More than four lakh new cases yesterday. A little more than a week ago, three lakhs was considered a big breach in the defenses. But it keeps growing. And these are only the recorded numbers. The real numbers are probably over a million a day.
The case count is beyond control. I don't think, given the kind of public administration we have, anything can be done about infections beyond the precautions we take individually. The virus is simply everywhere. The vaccine rollout is also slow. That leaves only one option.
We have to boost the capacity of hospitals and clinics to keep people alive. This means a massive supply of ventilators, oxygen, ICUs beds and drugs to as many facilities in the country as possible. And more new facilities, initially make-shift but intended to be permanent.
India has among the highest levels of private funding for health care. The pandemic has hung a big question mark around that. We are moving towards government funded care in starts and fits. Would be much better to declare a full system of care, and start working on the details.

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More from @ashwinmahesh

2 May
Scarcity is the main weapon of the corrupt. They maintain a limited supply of most things (housing, doctors, crematoriums, public transport, schools ... all sorts of things) so that there is a scramble for these things, and a queue of ppl pleading for help. Rent-seeking follows.
In normal times, people stretch themselves to get by with this, for many reasons (time, bandwidth, disregard, resignation). But these are not normal times. There's no getting by without oxygen and ventilators and drugs. But scarcities don't disappear overnight.
Electoral competitions between rent-seekers is not going to fix this problem. We need governments committed to abundance, in a public way. Leaders must dramatically increase the inputs to development - education and health facilities, and paths to livelihoods in different ways.
Read 5 tweets
1 May
Now the Bamar majority wants to join hands with the ethnic minorities in Myanmar to tackle the military. For all these years, the same majority cheered the persecution of minorities, but now that soliders are shooting at them too .... change of heart? No. Calculated, more likely.
The story of 'first they came for others, but I didn't do anything because I was not one of them' is quite an old one. Eventually, we are all them. The story of 'I didn't do anything myself' is also an old one. Doing nothing in the face of evil isn't a case for absolution.
With the military fighting the people on multiple fronts, there is a real danger of Myanmar disintegrating into a war zone on our borders, with arms and drugs running wild. Beyond talking about looking east, India needs to see what is plainly evident.
Read 5 tweets
1 May
Yesterday the Supreme Court wanted to know why, when there are 10 PSUs that can license and manufacture vaccines, the government instead gave a grant of Rs.4500 crores to the private sector to do that. The answer that cannot be told - those PSUs couldn't save anyone.
We have various navaratnas and various kinds of other jewels in our PSU crown. But most of them are biding time, and are not really market-facing firms that know how to operate with the pressures of time and costs. Imagine giving the vaccine production job to them!
The large Indian population has given some of the PSUs a volume business, but usually at low levels of operating efficiency, and sometimes by transfering or not counting costs they should be including in their accounting. They are more like Plodding Sector Undertakings.
Read 4 tweets
30 Apr
Supreme Court asks whether provisions of patent law, which allow the government to set aside patents to enable a public good outcome, have been considered. And whether vaccine and drug production can be ramped up if this is invoked.
All of this reminded me of an old article by George Monbiot. The history of patent law, its use and abuse by countries, and the growth of large companies in countries without patent protection, is quite interesting.
indiatogether.org/patent-op-ed
The court is also asking the government about the price of vaccines (which seems much higher in India than abroad), and what is being done to keep prices affordable as per the Drug Prices Control Order. Also asks why Centre isn't buying all vaccines at its cost.
Read 4 tweets
28 Apr
The number of tests carried out in Delhi is now more than 85% of the total population. Effectively, that's more than 1 test per adult in the city. In Haryana it is 25%, in UP it is about 17%. Similar large differences exist in ventilators, oxygen, etc.
Areas of Haryana and UP that are closer to Delhi may be slightly better than their state averages. Nonetheless, what these numbers show is that Delhi is picking up a very large part of the deficit in surrounding areas. To ease that, those areas too need to do their part.
The public does not have the luxury of sifting through the claims of governments. They go with something they can judge better - the experiences of people they know. If that experience tells them to 'go here' instead of 'there', that's what they will do.
Read 4 tweets
27 Apr
The top 15-20 cities in the country have 80-90% of the ventilation and oxygen supply facilities. One reason for the very large crush of demand in the cities is that even as little as 20 km away from them, there is a steep drop in critical care infrastructure.
When '20 km away' is still in the same state, the government should respond to this with a comprehensive plan for a large region around the city. If this is not done, the facilities that do exist will be swamped because they are suddenly asked to serve a much larger base.
Governments have always acted on the assumption that critical care patients will travel to the city to be served. But that's a kind of discrimination. While some services can only exist at sufficiently aggregated points, the hierarchy runs through virtually everything.
Read 5 tweets

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