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Thursday, April 15, 2021

Can’t afford another lockdown now…need to speed up vaccination to prevent more deaths: MCCIA president Sudhir Mehta

IDEA EXCHANGE-PUNE | Sudhir Mehta on the Covid surge: Now that the cases have started to rise again, we have been telling hospitals that they need to defer the elective surgeries right now, and try to arrange more beds for Covid patients. There is a big reluctance on the part of hospitals because the government has not cleared its previous dues.

By: Express News Service | Pune |
Updated: March 28, 2021 6:20:13 pm
Sudhir MehtaMahratta Chamber of Commerce Industries and Agriculture president Sudhir Mehta (Express photo)

As the president of the Mahratta Chamber of Commerce Industries and Agriculture (MCCIA), Sudhir Mehta has been leading the demand for increased vaccine doses for Pune, considering that it is the worst affected city right now. During an Idea Exchange programme at The Indian Express, Mehta spoke about this, and the impacts of the pandemic on Pune Inc.

Sudhir Mehta: Let me start with some statistics. Today, we have around 50,000 active cases. This is what is being reported. But given the positivity rate, I would assume that the actual number of cases would be three to four times higher. Even in the most optimistic scenario, we would have well over 1 lakh active cases in Pune right now. Also, the city has so far recorded five lakh cases. Again, the actual number could be anywhere between 10 to 15 lakh. Certainly, Pune is one of the worst impacted cities. Right now, about one in every eight new infections in India is in Pune, which is frightening. We are nearing 10,000 deaths, which unfortunately is next only to Delhi and Mumbai.

The second point is about vaccination. As we now understand, a vaccine does not completely prevent you from getting infected, but it almost certainly prevents death or serious complication. Given the fact that about 85 per cent of the people who have died due to the virus are above the age of 45, we need to vaccinate this population first. Extrapolating the data in Pune, it would be fair to say that we are heading towards a situation where there would be more than 50 deaths in a single day. My real fear is that in the next two weeks, Pune would see a big spike in the number of deaths.

Many of these deaths can be avoided if vaccination is accelerated. Studies have estimated that every one lakh vaccinations, after a two-month lag period, prevent 15 deaths. We have reached out to everyone, from the Prime Minister to the Health Minister, to say that since Pune is at the centre of the epidemic, in the first wave as well as the second wave now, there should be at least one lakh vaccinations happening in the city every day. If we look at the number of lives that we can save per 1,00,000 vaccines, the impact will be maximum in Pune.

And this is not beyond our capacities. We have more than 200 private hospitals ready to participate in vaccination. There are at least 900 facilities immediately available where the vaccinations can be done. Our data shows that in Pune district, there are 8,500 hospitals, health clinics and polyclinics, and each of them can be turned into a vaccination centre. If the stocks are available, 1,00,000 vaccines can easily be done. Most of the big hospitals, like Deenanath Mangeshkar Hospital, are already doing 1,300-1,400 vaccinations a day. You multiply that by 100, you would have achieved the target. So, the plea is to allocate one lakh doses for the city per day. The first dose is important because that itself provides 50-60 per cent protection. The second dose enhances that protection. One lakh doses of vaccine per day would significantly reduce mortality in the city.

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The other thing is slightly contentious but I think we need to propagate this idea of open sourcing of vaccine formulation. We are in a pandemic, many people are dying, and the economy would get into a severe shock if we again go in for a lockdown. We can open source the vaccine formulation at least for the ones that are being made in India, that is Covaxin right now. We must give royalty to the company. I am not saying they must not be compensated for their efforts. My point is that if the pandemic is going to remain with us for some time, we need to make vaccines easily available — it needs to be something that anyone can go to a pharmacy and buy. If you remember, at the start of the pandemic, the US government had asked companies like General Electric to make their ventilator technology open source.

Anuradha Mascarenhas: The question on vaccination that a lot of people are asking is why are we not doing more, or opening it up for everyone. Is it a problem of production, or difficulties in the supply chain?

I think there is a lack of trust. The problem is that we want to regulate everything. This talk about wastage, for example. According to me, there is no wastage. Most probably, somewhere, someone’s uncle or friend or someone important is getting the vaccine out of queue. Now, are we going to fight over that right now? I am not trying to justify that behaviour, but there would always be two per cent or five per cent of the people who would be able to game the system. Should we disrupt the rest of the system because of that?

Hospitals and doctors are not being trusted enough. They are not issued new vaccines till they consume their previous stock. Ironically, that is leading to a little bit of hoarding, because the hospitals are saying they want to keep about ten doses each for their own healthcare staff. You see, hospital staff have to queue up five hours at distribution centres to take delivery of their vaccines. The long lines there itself must be leading to more infections. Multiple levels of data entry are required. I think we have made it too complicated and been asking for too much paperwork. I don’t think all this is necessary.

Partha Sarathi Biswas: Is the trust deficit more political than administrative?

Yes, 100 per cent. This is because the state does not talk to the Centre. We (MCCIA) are often the go-between. They (state government) keep sending letters to us. For instance, we have been requesting the state government to ask for more doctors from other places to take care of our seriously ill patients. This is a large country, and I am sure we can get additional resources. But they want us to take it up. I said fine, but give us in writing. That they do not want to do. We are like an NGO. Our words can go only that far. When we take it up with officials in the central government, they ask us why the state government doesn’t write to us. There is clearly a lack of communication between the Centre and the state government.

Alifiya Khan: MCCIA has done several assessments of the impact of the pandemic on industries, and it has highlighted the fact that the biggest sufferers have been the MSMEs. How big is the impact?

Most of the large companies are almost back to their pre-Covid levels. There is no real worry there, except if there is another shutdown. Of course, some sectors like the hospitality and travel industry are still very severely impacted. If you talk about the smaller units, they face a challenge of, what I call, liquidity versus solvency. What did the government do last year? They pumped in a lot of liquidity. So, they said, look, if you have one crore loan pending, you will be eligible to draw another 20 per cent loan on that. That was actually a good scheme. It gave them liquidity. What it did not solve was the question of solvency, especially for the smaller companies whose revenues have taken a hit.

What I fear will happen more in the coming months is that companies which took this money will face problem in repaying the loans. The same holds true for hospitality, education or people who were freelancing. Women have faced the brunt of the lockdown. They have been affected in a more severe manner. That is another reason why I say our country can’t afford another lockdown. Already, there are reports of migrant labours trying to go away in fear of another lockdown. If they go away, the industries in Pune would grievously suffer. There is a big fear that if there is a lockdown now, the impact will be felt for a long time.

Amitabh Sinha: You mentioned 15 lives can be saved for every one lakh who are vaccinated. Can you please elaborate where that estimate has come from?

There was a particular French study last year which calculated the effect of vaccine hesitancy or delay. Of course, these were based on European numbers. But I will give you another data point from Pune. This study was done by Professor L S Shashidhar and his colleagues here. They tried to study the infections in different age groups. And the interesting finding is that between December and the second week of March, the percentage of younger people getting infected is much higher than earlier. These are the people who are moving around a lot, and probably the main reason for the spread of the disease, though they are not the ones who are very seriously impacted. The deaths are still happening in the higher age groups.

Amitabh Sinha: What has been the overall economic impact of the pandemic for Pune? Are there numbers for job losses, companies going out of business and the impact on overall economy?

We do not have a single number but I will give you some data points from which some conclusions can be drawn, I think. We did a series of surveys where we called the same companies every month and asked three or four questions. In April, business was down to 30 per cent. That has come up to 90 per cent now. This was rising pretty much every month. Some industries are back on their feet totally. The two-wheeler industry in Pune, for example, is back in business and doing well. The IT industry, by and large, especially the larger ones, have managed well. They were not very severely impacted.

I think the ones which have been severely impacted are the micro businesses and the sole proprietorship companies. Unfortunately, there is not very good data available on them. Pune has a very large number of MSMEs. Some of them would have gone out of business. We need more work to gather data on these.

Anuradha Mascarenhas: What is your assessment? Is the city ready to deal with the rising number of cases?

Well, our bed allocation for Covid is half of what it was last year during the previous peak. I am talking about beds in the private hospitals at the moment. If you remember, the bed allocation for Covid-19 patients in private hospitals was 80 per cent. That has been lowered, and rightly so, because the hospitals have to look after other non-Covid patients as well.

Now that the cases have started to rise again, we have been telling hospitals that they need to defer the elective surgeries right now, and try to arrange more beds for Covid patients. There is a big reluctance on the part of hospitals because the government has not cleared its previous dues. There were more than Rs 50 crore in dues pending to the private hospitals. So, we took up the issue with the local administration and thankfully, in the last few days, about half the dues has been cleared. The government is trying to persuade the private hospitals to go back to the 80 per cent allocation rule, but that is not easy.

At the same time, as a city, we must also worry as to what happened to Sassoon Hospital. It is the largest hospital in the state — so much money goes into Sassoon, but the hospital is bad shape. We need to find more hospital beds, get additional medical staff from other states, if required, and work together to prevent the deaths happening every day. Because many of these deaths are preventable if we manage things more efficiently.

Anuradha Mascarenhas: How is it we have not learned our lessons? The problem at Sasoon is nothing new. And where will the non-Covid patients go? Also, in your conversations with doctors and health experts, what is the sense you get about the emergence of this double mutant strain of the virus?

You are right. We have not learned our lessons. The leadership of the city, and ordinary citizens like us, we haven’t spoken strongly enough about the condition at Sassoon. Everyone knows that Sassoon needs to be improved, but right now, there are noises, and six months down the line we will all forget about it because the urgency would be over. The fact is that other hospitals would not be able to take the load if the main public hospital is unable to do its job well. Look at the Deenanath Mangeshkar Hospital for example. It is one of the finest in town, and so everyone wants to go there. But its occupancy is full and it is struggling at the moment.

On your other question on the double mutant virus, what I am hearing is that these days entire families are getting infected. The positivity rate in the city is somewhere around 40-45 per cent on some days. That would mean that we would not be able to catch all the infections. Thankfully, the severity of the disease is not that high. You can’t hide deaths. Deaths being reported are fairly accurate. So, severity is far less, for sure.

I know of many cases where doctors who have taken both the doses of vaccine have still got infected. One thing is very clear. Vaccination does not guarantee that you will not be infected. This was known right from the start. They are not 100 per cent effective. So, there will always be a possibility of getting infected. But what is more important is the fact that vaccines do save you from severe complications and death. So, even if you do get infected, at least your condition will not become serious and you won’t die.

Partha Sarathi Biswas: Are enough ventilators and PPE kits available in the city?

The answer is that we do not have enough supplies. The PMC data, for example, was only showing 23 available ventilators. But 23 is nothing. It means we are already out of ventilators. You talk to hospitals on a one-on-one basis and they will tell you they don’t have enough ventilators.

There is another indication. We have a company here, a young start-up, which makes ventilators. I got four calls yesterday from different hospitals asking for their contact. This can be a hit now that we are running out of ventilators.

At the same time, we need to ask what happened to the ventilators which had come last year through the PM CARES Fund. My understanding is that many of them are just sitting idle — they cannot be deployed because they do have spare parts. The information I have is that several of these are not working because of want of spare parts, or because their annual maintenance contracts were not worked out.

For the sake of comparison, the allocated ICU ventilators in private hospital in Pune was 366 on October 10 last year, and it is 246 now, which means we have 120 fewer ventilators now.

Alifiya Khan: Mumbai seems to be making much more effort, like randomly testing people, or whisking people to government-run Covid care centres. Is Pune lagging behind in effort?

It has been flagged by several people in our group that Pune is not doing a very good job of micro-containment. Contact tracing is also not happening at the level it should. On the testing front, there is a limitation. There aren’t many laboratories that can conduct RT-PCR tests.

That brings me back to something that I keep on stressing. We are ready to spend Rs 800 on RT-PCR tests and Rs 500 on rapid antigen tests, but we seem to be reluctant to pay Rs 250 for vaccine doses. My point is that vaccines provide the most cost-productive solution out of the crisis. We need many more vaccinations than we are currently doing.

Sushant Kulkarni: Are there are data points about which sectors had seen the most job losses?

From what I remember, the micro and small sectors have reported the most job losses. Also, the sectors which have been badly hit by Covid, like hospitality and travel, have seen big job losses. If you think in terms of percentage, the women were more severely impacted.

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