By Ardhendu Shekhar Sarangi in Bhubaneswar, July 10, 2021: The largely negative discourse that has been going on amidst the chaos surrounding the horrific Second Wave of the Covid-19 pandemic has generated more heat than light. An objective assessment of their performance would reveal that all States did not perform equally well in dealing with the calamity, and that both the spread of the disease and the loss of life due to it varied greatly among the States. This variance was visible in the States’ management of the pandemic in its First Wave itself, and was simply carried over into the Second Wave.

Before we make any observations, let us have a look at the figures in the Table below. The data on which these figures are based is available in the public domain and are updated on a daily basis. I have taken the First Wave as extending up to 15 March, 2021 and the Second Wave starting from there. The figures in respect of the Second Wave have been reckoned up to 23 June, 2021. The wave is now in its dying phase; and the ratios on which the analysis is based would not have changed much by the time it would have run its full course.

PERFORMANCE OF STATES DURING THE TWO WAVES OF COVID

Three metrics can logically be applied to assess the performance of the country and the States in managing the pandemic. The first would be the extent to which the spread of the disease could be controlled in a territory. The lower the number of people in every million population contracting the disease, the better, we can say, the containment measures were. The second measure would be the extent to which the healthcare system could help people to recover from the affliction. Conversely, the failure of the healthcare system can be gauged by the percentage of patients who could not recover and succumbed. The lower this figure, the better we can say the healthcare system’s performance was. The third measure, which sums up the outcome of the total efforts, both for containment and in providing medical care for the afflicted to recover, is the proportion of the population, say the number of people per million population, who lost their lives due to the pandemic. The lower this figure, the better the overall performance can be said to be. The Table gives, for the country and some States, the number of cases per million population, the mortality rate expressed by the percentage of deaths to recoveries, and the number of deaths per million population in the fourth, eighth and ninth columns respectively.

The Tale of Two Waves

The Pandemic has been hitting countries in waves. While many countries have had three waves, we have experienced two waves so far. Though we have reckoned the First Wave as lasting from the beginning of the pandemic till Mid-March, 2021, the effective period of this wave was 184 days from 01 July,2020 till 31 December,2020. The daily cases at the start of this period was around 20,000 which rose daily to peak at around one lakh by mid-September and gradually declined to the 20,000 level by end December. Out of a total of around 114 lakh cases in the first phase, around 97 lakh cases occurred during this six-month period. Similarly, this period saw 1.31 lakh deaths out of 1.59 lakh deaths in the First Wave.

The Second Wave advanced very fast and rose very sharply. The high started in early April with around 80,000 cases daily and peaked in the first week of May with over 4 lakh cases daily. The curve fell thereafter and hit the 80,000 level again by the middle of June. Thus the Second Wave appears to last for a much shorter period of two and a half months and peaked to a daily case count four times as high as the First Wave.

During the Second Wave a total of around 187 lakh cases have occurred so far of which 170 lakh cases were in the high-period starting 01 April up to mid June. Out of the total 2.33 lakh deaths in the Second Wave so far, 2.07 lakh deaths occurred during this 75-day period. Thus the cases recorded per day on an average during the high-period of the Second Wave were 2.27 lakhs and the daily death figures averaged 2760, which were about four times the corresponding figures of 52,717 cases and 712 deaths during the First Wave.

Daily cases of infections were at their worst during a month long period from mid-April to mid-May. Sudden peaking of daily cases to a very high level gave rise to unprecedented problems for the healthcare infrastructure. During the period 28 April to 27 May, over 3650 Covid deaths were recorded every day. It is interesting to note, however, that during the Second Wave the mortality rate was lower at 1.29% as compared to 1.44% during the First Wave, which means the Healthcare system fared better during the Second Wave in spite of the heavy odds.

The task of combating the pandemic at the ground level basically rested with the States, while the Centre provided necessary technical and financial assistance, and arranged supplies of required clinical material and equipment. How did the States perform? Did they all fare equally well or was there glaring asymmetry in their performance? Now that the Second Wave also is on its way out, we may attempt an assessment. We consider the cases of seven States which have been prominently in the news.

The Tale of Two States

Let’s see how two of our States – Odisha and Kerala – are faring. While the number of deaths per million population has been substantially lower in Odisha, indicating a good overall management of the pandemic, both Odisha and Kerala have achieved low mortality rates, indicating a better performance in providing treatment for the disease. The true test of the efficacy of the Healthcare system is what percentage of people got cured? The lower the mortality rate, the better is the performance of the system.

During the First Wave, the mortality rate at the All India level was 1.44%. Odisha had a mortality rate of 0.59% and Kerala even better at 0.41%. Healthcare services were provided to Covid patients in existing hospitals, specially set up Covid hospital and Isolation centers and also through Home Visits, Telephonic advice and IEC advisories. The outcomes achieved in both Odisha and Kerala were far better than the national average and in other states. During the First Wave, Odisha also recorded a substantially lower number of deaths per million population. While the deaths per million was 115 at the All India level, it was only 42 in case of Odisha. Kerala’s achievement is not so good. At 127 deaths per million, it was in fact slightly worse than the national average. This resulted because Kerala had a high incidence of the disease at 31,479 per million population as against the national average of 8268 and Odisha’s 7197. Thus while Kerala provided better care for the people afflicted with Covid, it failed to control the spread of the disease. Its containment measures were not quite successful. Odisha did well both in containment and treatment; hence it came out as winner.

During the Second Wave, the mortality rate at the All India level was 1.29%. Odisha had a mortality rate of 0.35% and Kerala 0.47%. While the deaths per million was 169 at the All India level, it was only 38 in case of Odisha. Kerala’s achievement at 231 deaths per million population is not so good. This again is due to a high incidence of the disease in Kerala. While the incidence of Covid per million population was 13530 at the All India level, it was as high as 50430 in Kerala. Odisha recorded 11674 cases per million population which was slightly lower than the national average. Thus Kerala continued to provide better healthcare for the afflicted, but it again failed to implement containment measures successfully and failed to control the spread of the disease. As a result, in spite of good medical care, Kerala recorded a high death rate of 231 per million. Odisha, doing well both in containment as well as treatment recorded a low 38 deaths per million population.

The takeaway from the case of the two States is that in order to succeed in reducing the impact of the pandemic, a State must focus on both containment and treatment. If containment measures are not good, the death toll will end up being high with the best of health care services being made available.

Teams With Best Resources Lose the Match

Let’s now have a close look at the cases of three other States – Maharashtra, Delhi and Chhattisgarh. It will be evident that the performance of each of these States in terms of the three criteria adopted by us left much to be desired.

During the First Wave, as against a mortality rate of 1.44% at the All India level, Maharashtra had a high mortality rate of 2.47% and Delhi 1.73%. This reflects a high failure rate of treatment in Maharashtra and Delhi, two states which are endowed with better healthcare facilities than the rest of the country. Only Chhattisgarh with a mortality rate of 1.26% in comparison fared favourably with the national average. When compared with the outcomes achieved in both Odisha (0.59%) and Kerala (0.41%), the results of the treatment provided to Covid patients in the three States appear much poorer.

The containment measures of the three States taken for controlling the spread of the disease during the First Wave also yielded very poor outcomes. As against an All India average of 8268 cases per million population, Chhattisgarh recorded 10,670 cases, Maharashtra 18,938 cases and Delhi as high as 21,486 cases. The failure on both fronts – containment and treatment – resulted in Delhi recording a high 365 deaths per million population, and Maharashtra 430 deaths per million. Chhattisgarh’s figure of 131 deaths per million was only marginally higher than the All India average.

During the Second Wave, Maharashtra had a mortality rate of 1.84% and Delhi 1.80% as compared to the All India level of 1.29%. Compared with Kerala’s mortality rate of 0.47% and Odisha’s 0.35%, mortality in Delhi and Maharashtra seem to be inexplicably high. In Maharashtra the mortality rate has at least come down during the Second Wave as compared to the First Wave, but in Delhi there has been no improvement; in fact mortality has increased. At 1.44% the mortality rate in Chhattisgarh is not very much higher than the All India average, but is higher than its own record during the First Wave.

While, during the Second Wave, the incidence of Covid per million population was 13,530 at the All India level, it was as high as 29,822 in Maharashtra and 26,310 in Delhi. Even in Chhattisgarh it was 22,621. Thus these three States not only failed to provide good medical care to help people recover from the disease, they also failed in implementing effective containment measures to control the spread of the disease. Relative weakness in both fronts – containment and treatment – resulted in very high death rates per million population in these States. In Maharashtra 540 people in a million died of Covid during the Second Wave. In Delhi, deaths per million population was 466. Even in Chhattisgarh, this figure was a high 319 per million. Compared to the All India figure of 169 deaths per million population, do these figures not tell a very sordid tale? And comparing with Odisha’s 38 deaths per million population during the Second Wave, one cannot help concluding that there was something lacking in the Covid management in these States. Should the Governments of these States made to account for this?

It is interesting to note that the same States which performed poorly in the First Wave carried over this inefficacy to the Second Wave. They ought to have compared their achievements with the better performing States after the First Wave, identified the lacunae and made course corrections. May be, the Centre should have reviewed the relative performances of States and pulled up the laggards, forcing them to take remedial measures.

The Punching Bag States

It has become the practice of States to say something negative about UP or Gujarat and try to divert the attention from their own failures. So let’s see how these two States have actually managed the pandemic.

During the First Wave, UP had a mortality rate of 1.47%, almost the same as the national average of 1.44%. Gujarat’s mortality rate was higher at 1.64%. When compared with the treatment outcomes achieved in both Odisha (0.59%) and Kerala (0.41%), the results of the treatment provided to Covid patients in UP and Gujarat appear much poorer. The containment measures of the two States taken for controlling the spread of the disease during the First Wave however were more effective than the overall national scenario. As against an All India average of 8268 cases per million population, UP had only 2621 and Gujarat 4307 cases per million population. Both the States’ performance in this area is impressive, particularly in view of the horrendous migrant labour exodus problems they had to face. As a result of the reasonably successful containment measures the two States recorded low number of deaths per million population in spite of the relatively higher mortality rates. UP recorded only 38 deaths per million population, and Gujarat also a low 68 deaths per million as compared to the All India average of 115.

During the Second Wave, the incidence of Covid per million population was 4759 in UP and 8389 in Gujarat as against 13,530 at the All India level. Thus both the States can be said to have been quite effective in containing the spread of the disease, particularly UP. However, since these cases occurred in a space of only 115 days, the daily numbers of cases were quite high and put tremendous pressure on the health care infrastructure of the States. Still the States succeeded in providing effective medical care to help people recover from the disease. These efforts succeeded in restricting the mortality rate in UP to 1.25% and in Gujarat to 1.04%. These rates compare favourably with the All India level mortality rate of 1.29% during the Second Wave. More interestingly, the mortality rate recorded during the Second Wave in both the States was lower than the mortality rate recorded during the First Wave, indicating an improvement in the Covid care services.

As the two States were able to contain the spread of the disease to a great extent and also to bring down the Mortality Rate to a certain extent, the number of Covid deaths per million population was within reasonable limits in both the States. UP recorded 59 deaths per million population while Gujarat recorded 87 deaths per million population. These are substantially lower than the All India average of 169 deaths per million population during the Second Wave. Thus, going by hard facts and figures, the management of the Covid pandemic in UP and Gujarat were better than the national average and many other States, and the outcomes were far superior in contrast to the perception in the media. It is alleged that UP manipulated its figures and the deaths due to Covid may be in reality 5 or 6 times higher. It would not be out of place to point out that even if UP’s number of deaths per million population is raised six times it will be smaller than Delhi’s 466 and Maharashtra’s 540 deaths per million population. Similarly, UP’s numbers of cases per million during the Second Wave at 4759 is less than one fifth of Delhi’s and less than one sixth of Maharashtra’s figures for cases per million population. This is the reality.

Takeaways

The performance of States varied greatly both in implementing the containment measures as well as in providing treatment and care to the people afflicted with Covid; resulting in very different numbers of deaths per million. The Table below sums up the situation and helps us make an objective assessment getting rid of perceptions.

It can be clearly seen that during the First Wave the over all performance reflected in the number of deaths per million was good in Odisha, UP and Gujarat. Also, during the First Wave Odisha and Kerala performed decidedly better in terms of the outcome of their Covid care and treatment reflected in the markedly lower mortality rates. In containing the spread of the disease, UP, Gujarat and to some extent Odisha achieved better outcomes.

It can also be seen that these performance standards were carried over by these States to the Second Wave. Those who performed poorly during the First Wave continued to perform poorly during the Second Wave also. One wouldn’t be wrong in asserting that if there was a proper stock-taking and comparative evaluation of the performance of the States at the end of the First Wave, there would have been an awareness of their relative achievements and failures and pressure generated on the States to make necessary course correction. The States’ own and the Centre’s failure to undertake such evaluation led to an absence of accountability. The States had no need to explain why they performed poorly and just carried on with their old ways.

Did the Oxygen shortage during the Second Wave make the impact of the pandemic more severe? The fact is that in the 15 days between 24 April and 8 May (Oxygen scarcity) there were 5530 deaths in Delhi giving a daily average of 369 deaths. On 9 May the State declared that they had surplus oxygen, and their quota can be reduced. In the ten days between 9 May and 18 May a total of 3040 deaths were recorded giving a daily average of 304 deaths. The median number of active cases during the first period was 1.24 times that during the later period. This easily explains the higher number of daily deaths. The Oxygen scarcity had no impact and cannot be an alibi for the high mortality rate in Delhi.