical assistance to the people suffering from corona in his constituency because there is no hospital in his entire constituency which can provide effective covid treatment with oxygen, ventilator and other logistics, medical equipment, drugs and medicines. If the funds meant for the applicant as an MLA are utilised towards setting up an oxygen plant with the help of competent and suitable agency, and if primary and community health centres are equipped with ventilators and other necessary medical logistics and equipment, besides the oxygen, the constituency of the applicant will have an effective corona hospital.” Mevani said that if the primary and community health centres could be equipped to treat COVID-19 patients, it would ease the burden on urban hospitals.
Most activists and noted civil society members have been suggesting an approach similar to Mevani’s—essentially, a community approach with state assistance in handling treatment and vaccination rollout. They believe it will be effective as the community will take ownership of the pandemic. However, unless the Centre realises this, it is unlikely that improvements will be seen. If a Bharatiya Janata Party-ruled State, one that is the home State of both Prime Minister Narendra Modi and Home Minister Amit Shah, who is supposedly steering the management of the pandemic, cannot look after its own, what will be the condition of the rest of the country? a resident of Ahmedabad asked. m