DYFI memorandum to Maharashtra CM about Covid 19 Featured

DYFI memorandum to Maharashtra CM about Covid 19 Featured

June 16, 2020

To,
Shri. Uddhav Thackeray, Honourable Chief Minister of Maharashtra,

Subject: Practical measures and policy changes needed urgently to save Maharashtra from uncontrollable spread of Covid-19.

Dear Sir,
It is extremely alarming to note that the spread of Covid-19 is spiraling out of control in our state. As per the website of public health department, total number of positive cases recorded till 15th June is 1,10,744. Out of this, 56,049 have recovered but fatality rate in our state is 3.7 % which is much higher than the national average of 2.9 %. Nearly 80,000 of positive cases recorded till 15th June are in the Mumbai Metropolitan Region and more than 11,500 are in Pune and its satellite city Pimpri-Chinchwad. The total number of Covid19 deaths reported in Maharashtra till 15th June is 4128, of which 2814 are from MMR and 475 are from Pune urban region. But, in our view, if we do not break the chains of transmission effectively, all urban centres of our state and even villages will be severely affected by this epidemic.

Health workers, sanitation workers, ASHA and Anganwadi workers, municipal employees, police personnel and various other sections have been fighting the Covid-19 pandemic heroically. We take this opportunity to salute their sacrifices and courage. Various organisations and well-meaning individuals have been doing voluntary work and contributing resources to provide relief to people affected by Covid-19 as well as the lockdown. Distributing meals and food materials, helping the needy to get hospitalized, educating the masses about science based approaches in dealing with the epidemic, offering professional counselling to people in mental distress – these are some of the areas in which social/political/community organisations have done considerable work. Democratic Youth Federation of India (DYFI) has also been trying its best through all means available to strengthen our state’s fight against Covid-19.

However, no amount of voluntary work can substitute government-led efforts in fighting an epidemic like Covid-19. It is our considered view that Maharashtra is on the brink of a catastrophe and extraordinary measures are necessary to save lives and livelihoods. In this context, we would like to register some of our key observations and demands as below.

1. Healthcare infrastructure and services:
a) It is a tragedy that Covid-19 patients as well as people suffering from other ailments are not able to get admission in hospitals. The government must make efforts on a war-footing to arrange additional capacity in existing facilities and build new facilities. This must include drastic increase in availability of ambulances.
b) Equipping Civil hospitals to provide effective tertiary care at district levels is necessary to minimize dependence on hospitals in Mumbai and Pune. There should be a massive effort to increase capacities and improve facilities at all Civil hospitals.
c) Capacity building and improving facilities of public health institutions at all levels up to Primary Health Centres should be undertaken on a war-footing, steering clear of the PPP route which has proven to be a disastrous model.
d) All private hospitals should be brought under the control of the state government till the pandemic subsides. If the provisions of Epidemic Diseases Act of 1897 and the Disaster Management Act of 2005 are not adequate for this purpose, a new ordinance that will empower the government to take over private hospitals should be promulgated immediately. This is all the more necessary because private hospitals and private laboratories are charging enormous sums of money which most of the citizens just cannot afford. It is a shameful case of ‘profits over people’.
e) As part of the privatisation drive, several public health institutions were handed over to private agencies and trusts to run them on a commercial basis. All such public health institutions should be immediately taken back and run by the government or municipal administrations.
f) Government run testing centres are overwhelmed and ordinary people are not able to approach private laboratories due to prohibitive costs. Private labs were taking Rs.4500/- for Covid-19 test. After government intervention it has now been reduced to Rs.2200/- This amount also is burdensome to ordinary citizens. If one person in a family is tested positive, the entire family has to be tested which adds to the financial burden. In these circumstances large number of people are forced to skip Covid-19 test thus causing unchecked spreading of the disease and higher rates of fatality. Therefore, government should take over private labs and provide free testing.
g) The government should address the root causes which have led to resignations of health workers from private hospitals and absenteeism in public hospitals. Insufficient supply of personal protective equipment (PPE) is a major reason for fear and panic among medical professionals. As far as private hospitals are concerned, pitiable wages and working conditions prompt medical staff to avoid the risk of contracting Covid-19. Through its concrete actions, government should instill confidence among medical professionals and other frontline workers about safety and fair treatment in respective institutions.
h) Doctors, nurses and other healthcare workers in Maharashtra are among the lowest paid in the country. Their remuneration should be increased forthwith.
i) Public hospitals were already having large number of vacancies even before the onset of Covid-19. Recruitments made now are not at all enough to fill the gap. The government should urgently fill all the vacancies in public health care institutions through a new recruitment and training drive.
j) In addition to filling the existing vacancies, government should create additional posts to cater to the burgeoning number of patients.
k) Private OPDs of general medical practitioners are closed in containment zones and in slums due to physical distancing issues in small OPD spaces. Government health centres are overcrowded and many of them are converted to Covid Care centres. Thus, people are not getting much-needed primary care for other ailments. Therefore, government should start community clinics in every Basti making use of space available in public institutions. Private general practitioners should be mandated to provide free service at these clinics till the epidemic is brought under control.

2. Best practices in Data Quality and Pandemic Control:
a) Government machinery has not been doing its best to implement basic guidelines given by the World Health Organisation (WHO) which consist of widespread testing, aggressively tracing contacts, quarantining the contacts in hygienic facilities, isolating the infected and providing treatment in hospitals to all the infected.
b) It is a fact that the level of testing in Mumbai and other parts of Maharashtra is extremely low in spite of claims by BrihanMumbai Municipal Corporation about number of tests per million in Mumbai. The definitive index to assess the efficiency of testing is the ratio between number of tests conducted and number of positive cases. This index should be above 50 as per the best practices; for example, it is approximately 65 for the state of Kerala. The national average for number of tests to number of cases ratio is 17 but for our state this index is just 5. Therefore, we should increase the number of tests to achieve a ratio of at least 50 tests per positive case.
c) As lockdown is being withdrawn in phases, a huge surge of new cases and clusters might emerge. To prevent this, it is required to ensure that new infections in the community are detected promptly, and their contacts traced to contain transmission as early as possible. It is necessary, therefore, to test widely and strategically using sentinel surveillance or random testing methods.
d) Insufficient testing prevents the government and citizens to become aware of the true extent of infection. We have anecdotal evidence that patients dying at some of the private hospitals due to Covid-19 infection, but not tested for Covid-19, do not get entered in the calculation of Covid-19 fatalities. This may be the case for many old people who died at their homes too.
e) When Covid-19 deaths remain unrecorded, local communities and authorities will fail to take appropriate quarantine measures. So, the government should strictly insist that the bodies of all who die with Covid-19 symptoms be tested for the virus before funeral.
f) Getting the number of deaths due to Covid as accurately as possible is necessary to calibrate the measures for containing the pandemic. It is necessary, therefore, to make corrections in Covid-19 death count based on reliable circumstantial evidence as is the globally accepted best practice.

3. Breaking the chains of transmission in workingclass localities:
a) Unlike the initial phase, Covid-19 is now spreading increasingly in workingclass neighbourhoods of Mumbai. It appears that authorities and the media are taking comfort in the slow spread of the disease in Dharavi. One should realise that Dharavi is not the only slum in Mumbai. More than one crore people of Mumbai Metropolitan Region live in slums. The now fashionable slogan “Learn to Live with Corona” may be a good one for the upper classes and upper strata of the middle classes of Mumbai. However, the workingclass cannot live with Corona; they can live only by eliminating this highly contagious virus from the bodies of everyone. Therefore, a huge effort should be directed towards making the workingclass bastis safe.
b) It is very important to keep the healthcare system free of all avoidable burdens in this season so that we can marshal all our resources to stop the pandemic. Minimising the incidence of diseases like Dengue, Malaria, Tuberculosis, Diarrhea and Amoebiasis is a critical requirement in this respect. Therefore, the government should accord utmost importance to maintaining a hygienic environment in densely populated workingclass localities.
c) ‘Slum lords’ and corrupt elements in government establishment do have a perverse joint business around slum dwellers’ basic requirements like drinking water. Authorities deny legitimate access to municipal water supply and their business partners, the slum lords, sell small quantities of water at exorbitant rates to the poor people! This exploitation should end now. Clean water should be provided in sufficient quantity directly to all slum areas by Municipal authorities.
d) Authorities have always shown criminal negligence as far as waste disposal from low income neighbourhoods is concerned. This cannot continue any more. There should be a massive increase in waste disposal bins, frequency of waste disposal rounds, number of waste disposal trucks and deployment of sanitation workers. Providing personal protection gear to sanitation workers and their health checkup should be given high priority.
e) Drainage systems should be repaired and newly laid where necessary on urgent basis.
f) Adequate number of public toilets should be built immediately.
g) A rapid expansion of sewerage lines should be undertaken so that a large number of households in workingclass localities can construct inhouse toilet facilities. Government should provide financial aid for construction of toilets inside houses.
h) A ‘Break the Chain’ campaign should be taken up encompassing all public places and workingclass neighbourhoods. Hand-wash facilities with soap and water should be installed all over urban clusters.
i) Massive sanitization drives should be undertaken in workingclass Bastis on regular basis with special focus on common facilities like public toilets.

4. Organising public action:
a) The WHO has been repeatedly underlining the truth that human race can survive this pandemic only with international solidarity and national unity. In this context, harmonious co-existence of various religious and linguistic communities is extremely important. Some rightwing political forces and rightwing media outlets have been indulging in hate speech and intimidation targeting religious and linguistic minorities. All those who indulge in such activities should be isolated and promptly brought before the law.
b) One of the ways to increase manpower in treatment centres is to deploy medical college and nursing college students as supporting staff to doctors and nurses. This step must be taken immediately.
c) Public health department staff, ASHA and Anganwadi workers constitute bulk of the manpower for reaching out to households to monitor and intervene in the community health situation. In the present circumstances, their efforts should be augmented by enlisting volunteers from among the youth in all neighbourhoods. These volunteers should be given training and N95 masks and gloves etc. These volunteers can help in regularly monitoring the health condition of the people, driving the ‘break the chain’ campaign and organising quarantine facilities etc.
d) There is a need for the government to disseminate detailed information about the developing situation in a transparent way so that all citizens can be mobilized effectively in the battle against the pandemic.

5. Public provisioning of essential food items:
a) Hunger and starvation are stalking the poor workingclass families in urban centres. People have been let down by the dysfunctional public distribution system. After a lapse of two months, our state government declared that 5 kilograms of food grains will be supplied under ‘Atmanirbhar’ scheme to migrant workers without ration cards here. But the government order in this connection stipulated that if a worker has his or her name in the ration card in native state, that worker would not be eligible for even those 5 kilogram food grains! It is a shame that the state machinery displayed such cruelty to the working poor.
b) The monumental failure in providing food grains and essential commodities to the working poor during the forced lockdown should be a thing of the past. Adequate amount of food grains and other essential commodities should be distributed free of cost to everyone. People who have ration cards in their native states / districts but not in big cities like Mumbai should also be given food grains and other essential commodities free of cost.

6. Seeking financial support from central government:
a) The state government should insist to the central government that, in this time of crisis, Maharashtra be provided with a relief package to strengthen the public health and public distribution systems. In addition to providing such a relief package, the state government should insist that the Centre transfer 7500 rupees per month to bank accounts of all non-income tax payers in the country.
b) We should demand additional resources for revitalizing and greatly expanding MNREGA and also starting an Urban Employment Guarantee Scheme.
c) We should get increased food grain allocation to meet the needs of the public distribution system in the new circumstances.

7. Re-opening after lockdown:
a) We should take into consideration the fact that the urban centres of our state have more than 1 lakh recorded cases which is increasing at a rate of more than 3000 per day even as the lockdown is in force. It is obvious that the number of people getting infected will increase at a much more dangerous pace once the lockdown restrictions are removed unless the reopening steps are planned and executed with utmost caution. What is extremely worrisome is that Covid cases are now spreading even to several villages across the state.
b) As the factories, shops, offices and other establishments reopen after the lockdown, maintaining physical distance is going to be a huge challenge. In order to avoid crowding in public places, maximum working days in a week should be reduced to 3 at least in the first few weeks. Working week for different institutions should be staggered as per a central plan with Sunday being holiday for everyone. Every working day should be divided into two shifts, one shift starting at 7 am and the other starting at 12 noon. The shift system also should be regulated as per a central plan. Gradually, as the pandemic subsides, the number of working days can be increased to the normal.
c) Mumbai cannot go back to overcrowded suburban trains and public transport buses. Frequency of suburban trains and buses should be increased significantly. All suburban trains should be converted to 15-coach trains. The police should ensure queue system outside railway stations and only limited number of people should be given entry into the platforms. Police personnel deployed in the platforms should ensure that the trains do not get crowded. Dedicated lanes should be provided for public transport buses so that the frequency of services can be significantly increased.

8. Employment and education:
a) The problem of rising unemployment had become very serious even before the onset of Covid 19 pandemic. The pandemic has further deepened the crisis. Private sector companies have started retrenching people taking advantage of the situation. The government should act decisively to prevent arbitrary retrenchment.
b) We demand that the government issue strict orders prohibiting private companies to retrench any employee at any level without obtaining prior consent from respective Labour Commissioners. Affected employees shall be given opportunity to place their opinion to the Labour Commissioner who shall also take into consideration the financial health of the company while giving decisions.
c) The Labour department shall open an online portal for private sector employees to report any move from their employers towards arbitrary retrenchment.
d) Employees whose salary is frozen or who have already lost their jobs are facing a serious problem in housing loan repayment. The State Government should bring about a moratorium on loan repayments to banks.
e) Rural employment guarantee scheme (MNREGA) should be revitalized and greatly expanded. Urban Employment Guarantee scheme should also be started.
f) The public education system of Maharashtra has been on a fast path of deterioration since many years now, effectively denying quality education to the economically and socially disadvantaged sections of society. The pandemic is now leading the public education system to near-total destruction. Therefore, we should start preparations for rebuilding the public education system, compensating for the many decades lost due to rampant privatization.

The first corona positive case was detected in Maharashtra in the second week of March. It was more than one month after World Health Organisation declared Covid-19 as a “public health emergency of international concern”. But Maharashtra as well as most of the other states are finding it extremely difficult to cope with the pandemic inspite of getting many months to prepare for it. The root causes of this tragic situation are two-fold: (1) systematic degradation of the public health system coupled with extreme levels of healthcare privatisation that have occurred in the last three decades and (2) prevalence of poverty among large sections of our people even after 73 years of independence.

Unleashing ‘market forces’ with maniacal ferocity on our impoverished nation has created untold damage to all our common facilities and public services. Without reversing the prevailing public policy trajectory, our society cannot effectively combat this pandemic. We have no other way but to place ‘people over profit’ and build a critical mass of ‘commons’ in all domains of social and economic life. We request the government of Maharashtra to take a realistic view of the situation and implement the measures listed in this memorandum and adopt other measures necessary to save the lives and livelihoods of our people.

Yours sincerely,
Preethy Sekhar,
Secretary, DYFI Maharashtra State Committee.

Click here to Download Memorandum in PDF

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