In an exclusive interview, Maharashtra Chief Secretary Sitaram Kunte talks about the state government’s strategy to bring down COVID-19 cases in the second wave and how it is geared up to tackle the third wave.
How is the government prepared to combat the virus in the third wave?
We are preparing for the third wave of COVID-19. The first wave struck big cities. The second wave started in tier 2 cities. The third wave may emerge from rural areas. Demographically, the third wave may affect the younger population below 18 years of age.
The state government will ensure how testing can be taken deeper into villages. There are limitations to setting up highend labs to conduct RT-PCR tests. We can take rapid antigen tests. Outreach into villages will be important and still have many challenges. Because of the fear of stigma, there may be resistance from the villagers. So we have to work on social aspects and see how the health staff will deal with it.
The state government has formed a task force of pediatricians to deal with cases amongst children. It may need pediatric ventilators, different equipment and medicines. Similarly, protocols may differ. The task force will evolve.
In addition, the government is focusing on augmenting all its facilities, oxygen, storage, beds and ventilators, amongst others. The government has commissioned a genome sequencing study to take 4,000 samples in Maharashtra in one month. It is very important; once we know what kind of virus it is, how fast it is spreading and what treatment it is responding to, doctors will know how to deal with it.
Even though the government has succeeded in containing the cases, everyone must continue to follow COVID-19-appropriate behaviour. The message is: avoid declaring a victory and not be complacent.
Oxygen is key for treatment. Did the state overcome its shortage?
Oxygen turned out to be a key element. In the first wave, of the total positive cases that were active, 10% required oxygen support. However, in the second wave, almost 13% to 14% needed oxygen support. The state government raised the alarm on March 20 and started procuring additional oxygen from Bhilai. It decided to reduce the availability of oxygen for industries and diverted it for medical usage. However, a stage came when the in-house capacity of 1,250 MW was being entirely consumed. At that time, the government raised the issue with various ministries and sourced oxygen from the east, west and south.
There were 80,000 patients who were on oxygen beds at the peak of the second wave. Therefore, the government launched Mission Oxygen to produce it within the state. The whole idea was to ramp up the capacity by 1,800 MT as soon as possible and take it up to 3,000 MT. The government will not import liquid oxygen and instead focus on increasing its production capacity. It is interacting with suppliers from various countries for the transfer of technology for PSA plants.
What is the government's vaccination strategy, as it is currently struggling to meet the demand?
The government aims to procure vaccines domestically at the known rates -for Covishield, it is Rs 300 per dose, and for Covaxin, it is Rs 400 per dose. The sources are known. The government has taken a policy decision to provide free vaccination to those in the age group of 18 years to 44 years depending on the availability of vaccines and has earmarked the requisite budget. It is in touch with the Serum Institute of India and Bharat Biotech to get vaccine doses, which are much lower than the government would ideally like to have.
Internationally, we still have to figure out the rates, who is coming forward and their conditions. It is difficult for states to procure vaccines internationally, as there are various aspects, including international law, approvals and patents on which states may not have requisite competence. The Pfizer vaccine needs minus 70 degrees Celsius temperature for its storage and it will not be easy to maintain it in a hot climate and interior parts. It is learned that some foreign supplies are asking for an indemnity clause. The government has issued Expression of Interest as an exploratory exercise to know who can supply vaccines. There are the World Health Organisation-approved vaccines. Sputnik has replied and the government is studying their offer.
