Our Supreme Court has directed the Central and state governments to consider imposing a ban on mass gatherings and super spreader events. “We would seriously urge the Central and State governments to consider imposing a ban on mass gatherings and super spreader events. They may also consider imposing a lockdown to curb the virus in the second wave in the interest of public welfare,” the SC said.
Let us understand that the national lockdown in the first Chinese Wuhan Virus Wave was to create the requisite infrastructure and capacity to ensure that the country does not go into a crisis and the 7-day moving average (7DMA) of infection does not increase the stipulated doubling rate of 1 day. Moreover, the cost of lockdown to the economy for a single day of lockdown is around USD 6.0 billion (INR 45,000 crores approx).
In the second wave, the issues are different. We have our 7DMA of infections is much lower and the doubling rate is much higher. Moreover, as the immunization drive picks up, we will see the two parameters of 7DMA and doubling rate become even more manageable.
So the issue in front of us is, should we impose a complete lockdown and for how long taking cognizance of the Supreme Court directives.
How Far Are We From the Peak in this Second Wave?
In order to arrive at a predictable view of how long should India and its states go into a lockdown and even out the daily economic losses to the country, there are several parameters which we need to consider:
Second Covid Wave in 12 countries before India
Second Covid Wave Peaks in Different States and Cities in India
Covid Immunisation strategy
Second Covid Wave in 12 Countries before India
we can learn from the other countries which have gone through the second wave before India. Based on the learnings from these countries, our Central and State Governments can work out a formula to impose lockdowns and unlockdowns without hurting the economic activity in the country. The table below gives out the duration of the second wave (in days) and % of population that was infected during the Second Wave:
While it is pretty apparent that each country reacted to the second wave differently. The chart below shows how effectively did each of the 12 countries manage the second wave.
Spread of the Second Wave of Chinese Wuhan Virus
Mexico, Turkey, Israel has the second wave duration of less than 100-days, while Germany and Canada had a duration of over 200 days. The peak of the Second Wave was around 120 days (ie 4 months) as an average). The average population that was infected in these 12 countries was around 2.5%.
Analysis of Second Wave of Chinese Wuhan Virus Infections in the 12-Countries
This is valuable information and analysis for us to predict where India is in the second wave.
Second Covid Wave Peaks in Different States and Cities in India
Maharashtra including Mumbai was the first state to begin with the Second Wave in India. It has already seen the peak and is around the global average of around mid-point of the 120 days wave (ie. 60 days). We will see India as a country peaking by mid-June 2021, unless we solve all the infrastructure and logistical nightmares which some cities like Delhi is undergoing.
Analysis by IIT Kanpur Prof Manindra Agrawal
The other silverlining is that many other Indian cities are already in their peaks. An interesting analysis by IIT Kanpur Prof Manindra Agrawal shows.
Covid Immunisation Strategy
As I have already written, our Covid immunisation strategy needs to be reworked. It’s not the political compulsions and broad headlines. We need to immunize over 15% of our population by Mid-May 2021 which we have not yet achieved and most likely going to miss the target for the total duration of the second wave and the imposition of nation wide lockdown durations to recede.
Therefore, the opportunity costs for the country in reducing the duration of the lockdown in the second wave is huge provided we implement our covid vaccine immunization strategy and coverage astutely. Invest, invest, invest in immunizations and make it free for all as an incentive. The rest the statistics at the end to the lockdown will reveal.
No Courts in the World Bear the Economic Outcomes of the Country based on their Judgement!
Earlier in the last decade I was part of the Healthcare Committee of Bombay First which was assisting the Maharashtra Government in the Mumbai Masterplan 2045. One of the key concerns and recommendations made by the Committee was building the healthcare infrastructure for the city, Mumbai lags behind in beds per 1000 population with several key peer Indian cities such as Gurgaon, Delhi, Chennai, Hyderabad and Bangalore. Alongside the shortfalls in hospital beds, there is also a shortage of healthcare professionals, equipment and infrastructure needed at various levels in the healthcare delivery supply chain. The second wave of Covid in the city has once again proved that the healthcare delivery to the Mumbai residents is again in short supply, be it beds, healthcare workers or vaccines. With the crisis looming large, the city is on the brink of a long second lockdown. Without delving into the politics and finger pointing, I want to point out the gaps.
The Gaps in Healthcare Delivery and Covid Response in the City
Hospital Beds Shortage in Skewed Distribution Geographically
In Early 2000s, Mumbai has around as per the Bombay First report, 24,984 beds. As per the recent Mumbai Municipality report, there are 24,039 beds in 2021 in Mumbai. In other words, hospital beds have actually reduced over the last 20 years in Mumbai. It is obvious that many nursing homes have shut down as the doctor/owner have found it lucrative to monetise their nursing homes to commercial real estate. As a result, Mumbai is amongst the worst cities in India with a bed to population ratio of 1.17 beds per 1000 (as against the WHO norm of 3 beds 1000). It was 1.63 beds per 1000 in 2000. Moreover, these beds have been unevenly distributed in Mumbai. South Mumbai has around three-fourths of the total beds in the city which was the case in 2000. This means as the city expands to the suburbs, no additional bed capacity has been augmented in the last 20 years in Mumbai.
Map highlighting the Geographical Coverage of Prominent Hospitals in Mumbai
Second Covid Wave in Mumbai and Skew in Spread
As per the recent Mumbai Municipality Report on Covid, the highest increase of positive Covid Cases in the Western and Central Suburbs of the City in the last 7 days. (See the chart below). While the alarming rate of growth of covid positive cases in these wards would take less than 28 days to double the cases. As compared to 35 days as an average for Mumbai city. While the response to Covid is in the Western and Central Suburbs, the concentration of healthcare facilities is predominantly in South Mumbai. While this is leading to a lot to movement of people seeking admissions to hospitals for Covid treatment.
Spread of Covid Positive Cases in Second Wave till 8 April 2021
Action Plan for the Future
The cost of real estate in Mumbai very prohibitive for private healthcare operators to set up greenfield hospitals unless there are regulations to incentivise them. Various recommendations provided by our Committee is not been implemented on the ground. The Covid Pandemic is a wake up call for the City administrators to buckle up and bit the bullet to accelerate healthcare infrastructure in the city by our planners for the future.
India has finally developed a vaccine for Covid which was approved by the regulatory authority the DCGI and it now the front runner for production of vaccines in the world. This is a great moment for India’s scientific might and I want to congratulate all the scientists who have worked tirelessly to deliver this solution to fight Covid to the world. Let me tell you that having worked in the drug development industry and also on the boards of several pharma companies, and biotech industry policy making, all efforts of the scientists are guided towards drug safety and efficacy before the final vaccine candidate is commercially produced for the masses. In the last 24 hours, leaders of several political parties have placed their roles in shamming and shaming the Indian scientists on the Covid vaccines being approved by the regulators in India. Let me inform you that Indian scientists do not work for political parties, they work for the advancement of science and technology. In this blog, I want to debunk some of the politics going on around our Covid vaccine and the timing of their political statements
The Political History of Bharat Biotech
Bharat Biotech whose vaccine Covaxin started in 1996 in the Genome Valley in Hyderabad. At that time the Deve Gowda Government with the support of Congress was at the center and the Telgu Dessam Party (TDP) was ruling in Andhra Pradesh. Let me remind the leaders of Congress who have come out with some statements, why did your Minister heading the Department of Science and Technology under which Department of Biotechnology (DBT) comes in provide grants to such a company if you believed that today that company is a fraudulently and premature in producing a vaccine for Covid. Over the years under the Congress rule, Bharat Biotech received some many grants and awards from the DBT to further their development of various vaccines. Infact BIRAC an arm of DBT also owned equity in Bharat Biotech at some point in time for the funding that was provided to Bharat Biotech by the Congress Government. I had been associated with the DBT and the Principal Secretary, DBT during the Congress Government who I worked closely to deliver the Biotech Ignition Grant Policy to the nation. He was very appreciative of the work Bharat Biotech had done and achieved several milestones in its journey with several vaccines and patents.
The Science into Politics – Way Forward
Rather than making baseless statements around the vaccines being approved, its time political parties appoint a Chief Scientific Advisor like they had Chief Economic Advisors in their party. The job of this Chief Scientific Advisor and his team would be to sieve through the clinical data presented to the regulators DBT, DCGI and other departments and raise scientific issues and challenge the science on the floor of both the houses of the Indian Parliament through their elected party representatives rather than make frivolous public and press statements outside the house. This would imbibe science into politics and allow for the ruling political party of the day to address any issues relating to the science of drug development through the right governance mechanisms of our Parliamentary Democracy. All I must say here is: Dear Politicians, please do not debunk our Scientific progress for your political gains and headline statements for your parties and your social media impressions and eyeball. In the eyes of science, you all have been marginalized completely.
How can Social Media be Socially and Inclusive in Healthcare in the New Normal?
With the recent US Government action on Facebook and the pace at which fakenews have been spread during Covid and now on the Covid Vaccine, I am tempted to share my earlier article on this subject.
Background
India is world’s second largest growing online population in the world after Brazil. Over the last one year, India witnessed a YoY growth of 31% in people going on the internet, making it the world’s third largest population on the internet. More importantly, this growth has been fuelled people using tablets and smart mobile to go online. However when we look at in absolute terms, only 73.9 million people were on the internet (less than 10% of India’s mobile connected population) of this only 86% of the population (63.55 million) is using social media. While the use of healthcare online grew by 17% last year, it is still lower than retail sector’s growth of around 80% last year. It is fairly evident that several vertical online and social media options have sprung up in India, which has led to the heady growth in retail social media in India. Social media is not about page views, eyeballs or clicks (see box – What is Social Media?). Healthcare is no exception to this, as social media platforms radically changes the nature of business relationships. While over $ 750 million was invested in social and online retail business models last year, why has online and social healthcare business models and solutions remained a laggard in India?
What is Social Media?
Social Media is different from other communication platforms and channels in four ways:
Content is generated and governed to a varying degree by the users
Communities connect people with common life experiences, preferences and interests
Information can be developed quickly and distributed broadly
Open, interactive dialogue and information sharing among media users is encouraged
Top – 10 Need-to-Knows about Social Networking and Where It’s Headed
Social networking is the most popular online activity worldwide Social networking behavior both transcends and reflects regional differences around the world The importance of Facebook cannot be overstated Short Content and Microblogging has emerged as a disruptive new force in social networking Local social networks are making inroads globally It’s not just young people using social networking anymore – it’s everyone “Digital natives” suggest communications are going social Social networking leads in online display advertising, but lags in share of dollars The next disrupters have yet to be decided Mobile devices are fueling the social addiction
The Social Media Landscape
Today there are over 450 social networking sites globally and they collectively serve over 6.5 billion registered users. Nearly 1 in 5 minutes online is spend online on social media, with Facebook getting a lion’s share of the time spent on social media. Healthcare consumers are now starting to leverage social media globally and in India. However, healthcare decisions or dis-engagement at any point in time with the decision making process is a very complicated process and there are many factors associated with this in the social media usage. Nor this is about hospitals putting up their Facebook pages, doctors in India putting up their profiles on Linkedin or some surgeon’s putting up their videos of their procedures on You Tube. This fragmentation has led to assessing not only beyond Facebook, Linkedin, Google+, Twitter, Instagram and You Tube.
Understanding the 4Es in Social Media Usage in Healthcare
Enhance
These are players who enhance and push content into the social community. By seeding conversations and then enhancing it, healthcare companies create and perpetuate an ongoing focus group that can help identify opportunities to create, enhance and modify products and services for consumers. These also include tools that enable the social media networking
Engage
The are platform that are used by healthcare providers, payers and employers to communicate and create a dynamic interaction with their community of patients, members and professional affiliates
Educate
There are several platforms where user generated content and shared learning supports improved healthcare.
Enable
Enabling consumers to take a lead role in finding, sorting and acting on health information.
There are over 40 different micro-segments from the 4Es for social media features and services that can be offered by different social media platforms in healthcare. This is where there is opportunity for Indian social media platforms in healthcare to emerge and grow out globally. Analyzing the marketplace for vendors marketing social tools related to healthcare and I found a wide variety of business models and
strategic approaches. Of the numerous healthcare-centric solutions, many are geared toward consumer use, most are small and a scant few have “platform features” where broad social initiatives could be supported.
There are about 150 players here in India and abroad
Enable
Snapdeal, Groupon, CarePages, eCareDiary, FitBit, Digifit, Endomondo, Gamercize, HealthCentral, LivingSocial, ZocDoc, 15 sites in India
Roadmap to Business Models for a Social and Inclusive Social Media in Healthcare in India
As you will notice from the table above, there are handful of social media business models or platforms in healthcare that have emerged out of India even though there is a huge potential to tap the huge mobile teledensity of close to 900 million. We have tapped less than 10% of this, even though healthcare is an important part of the way people live, work and communicate in India. How do we create a similar platform for rural areas, where Internet platforms are not usable due to literacy, access, and affordability challenges? Building on from my work at the Health and ICT Minister’s Panel for Africa in the last decade. The key takeaways from my work in the emerging market with respect to healthcare, ICT and social media is that these business models will be successful only when:
Transparency
The transparency of activities is a key feature in social media; health is a subject affects private provider companies, public administration as well as consumers
Rise of ubiquitous participatory communication model.
Newspapers, urban spaces and television will all be supplemented with interactive social media applications.
Reflexive empowerment.
Healthcare empowerment through social media is mostly reflexive, i.e. it is usually based on a specific issue and temporary coalitions that engage in dialogue on the topical issue.
Personalization/fragmentation versus mass effects/integration.
Practices and services in the web can be tailored and personalized to almost every detail with the help of portable profiles. Simultaneously, social media opens vast potential also for enormous mass effects and integration.
New relations between physical and virtual worlds
Practices induced by social media, e.g. communication, participation, co-creation, feedback and rating, get more common in daily environments and in urban spaces.
Key Drivers to Social Networking
There are 12 key drivers that need to be broadly analysed for developing social networking business models in (see box) in healthcare in India and that can then be exported to other emerging markets. Every business model in social networking in healthcare would pick 2-3 key drivers to disrupt the social networking landscape as described earlier.
Creating a Framework for Transformative Business Models in Social Media in Healthcare
Countries like Finland, Singapore are experimenting these models of social media networking for healthcare. There are several analytical tools being used to analyse this networking effect. One such tool is illustrated in the box below:
Charting out and exploring the social network relationships
As we are increasingly surrounded by a by a sea of tweets, e-mails, blogs, wiki pages, videos, wall posts and different apps that enable the social networking. It is important for any new business model to map out these relationships to understand where the gaps are in the overall social network landscape (4Es given earlier).
Not all social media networks include people as nodes. Some include content of interest, such as videos, images, or wiki pages. Increasingly, data from social media sites such as tags, comments, purchasing patterns, and ratings can be used to link related content together into networks. Viewing content as a network can help learners make sense of how individual concepts or experiences fit into a larger whole. They can provide a view that provides perspective on an entire field of knowledge so that information that is most relevant can be identified. The goal is to provide an overview on surgery, many of which can be used to help educate medical students, professionals, and consumers. It may be useful in finding relevant content and its relationship. Companies or educational institutions interested in medical content may use such a map to inform their decisions about what videos to post and how to carve out a unique niche in the existing information landscape. Or they may decide that their solution has a poor selection of videos on the topic of interest
Social Network Map of Surgery on You Tube
Case Study: Gram Vaani: Taking Social Media to the Masses
Gram Vaani is voice based social media network accessible from ANY phone (not a smart phone connected to a EDGE or 3G network). They have developed the novel concept of voice based social media, wherein they enable people to express themselves and share information in voice through ordinary phone calls. People can call into our toll-free number and leave messages or listen to messages left by other people (post moderation). It has captive user base of 35,000 families, over 2,000 impressions made per day. This enables
bottom-up information sharing where people ask questions and others from the same community help answer these questions, or share stories and experiences, and
accountability by giving reports on the performance of government schemes, demanding better performance from local and state social welfare providers, and policy inputs.
Their network in Jharkhand has seen several cases where reports filed by people led to redressal action by the government departments including healthcare, and the platform is also used regularly for information seeking on agriculture, livelihoods, health and education, and even cultural expression through folk songs and poetry. They have ability to run sponsored channels and programs and to incentivize local entrepreneur networks to conduct social marketing. 90% community sourced content which includes local news, interviews and informational services, opinion on topical issues, guided discussions and campaigns, grievances and feedback on government schemes, cultural artifacts including folk songs and poems. 98% of the users of this social media platform is educated class 12 and below. This platform is also very interesting for a vertical health through rural social media application.
Summing Up
India is a typical to many other emerging markets where social media has only penetrated the urban and the educated sections of the society, while over a large majority 90% of the mobile population is still not seen the face of the Facebook. Healthcare is now emerging as investments in retail sector have penetrated deeper into India. We need business models that can become the next twitter or facebook in India. Folks like Graam Vaani have demonstrated in a small way that they can bring social media to the mobile connected populations of India and emerging markets. It is time to look at the 4Es of healthcare social media and start building vertical healthcare solutions on top Creating a Socially and Inclusive Social Media in Healthcare in India
Ending Endemics: My Learnings from Eradicating Polio from India
Background
The rumors, fake news and experts comments around Covid Vaccination has pitched. In China, the mass sentiment is that their Covid vaccine is not effective and is just a placebo. While in India there are concerns on the efficacy of the vaccines under development and their safety. As a result our Hon. Prime Minister, Narendra Modi has to address the nation around this issue. There was a similar safety concerns around the pulse polio program in Tamil Nadu and Karnataka back in 2010 which was being organized by Rotary International. A few kids has some effects from the polio drops in the adjoining district of Bangalore, Hosur in Tamil Nadu. I was part of the Rotary which was planning the campaign for polio to ensure that there was a maximum turn out. The rumours and fears of the people in Hosur would have an impact on the turn out in the bordering districts of Tamil Nadu near Bangalore.
Our Strategy and Learnings
Back then the power of social media such as Facebook, WhatsApp was not effective medium to reach to the rural masses. Our challenge was to communicate effectively with every household which had children in immunization age in our state on the safety, benefits and turning out for the polio drops. As Rotary was a not for profit organization supporting this initiative, we had limited budgets for the campaign. The jugaad we used was SMS to every mobile subscribers in the state. Airtel, Vodafone, Idea, Tata Docomo, Spice Telecom, Reliance Mobile Circle CEOs were reached out to provide pro bono three broadcast SMS, free of costs to support the Rotary Polio initiative. All the mobile operators except Reliance Mobile agreed to support the campaign. Through the broadcast SMS, we communicated with the masses on informing the safety and need for polio drops for the children; it was free of cost; inform on the date of the polio program; reminder on the polio program one day before and on the date of the program. The result of this SMS campaign was over 99% coverage and turnout in Karnataka for the polio drops for the children. While Tamil Nadu had around 80% turnout.
Armed with this information, I visited Planning Commission office in New Delhi on one of my visits and met with Dr. Salma Hamied and Dr. Jagendra Haldea. I urged them to make free broadcast SMS mandatory for polio program for all states of India through the mobile operators. This request was accepted and sent to the Ministry of Telecom and actioned immediately. Through this process, India was declared Polio free on 27 March 2014 by World Health Organisation. I was honored by Rotary International with Paul Harris Fellow Medal for organizing and pushing the campaign.
Ending Endemics of Covid in India: Getting the Covid Vaccination Program Logistics in Place
The Numbers
As per my estimate, on the demand side, around 800 million Indians will be covered in the Covid immunization program. I am assuming that there will be a boster dose also. Hence we would require around 1.6 billion in two phases along with the allied materials such as gauge, syringes, swabs, etc to be provided for distribution to every nook and crany of India. Unlike the polio drop which the Rotary volunteers could easily deliver, this program will required trained volunteers in delivering injectables. My estimate is that we would require any where between 50 million trained volunteers in injecting the vaccines throughout India. These need not be medical professionals. On the supply side of the four key vaccines under development for India, Serum Institute, Cadila, Bharat Biotech and a few others would be able to deliver around 1 billion doses through their ramped up manufacturing facilities. The issue is the last mile linkages and cold chain required to reach the masses. Around 10 key states have ready excellent cold chain and warehousing and reefer facilities. These constitute around 68% of India’s eligible population for Covid immunization by April of 2021. The challenge will be for the other states which would need to be ready by April 2021 in the cold chain logistics.
Busting the Myths: Communication Mediums
During Covid, we have implemented Covid Bots on the National Health Mission’s program through WhatsApp. It was a struggle to get the policy change in WhatsApp as there was no such policy in WhatsApp in March 2020 at the beginning of the pandemic. India was the first country in the world to get the approval to go ahead from WhatsApp headquarters to implement such Covid Bots. I would like to personally thank WhatsApp India and Facebook India Government Affairs teams to be able to push this with their global headquarters to get a policy out and obtain such approvals for roll out of such CovidBots. These Bots can be upgraded to answers queries on the Covid Vaccine program to be rolled out in March 2021 rather than the operators replying to the queries on the normal 104 helpline. We already have the policy in place for the mandatory SMS in place. This would give us reach and coverage to around 800 million eligible population of India for the Covid immunization.
