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COVID 2.0
NEW THREATS ,
UPFRONT
KUMBH MELA
The
Price of
Optimism
By Anilesh S. Mahajan
A
s the day of the last shahi
snan (royal bath) of the
Haridwar Mahakumbh Mela
approaches on April 27, the
crowds in Haridwar have thinned quite
dramatically. Following the surge in
Covid-19 cases, several akhadas (con-
gregations) of seers have departed the
festival grounds. For instance, of the 13
Bairagi akhadas—for whom the last
shahi snan day is considered most sig-
nificant—only six remain on site.
By April 18, about 80 seers at
various ashrams had tested posi-
tive for Covid-19. On April 14, Swami
Kapil Dev, the mahamandaleshwar
of Madhya Pradesh’s Maha Nirvani
Akhada, succumbed to Covid-19.
Mahant Narendra Giri, president of the
Akhil Bharatiya Akhada Parishad, has
been admitted to the All India Institute
of Medical Sciences in Rishikesh. VHP
working president Alok Kumar has
also tested positive. Between the Maha
Shivratri snan on March 11 and April
20, 8,251 people had tested positive for
the coronavirus in Haridwar.
While the state had earlier
announced that it was mandatory for
devotees to have negative RT-PCR
reports and medical certificates to get
e-passes to enter the Haridwar Mela
grounds, this was an order more hon-
oured in the breach than in the obser-
vance. Top officials in the Uttarakhand
government claim more than 4,000
vehicles, with occupants found to be
14 INDIA TODAY M AY 3 , 2 02 1
Covid-positive, were turned back at
state border points or from entering
Haridwar between April 1 and 10. The
8,000+ people who had tested positive
in Haridwar up to April 20 suggest a
different reality, as do the 31,516 new
cases across the state. The big spikes in
Covid+ve numbers have occurred as the
month’s second shahi snan on April 12
drew near—about 5,500 of Haridwar’s
cases were recorded after April 10,
and about 24,000 of the state’s overall
Covid surge. On April 12 and 14, the
second and third of the four shahi snan
days, an estimated total of 2.6 million
pilgrims and seers took holy dips in
the Ganga at Haridwar. The state had
earlier planned for six million daily visi-
tors to the Maha Kumbh Mela; this was
later reduced to about 1.25 million. (In
comparison, Haridwar saw perhaps
12.6 million devotees at the Makar
Sankranti snan in 2010.)
Another feature of the problem is the
millions of pilgrims who have returned
to their homes and communities already.
Some are likely infected and will infect
others. This has the potential to add
massively to India’s Covid-19 caseload,
which crossed 14 million cases in mid-
April, with nearly 250,000 new infec-
tions reported on April 17 alone. Many
states, including Odisha, Uttar Pradesh,
Haryana, Punjab and Rajasthan, have
made it mandatory for returning pil-
grims to be tested and quarantined,
but these are huge enforcement chal-
lenges, similar to Uttarakhand’s negative
RT-PCR requirement. After the nation-
wide furore over permissions being
granted to such superspreader event—
with millions in close proximity at the
Maha Kumbh Mela—Prime Minister
Narendra Modi spoke to the influential
Swami Avdheshanand Giri, chief of the
Hindu Dharma Acharya Sabha, request-
ing him to convince the other seers to
conduct the rest of the Kumbh as a sym-
bolic celebration.
However, people close to
Uttarakhand chief minister Tirath
Singh Rawat continue to rubbish the
evidence that the Maha Kumbh has
been a superspreader event. “This is
propaganda, we can prove it with sta-
tistics,” says a top functionary in the
Uttarakhand regime, refusing to be
named. While couching its worries
and reservations in an ‘appeal’ from
Prime Minister Modi, the Centre has
at least looked less in denial. Not in
denial but still keen to deflect, Union
Home Minister Amit Shah admitted
public behaviour at the Kumbh Mela
site was not Covid-appropriate, but
drew attention in the same breath to
similarly indiscreet behaviour during
Ramzan. Since then, the Uttarakhand

AP PHOTO
government has been attempting to
scale down the swelling crowds in
Haridwar, with RSS affiliate Vishva
Hindu Parishad (VHP) also begin-
ning conversations with akhadas to cut
down on congregation sizes. This was
followed by some akhadas—the Panch
Dashnam Joona, the largest, and the
Niranjani, Anand, Avahan, Agni and
Kinnar akhadas—leaving the Mela.
Top officials in Uttarakhand say the
administration has opened new testing
camps and has been random-testing
people at various ashrams in Haridwar
and Rishikesh. Since April 1, more
than 10,000 tests have been conducted
every day, with a maximum of about
32,000 on April 14. This means only
about 60,000 of the 2.6 million people
who visited Haridwar over April 12 and
April 14—the Somvati Amavasya and
Makar Sakranti snans—were tested for
ON APRIL 12
AND 14—SOMVATI
AMAVASYA AND
MAKAR SANKRANTI—
ABOUT 2.6 MILLION
PILGRIMS PARTICI-
PATED IN THE
SHAHI SNANS
SUPER SPREADER
Devotees at a ghat in Haridwar
during a shahi snan on April 12
the virus. Many thousands of infected
people were likely missed.
In terms of the challenge of polic-
ing such a huge event, shahi snans take
place at various ghats stretching across
18 km of land. The Maha Kumbh Mela
celebrations cover an area of roughly
25 sq. km. “But this is an open area, not
a closed one, and there is flowing water
for people to take a dip,” the state’s top
cop, Ashok Kumar, said. He says 2,000
additional beds were added in local
hospitals for the Maha Kumbh Mela,
and that all those who have tested posi-
tive have been either isolated in facili-
ties in Haridwar or Rishikesh or shifted
to local hospitals. Downplaying the rise
in cases, he says, “We have to compare
the statistics to the national figures.”
The stance taken by Prime Minister
Modi and the statement issued by home
minister Shah have left the state admin-
istration and the recently appointed
chief minister Tirath Singh Rawat red-
faced. Rawat, who took over on March
11, had sought to use the Maha Kumbh
Mela to forge links with the communi-
ties of seers and religious leaders that
make up the Melas. In mid-March, he
had travelled to Haridwar to review the
planning for a smooth execution of the
festival. (On his return to the state capi-
tal, he too tested positive.) And on April
20, the Uttarakhand High Court, while
hearing PILs on the state’s handling of
the pandemic, questioned the prepa-
rations for the upcoming Char Dham
Yatra in mid-May, saying it could not be
“allowed to turn into another Kumbh.”
Before he left office, former Chief
Minister Trivendra Rawat had earned
the intense ire of religious outfits and
their leaders for a legislative attempt to
take control of the Char Dham temples
(Gangotri, Yamunotri, Badrinath and
Kedarnath). Coming into power, new
Chief Minister Tirath Rawat promised
religious leaders he would ‘free their
temples’ from state control and play a
supportive role. Making good on his
word, he pushed to showcase the Maha
Kumbh to boost attendance, with full-
page advertisements in national dailies,
radio jingles and other means. Now,
the state is scrambling to identify the
potentially thousands of new Covid
cases among the millions of pilgrims
who recently travelled to Haridwar
or Rishikesh. Each one missed is an
infected person carrying the virus back
to their home communities, where
more people could be infected.
This year, in acknowledgement of
the dangers of the pandemic, the cel-
ebrations had been shortened to under
two months, beginning on Shivratri
(March 11) and going on till April
30. Traditionally, the Maha Kumbh
Mela, conducted once every roughly
12 years in four locations, takes place
over about four months in each loca-
tion, from mid-January to April. While
Haridwar’s numbers were clearly a
huge pandemic risk—2.6 million
over two shahi snan days alone, for
instance—they were just a fraction of
the tens of millions who might have
visited. All told, the Centre and state
had spent over Rs 1,200 crore on infra-
structure and support facilities during
the Mela. Even in its curtailed form,
one estimate had them looking to earn
Rs 4,500-5,000 crore back.
Maha Kumbh Melas are perhaps the
largest religious gathering in the world.
They are central to the Hindu religious
calendar and are a pivotal moment in
the lives of many devout Hindus.
In less than a year from now,
Uttarakhand will go to the polls for
assembly elections. This was a signifi-
cant moment for a chief minister who
only got the job on March 11. Even dis-
counting for the sentiments of devout
Hindus, public memory is likely to be
unsparing of the government’s man-
agement of this Maha Kumbh Mela,
more specifically the way it was allowed
to become a superspreader event
and a calamitous national risk. Chief
Minister Tirath Singh Rawat’s danger-
ously optimistic insistence that the fes-
tival and celebrations continue without
any rok-tok (restraint) might extract
too heavy a political price. n
M AY 3 , 2 02 1 INDIA TODAY 15
 C OV E R S T O RY COVID-19

THE SECOND
WAVE: CRISIS &
CONTAINMENT
As the coronavirus returns in a more infectious variant, a beleaguered
nation struggles to cope with the challenges and keep up its fight

O
By SONALI ACHARJEE WITH BUREAU REPORTS

n April 13, when former district judge Ramesh Chandra, a resident

of Lucknow’s Gomti Nagar, and his wife Madhu had a bout of fe-
ver and a sore throat, they got themselves tested for Covid-19. The
report found both of them positive. As Madhu’s condition deterio-
rated over the next two days, the former judge made frantic calls to
city hospitals for ambulances and, when none came, called up and
pleaded with the district magistrate and even officials in the chief
minister’s office—to no avail. His wife died on the morning of April
15. But the ordeal was not over yet. Chandra spent a harrowing
time trying to get a hearse to take her body to the crematorium. A
weeping Chandra says he spent four hours calling friends in high
places before one was sent and he could perform her last rites.
Chandra is not the only one facing this nightmarish col- bringing the positivity rate down to 5 per cent or lower in or-
lapse of medical infrastructure. And it’s not just in Lucknow der to prevent a surge of the pandemic, our national average
but across major metros, cities and even smaller towns, in the has been a high 13.5 per cent, and was an astounding 33 per
wake of a monster second wave of Covid-19 infections that cent in Delhi on April 20. Eighty per cent of our active cases
has swept the country. So rapid has been the spread that an are confined to 10 states (see accompanying report, Dread
average of 260,000 people were infected in the week ending and Despair)—Maharashtra, Uttar Pradesh, Kerala, Tamil
April 18—2.5 times the number at the peak of the first Covid Nadu, Karnataka, Gujarat, Chhattisgarh, Delhi, Madhya
wave in September 2020. Worse, it shows no sign of waning. Pradesh, Rajasthan—where the sudden surge in demand for
The rate at which active cases are doubling is an alarming 11 treatment has overwhelmed the medical system.
AMIT DAVE / REUTERS

days as compared to the 49 or so days at the peak of the first The country is, no doubt, paying a severe price for the
wave. While the World Health Organization recommends complacency shown both by the central and state govern-

18 INDIA TODAY M AY 3 , 2 02 1
A paramedic adjusts a patient’s
oxygen mask in an ambulance
outside an Ahmedabad hospital
Cover story Covid-19 11 days
the rate at which
49 days
rate at which cases
active cases are were doubling in
ments. Declaring premature victory over Covid early
doubling currently Sept. 2020
this year, they had begun scaling down Covid-19
containment and prevention measures. It lulled the WHO about the new variants of concern, it was only
public into discarding Covid-appropriate behav- in January this year that the government formed a
iour, shedding their masks and participating in mass consortium of 10 labs called INSACOG (the Indian
events such as the Kumbh Mela in Haridwar and SarsCoV2 Genomics Consortium) to hasten the pace
election rallies in five states going to assembly polls. of gene sequencing. The slow pace can be attributed
“In a country of a billion people, a pandemic cannot not only to the lack of funds but also to the lack of
go away so quickly,” says Dr Virendar Singh Chauhan, clear direction. While INSACOG has been asked to
director of ICGEB (International Centre for Genetic sequence 5 per cent of the samples, with 250,000
Engineering & Biotechnology) in Delhi. “There was cases a day currently, it would mean 12,500 samples.
always the chance of a second wave if we were not India is currently doing barely 1 per cent. “Not know-
careful. We were lucky to have had 3-4 months of ing how much these variants are affecting our popu-
calm, we shouldn’t have become complacent.” lation has been disastrous,” says Dr K.K. Aggarwal,
The challenges of the second wave aren’t limited to public health expert and former chairman of the
just coping with the mammoth number of infections, IMA (Indian Medical Association). “As we can see,
there are concerns about newer, more infectious vari- it isn’t just that the virus has spread more this time,
ants and a wider variety of symptoms. Then, there but the demand for oxygen too has been far more. By
are the massive shortages in testing, tracking, treat- not keeping track of the kind of clinical symptoms
ing and vaccinating. Not to mention enforcing strict the new mutations show, we could not prepare for
Covid-appropriate behaviour among people. It is a
humongous task. Tackling the immediate medical
crisis should, of course, be the first priority, but it will To prevent a
also be worthwhile to learn from the huge mistakes
we have made so far and avoid repeating them in
THIRD wave, we
order to prevent a third wave from striking us. need to MONITOR
STOP FLYING BLIND the progression of
Experts knew a second wave was lurking. After all, a
national serological survey (which uses blood tests to the various mutant
detect antibodies, a sign that an individual has been
exposed to Covid) conducted by ICMR (Indian Coun-
strains in India
cil of Medical Research) indicated that 80 per cent of
the country had still not been infected by December
2020. This meant there were still a billion people who
could fall sick. It was around this time that various
scientific institutions in the country began reporting
Covid variants—from Brazil, South Africa, the UK, as
well as a fourth Indian strain (B.1.167) that had two
mutations. All these variants showed modifications in
their spike protein, which helped them bind more eas-
ily to human cells and therefore become more conta-
gious. From barely any cases of double-mutant Indian
strain infections last year, today it can be found in 10
states and 60 per cent of the samples sequenced in
Maharashtra in early April. Anurag Agarwal, director
of CSIR (Council for Scientific & Industrial Research),
says US studies have found that the L452R mutation
in the Indian strain makes it 20 per cent more trans-
missible. According to Rakesh Mishra, director of
CCMB (Centre for Cellular and Molecular Biology),
“It is a more infectious Covid this time around, and we
could soon see it [the double-mutant strain] become
the dominant variant in India.”
However, despite global warnings from the

20 INDIA TODAY M AY 3 , 2 02 1
 THE COVID
EXPLOSION
the new challenges.” Experts say that to prevent a
third wave, India should monitor the progression of INDICATIONS THAT
the variants across the country and take appropriate THE VIRUS HAS
SPREAD MORE AND
steps to fortify the medical infrastructure to handle
FASTER THIS TIME
any breakout.

NEW THREATS
ICMR has now begun monitoring the Indian variant
8 % to 16 %
Test positivity rate from
more closely. Based on national data so far, ICMR Apr. 4 to Apr. 17. It has
chief Dr Balram Bhargava says that, in terms of mor- doubled in 12 days
tality, the second wave so far seems “less severe”. Its
BUT THE MORTALITY

2 mn
death rate of 1.2 per cent is slightly lower than in the
RATE HASN’T BEEN
first wave. However, in absolute numbers, the num- HIGHER, SO FAR, NOR
ber of deaths is much higher, given the higher number HAS IT INFECTED
of infections. On April 20, India lost 2,000 people to Active cases, as on April MORE YOUNG PEOPLE
20. The last wave saw

1%
Covid—the highest number of deaths in a single day.
Also, unlike the symptoms of dry cough, severe half the number at its
peak in Sept. 2020 ONLY
joint pain and headache that people were reporting
in the first wave, the second wave has more people more under-30-
THE MUTANT year-olds are
complaining of breathlessness. This is exerting extra
STRAINS getting infected in
pressure on the healthcare system. ICMR’s National ARE MORE this wave
Clinical Covid-19 Registry shows that 47.5 per cent of CONTAGIOUS
symptomatic patients this time are reporting breath-
lessness compared to 41.7 per cent last time. “This, in
turn, has impacted the demand for oxygen; there is
significantly more demand for it,” says Dr Bhargava.
60 %
The India variant
1.2 %
Death rate in the
According to the government’s task force report on is now present in current wave, the
April 19, hospitalised patients’ demand for oxygen this 60% of all samples same as in the
time has been 54.5 per cent, an increase of 13 percent- in Maharashtra, previous one
age points from the Covid peak in September 2020, compared to 20% a
BREAK-UP
month ago
REMAINS THE
SAME

20 %
PANKAJ TIWARI

greater
80 %
Asymptomatic
transmissibility of
the virus owing to cases
the L452R mutation,
according to CDC
20 %
Requiring
hospitalisation
BREATHLESSNESS,
A COMMON
SYMPTOM 5 %

13 % Needing ICU care

Additional demand
for oxygen among
those hospitalised
1 %
Needing
in this wave ventilators
A PPE-clad social
worker performs
last rites at
the Bhadbhada Source: MOHFW; ICMR; Rajya Sabha report September 2020
cremation ground
in Bhopal, Apr. 7
M AY 3 , 2 02 1 INDIA TODAY 21
 TREATMENTT
Cover story Covid-19
PROTOCOL
YASIR IQBAL
Top drugs used
and their efficacy

REMDESIVIR
Antiviral
USED FOR: Moderate PRODUCTION IN
to severe cases INDIA: Six companies
manufacture it at a
EFFICACY: Gilead’s production capacity of
phase 3 trials showed 3.88 million vials per
that in a five-day month. They also make
course for moderate the drug for 127 other
patients, more than countries. On April 14,
65% improved by Day 11 the Centre said it would
compared to those with fast-track approvals so
standard care. WHO, that production could be
however, maintains doubled in the next month
there is no concrete
evidence to prove the PRICE: Rs 899-Rs
drug’s efficacy against 3,490 for a 100 ml vial,
Patients at a wedding hall Covid depending on the brand
turned makeshift Covid
ward opposite the LNJP
Hospital, Delhi PRODUCTION IN INDIA:
FABIFLU Made by five companies:
Hetero, Cipla, Glenmark,
Antiviral
INFRASTRUCTURE CHECK USED FOR: Mild to
Sun Pharmaceuticals,
Zenara Pharma
1ST WAVE VS THE 2ND ONE moderate cases
PRICE: Rs 35-75 per
EFFICACY: Glenmark’s tablet depending on the
phase 3 data showed brand
around 70% patients
SEPT. 2020 APR. 2021 were clinically cured by
(peak of the (start of the Day 4 compared to 44%
pandemic) second wave) who received standard
care
Average daily
new cases 85,000 200,000
Average
active cases 1,000,000 2,000,000
going by data from 40 centres across the country. This
No. of Covid has caused a massive nationwide shortage of medical
facilities 15,403 18,800 oxygen, with both Maharashtra and Delhi sending out
SOS signals to the Centre to replenish stocks across
Total isolation
beds 1,554,022 1,852,265 major hospitals, as many of them were left with supplies
insufficient to meet even the day’s needs.
Oxygen However, Dr Bhargava points out, the rise in de-
supported beds 232,505 155,168 mand for oxygen does not necessarily imply that the
new wave is more lethal. The requirement for ventila-
Total ICU
beds 63,758 75,867 tors, for instance, which are needed for serious lung
infections caused by Covid, was 37.3 per cent last year
Testing and is 27.8 per cent in the current wave. The number of
labs 1,623 2,449 hospitalisations for symptomatic cases has also come
down from 87.4 per cent in the first wave to 74.5 per
Average
daily tests 1,000,000 1,300,000 cent in the current one, going by the National Covid-19
Registry data. (Last year, 80 per cent cases were as-
Ventilators given ymptomatic while 20 per cent required hospitalisation,
by Centre 34,228 6,303 of which 5 per cent needed ICU and 1 per cent ventila-
tor care.) While specialists believe that the second wave
Source: MOHFW; ICMR; Rajya Sabha report September 2020 may finally even out to similar statistics, the absolute

22 INDIA TODAY M AY 3 , 2 02 1
 Graphics by TANMOY CHAKRABORTY

AZITHROMYCIN
Antibiotic
USED IN: Mild to moderate
cases
EFFICACY: No trials
conducted as to their
efficacy. Has shown a
reduction in mortality and
progression to severe stage
in observational studies
BLOOD PLASMA
Plasma harvested from
recovered Covid patients
USED IN: Moderate to
severe cases
EFFICACY: Trials still
ongoing in India and abroad.
An ICMR study published in
BMJ journal found it to have
limited efficacy in halting
progression to severe
disease
PRODUCTION IN INDIA:
Harvested from recovered
patients after 30 days
PRICE: Rs 10,000-
Rs 20,000 depending
on hospital
TOCILIZUMAB
PRODUC IN IL-6 blocker
INDIA: Made by USED IN: Moderate to severe cases
over 50 companies, EFFICACY: Studies still ongoing; a
including pharma giants recent study in New England Journal
Cipla, Pfizer, Glenmark of Medicine found it to have limited
and Sun Pharma efficacy in preventing intubation
PRICE: Rs 60-65 per PRODUCTION IN INDIA: Made
strip depending on by Cipla which also has an import
brand agreement with Roche. On April 13,
the company warned it would face
shortages of drug at current demand
PRICE: Rs 34,000- 40,000 per vial
DEXAMETHASONE
Steroid
USED IN: Moderate to severe
cases
EFFICACY: Recovery trial
conducted by Oxford University
found it to reduce deaths by a
third in severe Covid cases
PRODUCTION IN INDIA:
Produced by several firms, with
Zydus Cadila holding 80% of
market share
PRICE: Rs 30 to 50 per strip

Source: Glenmark, Gilead, BMJ, Netmeds

numbers have been much higher in a shorter span of time.
Dr Rommel Tickoo, director of internal medicine at Max
Hospital in Saket who has been treating Covid patients for
over a year in the ICU, confirms that. “The symptoms are
similar,” he says. “In some cases, there is early lung infec-
tion but the overall proportion of people who are advancing
to severe lung infection is the same as last year.” However,
he goes on to add, “Last year, we saw around 8,000 cases.
Now, we are seeing 25,000, because the virus is more infec-
tious—entire households are getting infected at one go.”
Another challenge in the second wave pertains to the age
group of those getting infected. National data may show
a variation of only 1 percentage point over the 31 per cent
cases among the under-30-year-olds in the previous wave.
However, when broken up further, there is a slight increase
of around 2 percentage points in the number of cases among
0-19-year-olds and a similar spike in infections among
20-39-year-olds. There are also variations across states. In
Maharashtra, for instance, 88,827 children up to the age of
10 have tested positive from January onwards, and those
below 40 comprise 52 per cent of the state’s total active
cases (683,856 as of April 21). The national capital Delhi
faces a similar situation. “The Delhi spike has infected a lot
of young people, even infants,” says Dr Randeep Guleria,
head of the All India Institute of Medical Sciences in Delhi
and a member of the government task force on Covid.
“Most of them develop mild symptoms, but they are ca-
pable of infecting others. It is important for the young to be
responsible as they can spread it to vulnerable groups who
can develop serious symptoms.” Clinical management, he
goes on to say, has remained unchanged, and a lot depends
on early diagnosis and treatment.
A BIG TEST FOR TESTING
As cases surged exponentially in April, testing centres
found themselves unable to cope with the demand. India
currently has 2,449 test labs with the capacity to conduct
an average of 1.3-1.5 million tests daily, compared to 1,623
labs that could do a million tests daily in the previous wave.
The main difference this time, say lab owners, is that test-

M AY 3 , 2 02 1 INDIA TODAY 2 3
STATES OF RAJASTHAN DELHI UTTAR PRADESH

CONCERN 85,571
11,000
76,887
23,000
223,544
28,000
Ten states that are
reporting shortages 7,638 19,608 154,428
amidst rising case loads 8,036 2,668 15,400
3.6 days Already short 2.75 days
GUJARAT Oxygen Oxygen Oxygen, Remdesivir

76,500
10,000 CHHATTISGARH

79,994 129,000
27,180 13,000
13 days 26,042
Oxygen
10,432
4 days
MAHARASHTRA
Remdesivir
683,856
58,000 MADHYA PRADESH
350,340
3,840 78,271
Already short
12,000
Remdesivir, oxygen 13,849
7,352
KARNATAKA KERALA TAMIL NADU 3 days
Active cases
Remdesivir, oxygen
Daily new cases 142,084 118,670 79,804
Total beds
15,000 13,000 10,000 *Assuming 20% of daily
Beds available new cases require
as on April 20 13,500 35,834 191,301 hospitalisation and a
At current rate, 7,000 15,968 29,334 14-day hospitalisation
for each
beds to last *
Other shortages 2.3 days 6 days 14.6 days
Source: State health
reported by state None Vaccine Oxygen departments

ing criteria for Covid was limited last year. Today, on-
demand testing is possible in most states. This has led
to panic testing even amongst those with no symptoms
and a consequent spike in demand. The average wait
time for a test result, which was 24-48 hours a month
ago, has now lengthened, with some states taking as
long as four days for results.
Take Delhi, for example. It tested 180,000 samples
on April 18 and 19 at its 18 public and 23 private labs.
The state government has also ordered for large offices
to test their employees every fortnight. Many labs say
they are testing thrice the number of samples daily
and are close to running out of consumables such as
gloves, flasks, swabs and other safety equipment. The
National Institute of Cancer Prevention in Noida,
which has a contract with the government to collect
4,000 samples daily, is now receiving 6,000 per day.
Dr Dangs lab has seen a 150 per cent increase in tests,
with test slots getting filled within 20 minutes of the
online portal opening. Thyrocare, which tests in both
the capital and in Maharashtra, says the demand for
tests came down to 20 per cent of its capacity in Janu-
ary, but has grown by 100 per cent every week since
mid-March. “The positivity rate in the city has gone
up exponentially,” says Harsh Mahajan, founder of the
Mahajan Imaging Centre, one of Delhi’s most promi-
nent testing labs. “But our infrastructure is limited. It
cannot be ramped up overnight either, as a lot of the
testing machines are imported and it takes a few weeks
to set it all up. Investments by private players will also

2 4 INDIA TODAY M AY 3 , 2 02 1
Cover story Covid-19
be limited as there is a price cap of Rs 800 on tests in the city.”
There have also been concerns over the efficacy of the
RT-PCR tests, with many wondering if they can detect the
newer strains of the virus. Dr Bhargava is reassuring when
he says, “The test kits being used are designed to detect more
than one gene of the Covid virus and are reliable against all
new variants as well.” As for the false negatives that many
tests are throwing up, Dr Arjun Dang, CEO of Dr Dangs
Lab, lists two main reasons why this could be the case. The
first is poor sample collection. The second is testing being
done in the wrong time period. “Covid shows up in the test
on an average 5-6 days after exposure. If people come to
test immediately after meeting a positive case, it will be a
false negative, leading to a false sense of complacency. Labs
should ensure their kits are approved by ICMR and are de-
tecting the correct genes for SARS-CoV-2.” Dr Tickoo adds
that if someone has all the symptoms of Covid, a second test
should be done to ensure a person is indeed Covid negative.
A third reason could be the test kits themselves.
W
hile you need testing to treat individuals,
this was followed up last year with robust
contact tracing to ensure that the virus did
not spread. MoHFW (the Union ministry of
health and family welfare) rules state that
80 per cent of a positive case’s contacts should be isolated
within three days. In UP, contact tracing was the reason
why the state managed to avert a huge first wave—nearly
93 per cent of contacts in 75 districts were traced and then
tested last year. This required the effort of 70,000 workers.
At its peak, the state had 60,000 active cases last year. The
cases this time are thrice the number and sources say the
YASIR IQBAL
Te s t i n g f o r C ov i d a t
the district hospital in
S e c to r 3 0, N o i d a , UP
manpower for contact tracing needs to be ramped up
urgently. Most states have fallen short when it comes to
contact tracing and confinement of the afflicted. With
the delay in results of tests, the efforts to contain the
rapid spread of the virus are failing. “Close contacts do
not mean only family members but anyone the person
has come in contact with,” says Rajesh Bhushan, health
secretary, MoHFW. “Districts had become lax and were
only tracing family members while the virus was spread-
ing by those the positive case had met.” States need to
ensure proper contact tracing to avoid the other, bleaker
option of lockdowns to stop the chain of transmission.
LOSING SLEEP OVER BEDS
In the previous wave, the Centre had stratified Covid
treatment into three categories—Dedicated Covid Hos-
pitals (DCH), Dedicated Covid Health Centres (DCHC)
and Dedicated Covid Care Centres (DCCC). On paper, the
statistics look impressive: there are 18,800 Covid facili-
ties across the country, which together have 1.8 million
isolation beds, 155,168 oxygen beds and 75,867 ICU beds.
The Centre has also given out 6,303 new ventilators in the
current wave. The number of beds is roughly 300,000
more than last time when the active cases and daily new
cases were half of today’s count. Yet what these statistics
don’t reflect is that the epicentres of the second wave are
woefully short of beds and don’t have appropriate Covid
treatment facilities. In fact, treatment has become a lo-
gistical nightmare for many states from April onwards,
with Maharashtra and Delhi facing acute bed shortages.
This is largely because these states have been adding cases
faster than the time taken for people to recover. On an
M AY 3 , 2 02 1 INDIA TODAY 2 5
Cover story Covid-19

average, a person requires a 14-day hospital stay, which cannot save a patient,” says Dr Farah Ingale, internal medicine
could become longer if they develop severe symptoms. specialist at Fortis Hiranandani Hospital in Vashi, Mumbai.
On April 20, Delhi had only 33 ICU beds and 2,627 “Many people are stocking up cylinders at home. It is pertinent
treatment beds, while the city has been recording close to that oxygen is used at the right time alongside medical care and
23,000 new cases daily. Even if 20 per cent, or 4,600, of supervision.”
these cases require hospitalisation, the current availabil- Ventilators, too, are in short supply in the cities that need
ity is woefully inadequate. Interestingly, the Centre had them the most. Gujarat-based Max Ventilator, a company that
promised 6,000 ICU beds for Covid in Delhi in November can produce 1,000 ventilators a month, has received six times
2020. Today, the current capacity has increased by just a the number of orders this year that it did in the same period
thousand to 4,500 beds. “This brings to mind scenes from last year. “There are hospitals in Ahmedabad and Surat that
Delhi’s last wave. Why haven’t we prepared since?” asks are facing ventilator shortages. I have already delivered 600
Malini Aisola, a public health expert. ventilators and have pending orders for 800-1,000 more,”
The crisis is not restricted to the national capital. On says Ashok Patel, director of the company. Most state govern-
March 31, Madhya Pradesh said it had provision for 20,139 ments, he adds, prefer ventilators that can also be used for
isolation, oxygen and ICU beds and there was no need for non-invasive oxygen supply. However, simply ramping up
concern. The state then had only 2,332 new cases and 17,096 infrastructure will not be enough without personnel trained
active cases. Within two weeks, the state had 68,576 active in its use. For a 10-bed ventilator-equipped ICU, you need 48
cases of which 12,248 were new infections and the total nurses, six technicians and nine doctors every 24 hours, the
number of afflicted overtook installed bed capacity in the cost per patient is estimated to be Rs 5.02 lakh. In Maharash-
state. Indore and Bhopal have the bulk of the cases. Every tra, to meet the demand for more manpower, Pune has fast-
second hospital in the cities, including paediatric hospitals, tracked approvals for new recruits. Around 16,000 frontline
has now been converted into a Covid facility, yet bed capac- workers have also given up a day’s salary to incentivise better
ity cannot meet the galloping demand. To ease the burden, salaries for quicker recruitment.
doctors are advising mild patients to opt for home isolation
or a homecare package with a reliable hospital. DEFICIENT ON DRUGS
Indiscriminate use of Covid drugs across the country have
GASPING FOR OXYGEN become another area of concern. Cities like Lucknow, Bhopal,
Shortage in oxygen supplies also assumed critical propor- Mumbai and Delhi reported shortages of Remdesivir and a
tions in hospitals across major cities, including Delhi, waiting time of 24-72 hours for other Covid drugs such as
where some of the largest facilities reported dangerously FabiFlu, Azithromycin and Paracetamol. The Remdesivir
low supplies. The Centre and states were forced to take shortage was particularly acute. Currently produced by six
emergency measures to stem the crisis. The country has a companies in India which, according to a Rajya Sabha report,
capacity to produce 7,287 MT of oxygen per day. On April have a production capacity of 3.88 million vials per month,
12, for example, it used only 3,842 MT, or 54 per cent, of the supply would have been enough under normal circum-
the daily production capacity. As demand has been pro-
jected to rise further, most states have banned industrial MILIND SHELTE
use of oxygen. Meanwhile, the Centre has roped in new
manufacturers to increase capacity to 50,000 MT and
also issued a tender to import an equivalent amount. The
Centre has also issued 4,880 MT, 5,619 MT and 6,593 MT
to the top 12 Covid-affected states to meet their projected
demand as on April 20, April 25 and April 30. The railways
has been roped in to run Oxygen Express trains with dedi-
cated green corridors to ensure quick supply.
Nowhere is the situation as bad as in Maharashtra, where
the consumption of medical oxygen has already reached the
state’s full production capacity of 1,250 tonnes per day. The
state has 638,000 active cases, and 10 per cent of them—
an estimated 60,000-65,000—are on oxygen support,
more than in any other state. Maharashtra is now taking
50 tonnes from Chhattisgarh and another 50 tonnes from
Gujarat daily. It is also expected to receive
another 100 tonnes from Reliance’s plant
in Jamnagar, Gujarat. Scene at a
States have also been issued guidelines vaccination
for rational use of oxygen. “Oxygen alone centre in Mumbai,
Apr. 17

26 INDIA TODAY M AY 3 , 2 02 1
 The IMPACT of
govt freeing up
VACCINE supply will
be felt later. Currently,
it has to deal with the
2nd wave crisis
stances. But these companies also have export commitments,
which the Centre has currently halted. The government will
also fast track approvals for manufacturing the drug, so that
production can be doubled to 7.8 million vials per month by
the middle of May.
However, doctors say there is no cause for alarm. It is not a
drug essential for Covid treatment, with the WHO still saying
there is no concrete data as to its efficacy. “Remdesivir is an
experimental drug, it must be administered at the right time
by a trained professional,” says Dr Tickoo. All viral diseases are
self-limiting, which means the body can fight them off by itself.
The drug can help the body only if the viral infection is moderate
or severe. Moreover, administering steroids during the first 5-7
days actually aids viral replication. With more and more cases of
people buying drugs using false prescriptions coming up, states
have been ramping up efforts to advise against self-medication
and hoarding of essential Covid drugs.
In Telangana, for instance, where Remdesivir is in short
supply, a few pharmaceutical companies have constituted a
task force to streamline distribution by checking a patient’s
Aadhaar identity to end the rampant abuse and black mar-
keteering of the drug. Health authorities have also sensitised
hospitals against prescribing it for every case as it was meant for
restricted use. “During the first Covid wave, the powerful steroid
Tocilizumab was administered irrationally to a large number
of Covid-positive patients. They suffered due to the use of this
drug. The same mistake is being committed with Remdesivir
which is not meant for all Covid patients,” cautions
Dr G. Srinivasa Rao, Telangana’s director of public
health. “At present, it is being misused everywhere,
from homes to hospitals.”
THE GRIM BATTLE AHEAD
In his address to the nation on the evening of April
20, Prime Minister Narendra Modi, who imposed
one of the world’s severest lockdowns last year in
March, ruled out that possibility this time around,
even though the number of cases is far higher in
the second wave. Asserting that the health of the
economy was as important as that of the nation, he
made a case for micro-containment zones and self-
discipline to break the chain of the virus transmis-
sion. This is essential to reduce the load on hospitals
and resources, say experts. An average doctor at
LNJP Hospital in Delhi now works nearly 12- 14
hours a day. Over a year of Covid care has left them
fatigued. “The decision not to impose localised lock-
downs is important,” says former IMA president
Dr Aggarwal. “Even if you get more beds and ventilators,
manpower will remain limited. You can’t create a million
doctors, nurses, technicians overnight.”
Alongside lockdowns, the Centre continues to urge states
and districts to create micro containment zones. First used
successfully in Bhilwara, Rajasthan, last year, the strategy
allows authorities to isolate positive cases while limited
movement in a cluster keeps the infection from spreading.
In Delhi, there has been a 507 per cent jump in the number
of containment zones from April 1 to April 18, 2021. Ac-
cording to health secretary Bhushan, even as states saw a
marginal rise in cases in February, the number of contain-
ment zones didn’t increase. This is another factor that has
contributed to the current surge.
T
he Centre is also hoping that mass vaccination will
help reduce the spread of infection or, at the very
least, bring down the severity of cases. With central
control over production and delivery stifling the ef-
fort, so far only 128 million vaccine doses have been
administered, with a mere 17 million or 1.28 per cent of the
population fully vaccinated. Last week, in a series of welcome
measures, vaccination has not only been opened up to those
above 18 from May 1 onwards but states have also been al-
lowed to procure vaccines on their own. The liberalisation of
the vaccine programme will hopefully increase demand and
distribution. However, there are concerns as to whether the
supply will be able to meet the demand of 400 million-odd
additional people that the opening up the vaccination to
above 18-year-olds will generate.
However, the most important step the country still needs
to work on is Covid-appropriate behaviour. The PM ex-
horted the youth of the country to form local committees
to spread Covid awareness and enforce Covid discipline.
He also urged children to tell elders in the family to go out
only if absolutely necessary. According to WHO, wearing
masks and social distancing of 6 feet cuts down transmis-
sion by 85 per cent. That is a higher efficacy rate than either
of the vaccines available in the country. India, however, has
a serious gap in mask literacy. “There is no cotton cloth in
the world that can keep out a particle as small as the Covid
virus,” says Jai Dhar Gupta, founder of clean air solutions
firm Nirvana Being. “One needs an N95 mask at the very
least. Moreover, people haven’t received awareness on how
to wear the mask—it must cover your nose and chin. Thirdly,
not having a breathable mask is disastrous for health as
breathing your own carbon dioxide is poisonous.” Europe
has standards for community masks to ensure quality and
efficacy. India has yet to introduce something similar for
one of the pandemic’s most essential defences. While selec-
tive lockdowns may work to reduce our current case load,
vaccination and mask coverage on a war footing are crucial
to pre-empt a third wave. Meanwhile, states must focus on
handling the medical crisis precipitated by the second wave.
Covid is here to stay. You can ignore it at your own peril. It’s
a lesson we are learning the hard way right now. n
M AY 3 , 2 02 1 INDIA TODAY 27
 C OV E R S T O RY G R O U N D Z E R O S TAT E S

DESPAIR
Health services across states are on the verge of a breakdown.
Patients are struggling to get hospital beds, Covid test reports are delayed
by days and there is an acute scarcity of oxygen and vital drugs
REUTERS/DANISH SIDDIQUI

Covid patients at the

LNJP Hospital in Delhi
T
DELHI
he crematorium at Kalkaji, on April 16, had a line of plastic-covered people
waiting outside. Only their eyes, burning with grief, were visible. They were
members of 12 families who had lost their loved ones to Covid. “It took us two
days of calling up friends, family and relatives just to get ventilator support
for my mother. I also paid Rs 18,000 for Remdesivir treatment. By the time
we got her to an ICU, she was in severe pulmonary distress and died within
18 hours,” says Suhasini Arora, a 21-year-old law student.
Delhi, which has experienced three waves of Covid before, has never seen
anything like this. On April 19, the city’s positivity rate was 30 per cent, mean-
ing every third person was testing positive. In November, the highest positivity
rate was 11.03 per cent, with roughly the same number of daily tests being done.
The city has also never seen so many active cases. On April 19, it was 76,887;
at the peak of the last wave, it was 42,000. The single-day spikes are record-
breakers as well. The highest number of cases in 24 hours in 2020 was 8,593
on November 11. On April 20, it was over three times higher—28,395. “We are
seeing many more young people getting infected. People took the disease too
lightly,” says Dr Randeep Guleria, director, AIIMS Delhi.
Once cases began to drop, Covid-dedicated hospitals restarted non-Covid
services, entrants from states with high case loads, such as Maharashtra and
Kerala, were not screened and social events were allowed throughout March.
The government also let the city down in terms of preparation. On April 21,
Delhi was left with only 2,345 vacant beds, including 27 ICU beds; on April
19, the leading hospitals had an average of 11-16 hours of oxygen supply left.
Citizens say it’s taking 2-3 days of endless calling to get a hospital bed. “If
there are 2,000 beds left, then why couldn’t I get one? On calling the helpline,
I was asked to wait,” says graphic artist Sumeet Kaur, 39, who had to rely on
friends to secure her a bed at the LNJP Hospital. In the past two weeks, only
2,000 beds have been added to the public hospitals. If even 20 per cent of those
infected require hospitalisation, the city would need 5,600 new beds daily.
People are also apprehensive about the scarcity of essential Covid drugs
and the delays in testing. It is taking an average of 48 hours to get a slot for
an RT-PCR test, and the results can take 2-3 days. Low preparedness has
proved to be costly. Delhi has been reporting far more deaths than before.
While the total death rate remains the same (1.4 per cent), experts say it is
not the correct parameter to judge the proportion of deaths because the
denominator (total cases) has been increasing over a year.
It was a sad day when Chief Minister Arvind Kejriwal admitted that
the medical infrastructure
couldn’t cope with the de-
“Many more mand. The millions who are

YOUNG people are now under a week-long lock-

down can only hope that when
getting infected. they return to the streets, Co-
vid won’t claim them. Not only
People took it because they fear the disease,
but more so because they can’t
TOO LIGHTLY” trust the logistics of finding
Dr Randeep Guleria treatment in the city.
Director, AIIMS, Delhi By Sonali Acharjee

POSITIVITY TOTAL CASES TOTAL DEATHS

RATE* (APR. 20) (MAR. 1-APR. 20) (MAR. 1-APR. 20)

32.8% 266,077 1,727

*Positivity rate is the percentage of positive results to the total Covid tests done.
The WHO recommends a rate of less than 5 per cent to contain the pandemic.

M AY 3 , 2 02 1 INDIA TODAY 29

Cover story G R O U N D Z E R O S TAT E S
CHHATTISGARH
L
ast year, Chhattisgarh was envied for its very
small number of Covid cases, an impressive re-
covery rate and the fact that much of the state
remained untouched by the pandemic. Yet the
state now seems to be swamped by Covid’s sec-
ond wave. With 129,000 active cases as on April
19, it was the fourth worst-hit state in the country.
Like many states, Chhattisgarh had been lulled
into believing that the worst was over. At one point,
daily fresh cases had dropped to under 30 in the capital, Raipur.
Many suspect that the T20 cricket tournament, organised in
March at the 40,000-capacity Raipur stadium as part of a road
safety programme, turned into a super spreader event.
Chhattisgarh is currently staring at a shortage of hospital
beds, oxygen supply and critical drugs such as Remdesivir. The
state has a total of 26,042 Covid beds, including 8,088 oxygen
beds and 2,550 ICU beds. As on April 20, only 2,006 oxygen beds
and 171 ICU beds were vacant, but even these were filling up fast.
The health services in Raipur are particularly strained as it caters
to patients from over half a dozen adjoining districts.
The health department plans to create 1,000 new ICU beds
and has also reserved 50 per cent of all beds in private hospitals
for Covid patients. Efforts are being made to set up another
6,000-7,000 oxygen beds. Health department officials main-
tain that while the situation is one of concern, there has been
total data transparency, which is primarily why more cases are
coming to light. Also, the number of cases is higher because
EPA-EFE/SANJEEV GUPTA
Covid vaccination
drive at a village
near Bhopal
POSITIVITY
TOTAL CASES TOTAL DEATHS
RATE (APR. 20) (MAR. 1-APR. 20) (MAR. 1-APR. 20)
24.76% 171,602 848
30 INDIA TODAY M AY 3 , 2 02 1
An indoor stadium in
Raipur that was
converted into a
Covid hospital
there has been more testing, they
say. The state’s claims about tests
may be true. Chhattisgarh, which has
a population of 23 million, has been
testing around 48,000 people every
day and is ramping it up further. In
comparison, neighbouring Madhya
Pradesh, with a population of 72.3
million (2011 census), is conducting
around 50,000 tests a day.
Regarding Covid deaths, too,
Chhattisgarh has been maintaining
transparency, giving out details of the causes behind the deaths
along with the Covid bulletin issued each day. Of the 165 deaths
reported on April 19, 104 were classified as Covid deaths and the
remaining as deaths of Covid patients due to comorbidities. “We
are maintaining total transparency as we believe this is essential
for addressing this health crisis,” said state health minister T.S.
Singh Deo. On the shortage of drugs, he said that the govern-
ment had placed orders for 90,000 vials ofRemdesivir while the
procurement of another 45,000 vials was in the pipeline.
Officials anticipate that the total number of active cases will
climb to 170,000 by April 30. AIIMS Raipur has flagged the short-
age of oxygen beds, and its director Dr Nitin Nagarkar was quoted
in the media as saying that the state would need around 70,000
oxygen beds. As of now, Chhattisgarh is nowhere close to that.
By Rahul Noronha
MADHYA PRADESH
C
hief Minister Shivraj Singh Chou-
han, on February 21, held a meeting
to review the state’s Covid strategy, a
practice discontinued when cases had
started falling late last year. As the sec-
ond Covid wave struck, health infra-
structure in the capital, Bhopal, and
commercial hub Indore was left over-
whelmed by the first week of April. The government’s
initial efforts—appeals to wear masks, night/weekend
curfews, increased screening in the districts bordering
Maharashtra—did not help. A top bureaucrat claims
there was also resistance to a total lockdown due to
fears of revenue loss. “Liquor shops remained open
during night curfew in Bhopal,” he says.
On April 18, 38,915 Covid beds were available
across MP against 68,576 active cases—12,248 new
cases were reported that day. ICU beds in Indore and
Bhopal have been mostly full ever since. “Even hospital
owners who are childhood friends were in no position
 GUJARAT

G
ujarat has recorded a nearly five-fold jump in Cov-
id cases in the first 20 days of April. On April 1, the
state had reported 2,410 cases and nine deaths. On
April 19, the number stood at 11,403 cases and 117
deaths. Around 37 per cent of the total active cases
were in Ahmedabad.
The state has a total of 79,944 Covid beds, of which

BHUPESH KESHARWANI
the government claims almost 34 per cent were vacant
as on April 18. But the picture on the ground appears different. Sev-
en districts—Amreli, Kheda, Mehsana, Patan, Porbandar, Suren-
dranagar and Valsad—have run out of beds. Long queues have been
reported outside the designated Covid hospitals. In some places,
patients were seen on oxygen support waiting in autorickshaws. Dr
POSITIVITY RATE (APR. 20) Anish Chandarana, vice-president of the Ahmedabad Hospitals and

30.81%
Nursing Homes Association, said hospitals were discharging patients
in less than a week to make room for new arrivals. Chief Minister Vijay
Rupani maintains that despite the queues, everyone is getting a bed.
TOTAL CASES TOTAL DEATHS
The Gujarat High Court, on April 17, asked the government why it
(MAR. 1-APR. 20) (MAR. 1-APR. 20)
was not considering a lockdown to contain the spread of Covid. The
261,483 2,432 Gujarat Chamber of Commerce and Industry and the Federation of
Surat Textile Traders Association have also called for a lockdown.
Orders have been But deputy CM Nitin Patel says that while a lockdown will impact
jobs and businesses, there was no scientific evidence that it would
placed for 90,000 vials help break the chain of transmission. Traders in Valsad, one of the
worst-affected districts, think otherwise and have announced their
of REMDESIVIR and own 10-day lockdown from April 20. Valsad reported 2,101 cases on

another 45,000 vials April 19. Textile units in Surat remained shut on April 17-18, but trad-
ers say the need of the hour is a complete lockdown for at least a week.
are in the pipeline The Rupani government has decided to reserve all its oxygen sup-
plies for medical use. With a daily supply of 20,000 vials, Gujarat has
adequate stock of remdesivir injections. The state also has extended its
health insurance scheme, Mukhyamantri Amrutum Yojana, by three
months for those whose insurance expired on March 31.
By Kiran D. Tare
to help,” says Bhopal resident Jayesh Duggal, who lost a
close friend to Covid. Testing too has been inadequate. POSITIVITY TOTAL CASES TOTAL DEATHS
Around 54,000 RT-PCR tests were conducted on RATE (APR. 20) (MAR. 1-APR. 20) (MAR. 1-APR. 20)
April 18, but the high demand means test reports are
delayed, which is impacting treatment. 7.03% 157,862 1,204
The supply of critical drugs, such as favipiravir,
remdesivir and tocilizumab, dried up in the second
week of April. Black marketing was rampant with Migrant workers
remdesivir selling at Rs 20,000 per injection. Worse in Surat heading
back home
still, a stock of over 850 remdesivir vials was reported
stolen from the Gandhi Medical College in Bhopal.
The ineptitude is evident even in oxygen supply. On
April 18, at least six deaths were reported at the Covid
ward of Shahdol Medical College. Doctors blamed it
on disruption in oxygen supply but administrators
denied this. The health department plans to add
70,000 Covid beds by April 30, including 9,300 ICU
beds and 27,000 oxygen beds. Some 2,000 oxygen
concentrator machines are being purchased to aug-
ment oxygen supply.
By Rahul Noronha

NIRBHAY KAPADIA
Cover story G R O U N D Z E R O S TAT E S
MAHARASHTRA
W
hen Chief Minister Uddhav Thac-
keray announced a lockdown on
April 13, Maharashtra had started
reporting an average 60,000 new
Covid cases daily. This was almost
four times the numbers in end-Feb-
ruary. During the lockdown, only
shops supplying essential com-
modities like medicines, vegetables
and grocery are allowed to open between 7 am and 8 pm.
From April 20, the timings for grocery shops have been
restricted to 7 am to 11 am. Hotels, bars, restaurants,
gymnasiums, spas and salons remain shut.
The state has close to 500 labs to conduct RT-PCR
tests, but the growing load is delaying testing and results.
The average time for getting a testing slot is two days
while the report is available after three days. Health min-
ister Rajesh Tope says labs have been asked to make re-
ports available within 24 hours, but it looks like a tall order.
Maharashtra’s positivity rate was 16.19 per cent on
April 18. The state is facing a shortage of remdesivir.
There is a huge gap between demand and supply. Dr
Sanjay Oak, head of the state’s Covid-19 taskforce, says
remdevisir does not guarantee saving lives but it is useful
in reducing the hospitalisation period. There are reports
of remdevisir being sold in the grey market for as high
There’s a daily shortfall
of 500 metric tonnes of
MEDICAL OXYGEN.
The gap is expected to
be bridged by end-April
32 INDIA TODAY M AY 3 , 2 02 1
MAHESH TIKLEY
TOTAL CASES (MAR. 1-APR. 20)
1,798,892
POSITIVITY TOTAL DEATHS
RATE (APR. 20) (MAR. 1-APR. 20)
23.3% 9,159
A Covid patient waits for
a bed outside the Government
Medical College in Nagpur
as Rs 20,000-30,000 per vial. Aniruddha Patil, a resident
of Thane, was shocked when a dealer asked him to pay
Rs 22,000 for a vial. “I needed three vials for my ailing
father. Fortunately, one of my friends provided me the
spare vials he had bought for his mother. I had to pay him
only Rs 3,600 for three vials,” says a relieved Patil.
The state government has started a helpline where
patients can register to get remdesivir. It is mandatory for
hospitals to register their demand with the district collec-
tor, who has been made the nodal officer for distribution
of the injection. The government twice invited tenders for
supply of 800,000 remdesivir vials but Rajendra Shingne,
minister for food and drugs administration, says manufac-
turers were not interested in supplying the injections at
the rate of Rs 1,656 per vial fixed by the government. “One
manufacturer informed us they could provide the vials only
after May 30. Another said they could provide only 500 vials
every day,” said Shingne.
While the efforts to contain the pandemic are concen-
trated around the Mumbai-Pune belt, the Vidarbha region
has been suffering the most. On April 19, Nagpur district
recorded 113 deaths, the highest in the state that day. The
Bombay High Court, on April 17, ordered the state govern-
ment to supply 10,000 remdesivir vials to Nagpur.
Maharashtra is also facing shortage of medical oxygen.
The state has been ensuring 1,200 metric tonnes of oxygen
daily for Covid patients, but this is 500 metric tonnes short
of the total requirement. An ‘Oxygen Express’, run by the
railways between Visakhapatnam and Navi Mumbai, is
expected to bridge the gap by end-April.
Vijay Wadettiwar, minister for relief and rehabilitation,
says the government is thinking of imposing stricter restric-
tions from the first week of May if the number of new cases
does not come down. Maharashtra has vaccinated around
130 million people till April 19. Tope says 800,000 people can
be vaccinated every day if the vaccine supply is adequate.
By Kiran D. Tare
UTTAR PRADESH

F
or V.K. Srivastava, a 65-year-old resident of Lucknow,
testing positive for Covid on April 16 was a shocker, but
his nightmare really began when he tried to arrange for
his treatment. Srivastava made frantic calls to the Covid
control room in Lucknow but was unable to get himself

MANEESH AGNIHOTRI
registered for admission to any hospital. He passed away
on April 17. Eminent historian Yogesh Praveen, 82, met
a similar fate on April 12. After making calls and wait-
ing for hours for an ambulance, his family took him by a private vehicle
to Lucknow’s Balrampur Hospital, where doctors declared him dead.
Srivastava and Praveen are among the scores of people bearing the POSITIVITY RATE Grieving families
brunt of the second wave of Covid that has seen the near collapse of (APR. 20) of deceased Covid
healthcare in Lucknow and other parts of Uttar Pradesh. “We are trying
day and night to get patients admitted. But beds need to be available,” 14.79% patients at the
King George’s
says Sanjay Bhatnagar, chief medical officer (CMO), Lucknow. Medical University,
On April 19, Lucknow reported 22 Covid deaths and 5,897 new TOTAL CASES TOTAL DEATHS Lucknow
cases—it was the seventh consecutive day of over 5,000 new infections. (MAR. 1-APR. 20) (MAR. 1-APR. 20)
The same day, a total of 28,287 new cases and 167 deaths were reported
in Uttar Pradesh. The fast rising death toll has meant that even the last
305,797 1,432
rites can be delayed for hours. For the past fortnight, 150-180 bodies formation sent to the command centre later,” he says.
have been arriving daily at the cremation ground at Bhaisa Kund and The demand for oxygen cylinders and drugs like
the Aishbagh graveyard in Lucknow. Adesh Agarwal, who performed his remdesivir is leading to black marketeering. A resi-
father’s funeral on April 20, says: “One has to wait for 3-5 hours. Funerals dent of Lucknow’s Aminabad says a supplier asked for
take place as per token numbers issued.” Rs 40,000 for an oxygen cylinder that otherwise costs
In Lucknow, 96 hospitals under the Ayushman Bharat scheme have Rs 6,000. According to C.M. Dubey of the Lucknow
now been authorised to treat Covid patients. But former Lucknow deputy Chemists Association, “Covid medicines are either out
CMO Ramesh Kumar Verma says patients need to first contact the Inte- of stock or in limited supply. Even vitamin C, zinc and
grated Command and Control Centre and secure a referral for admission. paracetamol tablets are difficult to procure.”
“Instead, patients should be first granted admission in hospitals and in- By Ashish Misra

ROHIT JAIN PARAS

RAJASTHAN

O
Covid beds set up in the corridors
of the Rajasthan University
of Health Sciences in Jaipur
POSITIVITY RATE
(APR. 20)
n April 18, Chief Minis-
ter Ashok Gehlot held
a Covid review meet-
in g w h e re d o c tor s,
bureaucrats and some
ministers recommend-
ed a total lockdown. By
midnight, Gehlot had
ordered a partial lock-
down in Rajasthan. The second wave
of Covid, though not as widespread as
in the neighbouring states, has battered
Rajasthan’s health infrastructure and
forced the Gehlot government to turn
more and more hospitals into designat-
ed Covid centres and reserve 25 per
cent of the beds in private hospitals for
Covid patients.
In March, Rajasthan had recorded
31 Covid deaths. On April 20 alone, 64
people died, taking the fatalities in the
current month to 450. It is feared that
est ever), Jodhpur 1,641 and Kota 1,307.
The state has a daily testing capacity
of 77,000, which is being scaled up to
100,000. The RT-PCR test fee for pri-
vate labs has been capped at Rs 350.
Over 60 per cent of the active cases are
under 45 years of age, with a fourth of
those testing positive in April belonging
in the 21-30 age group. At the Rajasthan
University of Health Sciences (RUHS),
a dedicated Covid hospital in Jaipur, all
1,200 beds were occupied on April 19
against an average 30 in March. Some
150 beds laid out in the hospital’s cor-
ridors also had patients.
The state claims to have 3,000 venti-
lators, but only two-thirds are function-
al. Last year, Rajasthan had reserved
22,000 beds for Covid, but a grave cri-
sis is imminent given the pace at which
cases are rising. On April 17, 7,000 Co-
vid patients took admission in hospitals

14.21% the total number of active cases may

jump from 76,000 on April 19 to 130,000
across the state. The government is of-
fering plasma therapy at 12 places and
by the month-end. On April 20, the state is in the process buying 1,500 oxygen
TOTAL CASES TOTAL DEATHS reported 12,201 new cases. The recov- concentrators. A supply shortage has
(MAR. 1-APR. 20) (MAR. 1-APR. 20) ery rate has fallen to 81 per cent from meant some hospitals are providing pa-

118,330 481
98 per cent in March. Jaipur district re- tients half-filled oxygen cylinders.
ported 2,011 cases on April 20 (its high- By Rohit Parihar
C OV E R S T O RY ECONOMY

THE LONG
OF COVID
The Centre has ruled out a national lockdown to
contain the second wave of Covid-19 cases, but
businesses are already seeing red in many states
that have imposed severe restrictions

By SHWWETA PUNJ & M.G. ARUN

C
ovid-19 has been compared to the Spanish Flu,
which killed an estimated 50 million people
between 1918 and 1920. A grim feature of the
Flu was the devastating multiple waves of in-
fections, similar to what is being seen with the
coronavirus. In February this year, even as a
massive second wave of Covid-19 cases arrived
in Europe, India was in self-congratulatory
mode, believing the virus had been controlled
THE CENTRE
and that an economic recovery was under- does not appear
way following the recession in the first half of
2020-21. By mid-March, that sunny optimism keen on another
was proved false, as cases in India began soar-
ing once more. On April 20, India recorded
national lock-
259,000 new cases, with 1,761 fatalities in down, fearful of
just 24 hours.
With several state governments now re- the economic
imposing restrictions on public movement
(though Prime Minister Narendra Modi, on
repercussions
 33
MILLION
Estimated reduction
in size of middle class
India in 2020, from
99 million, measured
by daily income level

75
MILLION
Estimated increase in
the size of India’s poor
population in 2020,
measured by daily
income level

Sadar Bazaar wholesale

market in New Delhi
wore a deserted look
on April 20
RAJWANT RAWAT

April 20, ruled out another national lockdown), many
ask what the consequences will be for India’s fragile
economic recovery. There is no question that health
is paramount. Hospital workers are fighting to save
lives, still hobbled by weak infrastructure. At the same
time, the now-understood cost of lockdowns makes
implementing them a stark choice.
Last year, India imposed one of the strictest lock-
downs anywhere in the world, to prevent medical in-
frastructure from being overwhelmed, to buy time for
the state and private sector to beef up medical capacity.
It also led to India plunging into its first recession in
40 years, with GDP growth in the first and second
quarters of fiscal 2021 crashing to -23.9 and -7.5 per
cent, respectively. The human cost included millions of
lost jobs. A Pew Research Center analysis from March
18 estimates that India’s middle class—those with
incomes of $10-20 (Rs 750-1,500) per day—shrank
by 33 million in 2020 from a projected 99 million
to 66 million, while India’s poor (incomes of $2 (Rs
150) or less per day) increased by 75 million, from a
projected 59 million. The Centre for Monitoring In-
dian Economy (CMIE) says 19 million salaried people
lost their jobs between April and September last year,

M AY 3 , 2 02 1 INDIA TODAY 35
Cover story Economy

RECEDING
FOOTFALL
Retail mobility—consumer
B D E L HI
footfall at stores and N P U N JA UT
TA
A PR R
in businesses—is now TH AD
AS ES
cramped in many states AJ H

R
AT

B IH
JA R

AR

O
O

-10
-10

- 60 G U

-20
-20

-3 0
-3 0

-40
-40
-50

-50
- 60
-10
O

-10
O
-20

-20
-3 0

-3 0
-40

-40
-50

-50
- 60
- 60
MA

RH
HA

GA
RA

TIS
SH
TR

T
HA
A

CH
Mar 2021
KA A Apr 2021
RN HY
ATA
KA MAD ESH (till Apr. 14)
D
PRA Monthly averages of
INDIA daily data; percentage
change from baseline
Source: Crisil Research
Graphics by TANMOY CHAKRABORTY

while a survey by management consultancy SKOCH A recent survey by CII (the Confederation of Indian
Group estimates that 25-30 million jobs were lost in Industry) of 710 CEOs had 93 per cent of them against
the MSME (micro, small and medium scale enter- even partial lockdowns, with three-quarters saying
prises) sector by end-June 2020. Data from ActionAid industrial output would be impacted, arguing instead
India, an NGO working with marginalised groups, for stricter implementation of safety norms. Industry
says 80 per cent of workers in the informal sector lost body FICCI has written to the chief ministers of 25
their jobs to the lockdown last year. states urging them to avoid lockdowns of any kind, ask-
ing them to break the Covid chain with more testing,

C
hastened by the economic consequences enforcement and public awareness campaigns. Carmen
of an unplanned national lockdown, poli- Reinhart, chief economist of the World Bank Group,
cymakers are reluctant to even consider said in a recent interview that severe lockdowns are not
another one except as a means of last resort.
On April 20, Prime Minister Narendra
Modi ruled out a national lockdown, saying it should “Since 50-60 PER
be a ‘last option’, and urged state governments to adopt
micro-containment strategies in their worst-affected
CENT of our workers can
districts. The Centre has also reached out to industrial
groups to assure them that a national lockdown is not
now stay in our FACTO-
under consideration—meeting with owners of MSMEs RIES, production hasn’t
on April 18, Union finance minister Nirmala Sithara-
man said that the government was thinking contain- stopped”
ment zones as opposed to lockdowns. —RAKESH CHHABRA , President, Rai
Industry by and large is also against lockdowns. Industrial Area, Sonepat and board member, FISME

36 INDIA TODAY M AY 3 , 2 02 1
an answer for developing nations like India, suggesting
“less extreme [policies] that allow for some flexibility”. GDP GROWTH
Maharashtra, which contributes nearly 15 per cent
to India’s GDP and has the highest number of new WORRIES
Covid cases in the country, has implemented the strict- India’s economic growth projections are
est measures so far. At first, non-essential services already being scaled back, but with a hint
were ordered to close till end-April, with weekend of cautious optimism
lockdowns and night curfews in place. From April
14, Maharashtra went into total curfew, with only es- GROWTH ESTIMATES
(FY2022, projected)
sential services and export units exempted, until May
1. After a weekend curfew on April 17-18, Delhi began Previous Current
a week-long curfew on the evening of April 19, while
neighbouring Uttar Pradesh announced a 35-hour OECD 12.6 12.6
curfew beginning April 17. Local administrations in
UBS
many urban centres like Bhopal, Indore and Benga-
Securities 11.5 10
luru have also imposed curfews.
This time, curfews allow targeted exemptions. Citi
Construction, one of the largest employers in the in- research 12.5 12
formal sector, continues in Maharashtra (if work-
ers live on-site and are vaccinated on priority). Truck Barclays 11 11
movement in and out of Maharashtra has dropped by
half following the state curfew, hitting the movement Icra 10-11 10-10.5
of essentials such as fruits, vegetables and raw materi-
als. Transport companies also report driver shortages,
with people leaving the state for fear of Covid.
Nomura 13.5 12.6

E
conomists say it’s too early to put numbers
on fiscal year 2021-22 but point out that
the next weeks are crucial. Brokerages have
downgraded their projections for India’s
GDP growth in the current fiscal year, es-
timating a roughly 1 per cent hit. “Growth could fall
to less than 10 per cent [if restrictions continue],”
says Madan Sabnavis, chief economist at Care Rat-
ings. (GDP growth is estimated as the change over
last year’s figure. The nominally high rate—10 per
cent—is a result of last year’s low base, not strong
growth.) Stock markets already seem panicked—on
April 12, the benchmark Sensex crashed 1,707.94
points, its biggest fall since February 26. IIP (Index
of Industrial Production) numbers for February also
highlight the fragility of India’s economic rally, falling
to a six-month low of -3.6 per cent in February.
“If the closure of all non-essential services in Ma-
harashtra continues only till May 1, it won’t be too
damaging,” Naushad Forbes, chairman of Forbes
Marshall, said in a recent interview. “Consumers
will only be delaying buying that shirt or that TV for
three weeks. If it continues beyond May 1, the con-
sequences will be much greater.” Aditi Nayar, chief
economist at ICRA, says, “There may be some loss of
demand in the first half of FY2022 and some shifting
of demand from the first half to the second half of the
year.” ICRA expects India’s GDP to grow by around
10-10.5 per cent in FY2022, down from its earlier
RBI 10.5 10.5
10-11 per cent. Expectations of economic pain come
from many analysts and economists. D.K. Srivastava,
policy advisor at EY India, says first-quarter growth
estimates may have to be revised downward, which
will lower the forecast for FY2021-22 as a whole.
“India’s [national] distribution of vaccines is prov-
ing to be highly sub-optimal,” he says. “We expect the
need for vaccines will continue for five years. Getting
this right is critical.” Former finance secretary Sub-
hash Chandra Garg predicts this fiscal’s first quarter
growth will be lower than that in FY 2019-20, say-
ing, “We should be prepared for 400,000 cases a
day.” While extreme high frequency indicators are
not immediately alarming, some have picked up the
drop in retail mobility (consumer footfall at various
locations; see Receding Footfall). Agriculture is once
again expected to be the sole bright economic spot,
with estimates of growth in 2021-22 at 3.5 per cent.
The truth is that authorities were caught off guard
by the second wave of cases. The Indian economy
opened up fairly swiftly from its complete shutdown
of last year, with curbs being lifted on high-risk ar-
eas, like malls and gyms, and on high-risk activities,
like melas and political rallies. The enforcement of

M AY 3 , 2 02 1 INDIA TODAY 37
Cover story Economy

BUMPS ON THE E-WAY ENERGY SLIP

E-way collec- Power use has fallen
tions dropped E-WAY BILLS (millions, Jan-Apr 2021) of late, indicating lower
sharply in 20 economic activity
mid-April, be-
16
fore transport
POWER SUPPLY (billion units)
regulations were 12 4.2
smoothed out
8 4
3.8
4
3.6
0
Jan Feb Mar Apr 3.4
Total Inter-state Intra-state 3.2
3
Jan Feb Mar Apr

Source: Crisil Research Source: Crisil Research

Covid-appropriate public behaviour was lax, to put
it mildly, and the vaccine policy of centralising dis-
tribution and prioritising groups considered most
vulnerable slowed the rollout.. The New York Times
estimates that Israel’s population is near 56 per cent
completely vaccinated, with India at 1.3 per cent.
Vaccinations are crucial to preventing a new medical
and economic panic.
“So far, economic activity has not been badly hit,”
says Nilesh Shah, MD of Kotak Mahindra Asset
Management. “Everything depends on vaccines and
regional lockdowns. If Covid is controlled quickly, the
economy will scrape through. If there are longer lock-
downs, we will see a repeat of the June 2020 quarter.
We need to [clamp down on new cases] by the end
of April.” Government sources say vaccine shortages
will ease by May or June. With the Serum Institute of
India producing 70 million doses a month and Bharat
Biotech at 10 million—and Russia’s Sputnik adding
50 million—that’s 130 million doses a month, or close
to 300 million doses by June. With the Centre saying
that all aged 18 years and above will be eligible for
vaccinations from May 1, everything depends on how
fast a majority of the population can be vaccinated.
“ If Covid is CONTROLLED
QUICKLY, the economy will
SCRAPE through. If not, we
could see a repeat of the
In terms of a fiscal response, the Centre currently
has an improved ability to spend. India’s collections
last year were better than expected, with Goods and
Services Tax (GST) revenues in March 2021 at Rs 1.23
lakh crore, the highest since the GST was introduced.
However, few expect a central relief package anytime
soon. “Unless there is a full lockdown by the Centre,
there is no question of central relief,” says Sabnavis,
adding that state government capacities to pay for
relief spending vary. “A state like Maharashtra has
a larger budget, so spending Rs 5,500 crore is not a
big problem. Other states could find it difficult.” Most
states are already borrowing heavily—according to
Care Ratings, in FY2021, 28 states and two Union
territories cumulatively raised Rs 7.98 lakh crore, 26
per cent more than the Rs 6.35 lakh crore in FY2020.
Maharashtra is believed to have the largest borrowings
in the first quarter of 2021-22, at Rs 25,000 crore.
One sector to benefit from lockdowns is e-com-
merce, which saw major growth last year. But with
states like Maharashtra imposing curbs on the trans-
port of non-essential goods, even online sales are
pressured. Some manufacturers are better prepared,
with factory workers staying on the premises. Rakesh
Chhabra, board member of the Federation of Indian
Micro and Small & Medium Enterprises (FISME)
and president of the Rai Industrial Area in Sonepat,
Haryana, says, “We have ensured that 50-60 per cent
of our workers can stay in our factories, so production
hasn’t stopped. We are also testing and holding vac-
cination camps. Most workers have been vaccinated.”
In the weeks to come, everything will depend on

June 2020 business quarter” how quickly India ramps up medical infrastructure
and how effectively vaccines are rolled out. The Cen-
tre will also have to build employment safety nets
—NILESH SHAH , Managing Director,
with the states. India can ill-afford another economic
Kotak Mahindra Asset Management
body blow. n

38 INDIA TODAY M AY 3 , 2 02 1
C OV E R S T O RY THE MIGRANTS

NIGHT
END
Their mass exodus last year
following the lockdown
opened our eyes to this
invisible workforce. Has their
plight improved since?

By KAUSHIK DEKA

F
OR OVER A FORTNIGHT NOW, 24-year-old Chan-
der Kumar from Bihar’s Bahadurpur village has been Migrant workers
living with a sense of déjà vu in his one-room shack in arriving from
Delhi’s Chhatarpur area. His smartphone has been Maharashtra rest
outside Patna Junction
flashing constant updates on Covid-19 cases in the railway station,
national capital where he works as a domestic help. April 10, 2021
He is in two minds, and despite chief minister Arvind
Kejriwal requesting them not to leave the city, Kumar
and his friends are worried about the week-long lock-
down announced on April 20 in the national capital.
Not just in Delhi, migrant workers across Indian cities are
watching with trepidation the rising wave of Covid cases and
increasing restrictions such as partial lockdowns and night cur-
fews. More than the fear of the virus, it is the dread of economic
uncertainty that haunts them. Memories of last March are still
raw in their minds when the sudden lockdown left them with no
jobs, no food and no means to go home. Desperate, many of them
set out on foot, their meagre belongings and families in tow. This
 SANTOSH KUMAR / GETTY IMAGES

time, they are taking no chances. In Maharashtra, Gujarat,

Delhi, Tamil Nadu and Karnataka, they are already queue-
ing up at train reservation counters. “I have also bought a
ticket for next week,” says Kumar. “I hope the trains don’t
6.7
MILLION
60
MILLION
get cancelled.” Interstate trains and buses will keep plying No. of migrants who No. of migrant
during the lockdown in Delhi, so that will be a relief. Back returned to 116 districts workers who left In-
in six states following the dian cities during the
home, chief minister Nitish Kumar has already requested
lockdown, according to lockdown, according to
the Bihari migrants to return quickly in the backdrop of the Union government independent estimates
the raging second wave of Covid, saying his government
will arrange work for them.
Even official sources admit that the lockdown last year

100 111.7
triggered a reverse migration that resulted in the second-
largest mass movement after Partition. While the latter
saw 14 million people displaced, last year’s lockdown had
some 6.7 million migrants returning to 116 districts in MILLION MILLION
six states, according to the skill development ministry No. of migrants in the No. of people aided by
database. Independent estimates place the number much workforce in 2016, as MNREGA in 2020-21,
higher, at 60 million, or nine times the official count. disclosed in Parliament up from 78.8 mn in
In a recent study by ICRIER (Indian Council for Resea- in Mar. 2020 2019-20

M AY 3 , 2 02 1 INDIA TODAY 41
Cover Story The Migrants
rch on International Economic Relations) and the ISSRF
(Inferential Survey Statistics and Research Foundation), a
survey of 2,917 migrants in six states—Uttar Pradesh, Bihar,
Jharkhand, West Bengal, Odisha and Chhattisgarh, who ac-
counted for two-thirds of the reverse migration last year—was
used to assess their condition before, during and after the
lockdown. The study found that 38.6 per cent found no work
after returning home, and that household incomes dropped
by 85 per cent in the immediate aftermath of the lockdown.
Take the case of construction worker Manoj Kumar, 32,
from UP, who lost his job in Delhi in the lockdown. After
struggling to return home for a month, he finally made it to
his village Kasidaha in Sant Ravidas Nagar district in late
May only to realise there was no work for him there. By July,
he was back in Delhi. His friend Chaman, from Annupur vil-
lage in Ambedkar district, was a bit more lucky. Within two
weeks of reaching home, Chaman got a call from the UP state
authorities offering him work under MNREGA (Mahatma
Gandhi Employment Guarantee Act), 2005.
S
eeing the plight of the migrants, there was a grow-
ing clamour for policy interventions and long-term
measures to improve their living conditions. India
never had any comprehensive laws to protect this
silent demographic; there is the Inter-state Mi-
grant Workmen (Regulation of Employment and Conditions
of Service) Act, 1979, but its provisions apply only to those
recruited through a contractor. On September 29, this act
was subsumed under the Occupational Safety, Health and
Working Conditions (OSH) Code, 2020, through a notifica-
tion. The code mandates decent working conditions, mini-
mum wages, grievance redressal mechanisms, protection
from abuse and exploitation, enhancement of skills and
social security to all categories of organised and unorganised
workers, including migrant ones. The code is applicable to
every establishment that employs or employed on any day of
the past year 10 or more inter-state migrants.
The silence on minimum
wage guarantees in
the National Action Plan
for Migrant Workers is
worrying, especially
when states have dilu­
ted labour laws
42 INDIA TODAY M AY 3 , 2 02 1
MAPPING THE
MIGRANTS
Several temporary schemes were launched to
provide relief to migrants during the lockdown
last year, but a comprehensive policy
framework has yet to evolve. A handful of
steps are being taken in that direction
 A comprehensive pared an umbrella policy
national database of unor- framework—the National
ganised workers is in the Action Plan for Migrant
works. Estimated cost of Workers—for migrant
project: Rs 704 crore labourers. For coordi-
nated implementation of
 A survey to track the the policy, it proposes a
socioeconomic conditions governance structure and
of migrant workers and mechanisms for managing
their shifting job prefer- inter-state migration. No
ences has been launched action has yet been taken
on these proposals
 The NITI Aayog has pre-
In addition, as the Union minister of state (independent
charge) for labour and employment Santosh Kumar Gang-
war said in the Lok Sabha on March 22, “Migration-related
problems are to be addressed by a multi-pronged course of
action…through rural development, improved infrastructural
facilities, equitable dispersal of resources to remove regional
disparities, employment generation, land reforms, increased
literacy, financial assistance and various government welfare
and social security schemes.”
The NITI Aayog, on the request of Gangwar’s ministry,
has prepared an umbrella policy framework, the National
Action Plan for Migrant Workers. It identifies portability of
social protection, voting rights, right to the city and health,
education and housing facilities as focus areas to improving
their living conditions. For coordinated implementation, the
NITI Aayog draft proposes a governance structure with the
labour ministry as the nodal point and a dedicated unit under
it focusing on inter-ministerial and Centre-state coordination.
It also proposes mechanisms to coordinate the effort on inter-
state migration, especially on principal migration corridors.
Critics, however, say the NITI Aayog draft, while advo-
cating a ‘rights-based’ approach to tap the migrants’ poten-
tial rather than issuing handouts and cash transfers, fails to
address access to protected wages to mitigate the crisis. It
asks ‘source states’ to raise minimum wages to stem migra-
tion to some extent but doesn’t talk of any minimum wage
guarantee as a social security cover.
This silence is critical, especially in the post-lockdown
period, when several states have diluted the labour protec-
tion framework to ease economic revival. It is often argued
that guaranteed wages will lead to a shutdown of businesses
and loss of employment, despite substantial evidence to the
contrary. The government’s own reports, including the Eco-
nomic Survey, 2019, highlight the fact that stagnation in real
wages has hurt the consumption capacity of the poor, leading
to a slowdown of the economy. “What states such as UP have
done is to curtail the labour laws,” says Prof. Amitabh Kundu,
distinguished fellow at the Research and Information System
for Developing Countries (RIS). “The hard-earned rights of
workers have been diluted. The states must take a relook at the
relaxation given in labour laws to promote industrial growth.”
COUNTING OUR MIGRANTS
Despite contributing 10 per cent to India’s GDP, there is no
documentation of where migrants work and live and how they
are recruited. Finance minister Nirmala Sitharaman admit-
ted as much on May 20 last year, when she said the govern-
ment did not have data on them. So one of the first things the
NITI Aayog draft suggested is a central database on migrants.
Gangwar says the government is developing a comprehensive
National Database of Unorganised Workers (NDUW)—which
will include migrant workers—at an estimated cost of Rs 704
crore. On March 31, the Union government launched a survey
to track the socioeconomic conditions of migrant workers and
their shifting job preferences. “Our survey will provide three
snapshots,” says Prof. Kundu, co-chair of the survey. “First,
the situation in February-March last year before Covid struck.
Photographs by RAJWANT RAWAT
Second, the peak in September-October 2020 and, third, the
current situation. We will also be able to see how such medical
exigencies affect informal workers.” This could be the first step
towards setting up an information portal to collect data on
unorganised workers and formulate policies on health, hous-
ing, skill, insurance, credit and food.
WHERE IS THE MONEY?
Sitharaman’s budget this year announced various measures to
ease migrant distress. Among them was the One Nation, One
Ration Card proposal, a portability scheme that would allow
poor migrants access to subsidised foodgrains through the
PDS (public distribution system) anywhere in the country. The
scheme, however, is still to be implemented by all the states.
But then, in a retrograde step, the NITI Aayog proposed
lowering food subsidies from 75 to 60 per cent in rural areas
and from 50 to 40 per cent in urban areas. In November
2020, the Centre also discontinued the supply of additional
foodgrains through PDS. “The reduction in the scale and
supply of PDS deliveries is baffling,” says Indu Agnihotri,
former director, Centre for Women’s Development Stud-
ies. The ICRIER-ISSRF study also noted that while 74 per
cent of surveyed migrants had access to subsidised cereals,
only 12 per cent got subsidised pulses. Even during last year’s
lockdown, when the Centre’s Covid relief package included 5
kilos of wheat and 1 kilo of pulses per month to 800 million
migrant workers without ration cards, many were left out. For
instance, Ajay, 38, a plumber from Odisha’s Kendrapara, re-
mained jobless in Delhi for two months during the lockdown
CASE STUDY
MANOJ KUMAR, 32
CHAMAN, 18
OCCUPATION: Construction workers
CITY OF WORK: Delhi
STATE OF ORIGIN: Uttar Pradesh
THEIR PLIGHT IN LOCKDOWN 2020: The duo,
who live together in Delhi’s Mangolpuri area, were
stranded in Delhi without a job for two months. While
both took a train to Uttar Pradesh, Manoj returned to
Delhi within two months as he did not get any work
in his village. Chaman worked under MNREGA and
returned to Delhi in November. This year, they are not
planning to go home
GOVERNMENT ASSISTANCE: Both did not get any
foodgrains support
M AY 3 , 2 02 1 INDIA TODAY 43
Cover Story The Migrants

but he and his brother Pramod did not receive any rations
despite filling the forms twice. But in Delhi’s Lalbagh area,
Surya Nath, a 33-year-old construction worker, got lucky as he
got foodgrains for two months. He had to “stand in line from 2
am at night” but it came as much-needed succour for his fam-
ily of four—a wife, 9-year-old daughter and a 3-year-old son.
This year, the Centre has not announced any package for
migrants so far. In Maharashtra, Chief Minister Uddhav
Thackeray announced a Rs 5,476 crore relief package on April
14, a day before imposing a 15-day curfew in the state. This
includes free 3 kilos of wheat and 2 kilos of rice to 70 million
beneficiaries registered under the National Food Security
Act, 200,000 free cooked lunches per day, and Rs 1,500 as a
one-time payment to registered construction workers, hawk-
ers and autorickshaw drivers. The Delhi government also
announced financial assistance of Rs 5,000 to registered
construction workers. While such measures are welcome,
reaching the target beneficiaries remains a challenge. In Ma-
harashtra, there were about 560,000 registered construc-
tion workers in 2016, but 50 per cent of them were found to
be invalid last year. Indeed, a big majority of construction While 95% of internal
workers across India are unregistered. That’s the reason the
Delhi government has opened up registration of construction
migrants lost their jobs
workers, allowing newly registered ones also to avail benefits. during the lockdown,

T
he Centre believes its focus on a self-reliant India
and sector-specific thrust could directly benefit
migrants. “A financial package of Rs 27 lakh crore
under Aatmanirbhar Bharat has been launched to
create, among other things, jobs for migrant workers,
unorganised sector workers, strengthen the MSME sector and
promote the rural economy,” says Gangwar.
The budget had other schemes too. An outlay of Rs 1.97
lakh crore over five years for a production-linked incentive
scheme that covers 13 sectors—including agriculture, manu-
facturing, public services and construction—where migrant
workers are heavily employed. The construction industry em-
ploys 51 million workers, of which almost half are estimated
to be seasonal migrants. Then there’s the textiles sector, the
second-largest source of employment in India where 70 per
cent of the workers in the big apparel hubs such as Delhi,
Tirupur and Bengaluru are circular or temporary migrants
(2017 ILO report). The sector received a boost with seven
mega textile parks to be set up in three years. The ministry
of food processing industries has sanctioned 700 projects in
which migrant labourers can be employed. However, sectors
such as tourism and hospitality, the worst hit by the pandemic,
did not receive any direct support.
The biggest letdown in the budget has been the poor fund-
ing for urban areas, the epicentre of the migrant crisis. There
has been an approximately 10 per cent rise in expenditure for
labour, employment and skill development under the ministry
of labour and employment, but at Rs 54,581 crore, the total
only 7% benefitted from
the efforts to revive it
through MNREGA
budgetary outlay for urban development is just 1.5 per cent of
the total budget. Indeed, there is a shortfall in the total outlay
to urban local bodies, from Rs 25,098 crore last year to Rs
22,114 crore currently. Coming to housing, in June 2020, the
ministry of housing and urban affairs announced an Afford-
able Rental Housing Complexes scheme—as a sub-scheme
under the Pradhan Mantri Awas Yojana-Urban—target-
ing 300,000 beneficiaries. The scheme has a tax holiday till
March 2022, but with the pandemic, it’s all on paper now.
MNREGA TO THE RESCUE
MNREGA has emerged as a safety net in most rural areas in
the country. As of April 1, 111.7 million people had availed it in
2020-21, up from 78.8 million in 2019-20. Yet, an ILO study
last year revealed that while 95 per cent of India’s internal
migrants lost their jobs during the lockdown, only 7 per cent
benefitted from the efforts to revive it through MNREGA.
This was also borne out by the ICRIER-ISSRF study. Though
wages under MNREGA were enhanced from Rs 182 to Rs
202 per day, it is insufficient for city workers, say experts.

44 INDIA TODAY M AY 3 , 2 02 1
 CASE STUDY
AJAY, 38
OCCUPATION: Plumber
CITY OF WORK: Delhi
STATE OF ORIGIN: Odisha
PLIGHT IN LOCKDOWN 2020: Living in
Delhi’s Masoodpur with his brother, both
went without jobs for three months during the
lockdown. His brother went home but did not
get any work in the village and returned to Delhi
in October. This year, they will wait and watch
GOVERNMENT ASSISTANCE: Did not
receive any support
CASE STUDY
SURYA NATH, 33
OCCUPATION: Construction worker
CITY OF WORK: Delhi
STATE OF ORIGIN: Bihar
PLIGHT IN LOCKDOWN 2020: He lives with his wife,
nine-year-old daughter and three-year-old son in the
Lalbagh area of Delhi. Out of work for three months during
the lockdown, he was forced to borrow Rs 25,000. Though
he went to his village in Bihar last June, he returned within a
month as the money earned through MNREGA work was not
enough to sustain his family
GOVERNMENT ASSISTANCE: Received foodgrains—
wheat and pulses—from the government for two months
That’s one reason why Nath and the brothers from Odisha
have decided to wait before taking a call on leaving for home.
“Going back is no solution as we cannot earn enough in our
village,” say Ajay and Pramod. Even the two construction
workers from UP—Manoj and Chaman—have decided to
stay put at their work site, at least for a week.
“On average, if a worker gets about Rs 10,000 a month
as wages near their homes, most of them will not migrate to
urban centres where they are treated as second-class citi-
zens,” says Benoy Peter, co-founder and executive director
of the Centre for Migration and Inclusive Development. “But
getting Rs 10,000 in India’s villages is still a distant dream.
MNREGA jobs are not a solution to reduce migration, given
the very low wages, corruption, slow process of disbursement
and limited financial inclusion of rural households.”
The pandemic-induced reverse migration was an opp-
ortunity for the government to build rural infrastructure,
improve livelihood opportunities and rural governance and
bring out a better agrarian policy. “We need to ask whether
and what specific measures were taken to address this fun-
damental problem,” says Prof. Agnihotri.
The Garib Kalyan Rojgar Abhiyan was one such measure.
Launched in June 2020, it was aimed at creating durable
rural infrastructure and modern facilities like the internet
in villages. Skill mapping of rural migrant labour is also
done to enhance their employability closer to home. With
an allocation of Rs 50,000 crore, the scheme focuses on
the implementation of 25 target-driven works to provide
employment and create infrastructure in the rural areas of
116 districts in six states. Gangwar claims the campaign has
generated 508 million man-days of employment so far. There
has also been a demand to double the number of workdays
under MNREGA to 200 per household per year. Yet, not
many seem to have benefitted from these job schemes, either
because they failed to reach the migrants or, as the ILO study
says, the migrants did not want MNREGA jobs.
Given the limited choice, however, many still advocate
an employment guarantee scheme in urban areas as a social
security provision for migrants. In fact, social security is a
universal human right in international covenants to which
India is a signatory. The National Commission for Enter-
prises in the Unorganised Sector (NCEUS), set up in 2004,
showed in 2006 that providing a minimum level of universal
social security was financially feasible. The Commission also
recommended a universal registration system and smart
social security cards, but they have yet to be implemented.
Stakeholders in this domain, however, expect change
soon. “Although not adequate, India has leveraged the crisis
to improve the work and life of migrants. Though delayed, the
government took several measures to try and alleviate their
misery. To me, this is a good start,” says Peter. The challenge
is to keep the momentum going, especially as a more severe
second Covid wave may set back economic recovery. n
M AY 3 , 2 02 1 INDIA TODAY 45