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Written by Dr L S Shashidhara, Dr Vidya Mave, Dr Joy Merwin
The second wave of Covid-19 is consuming our nation’s energy, time, and the economy. The first wave of Covid-19 in Pune city, one of the worst-hit in the country, which peaked last September, was in retrospect more manageable, unlike the crippling second wave that we are currently experiencing. Among all major cities affected by Covid-19, Pune is the only one which is not a national or state capital, expected to have a quick and sustainable response to a crisis such as the current pandemic. Pune’s share of the national Covid-19 burden was, however, much higher than most state capitals.
A few days back, the Central Government expressed its appreciation at the way Mumbai and Pune managed the second wave. Here we want to highlight the collaborative and data driven response to Covid-19 in Pune that has several lessons for subsequent waves, and for cities yet to experience the second wave.
We list here a few major lessons, not in any order of priority, as all are equally important. But numbers speak the reality. We should not consider Pune as a success story and be complacent. It only managed the surge relatively better compared to other large Indian cities. It couldn’t anticipate and prevent the surge or be prepared weeks, if not months, in advance to deal with the surge in number of cases. The purpose of writing this note is to give a picture, in broad brush strokes, on how Covid-19 is being managed in Pune city so that we are better prepared in case of another surge and for any public health crisis in the future.
In any public health crisis of the scale of COVID-19, local authorities must deal with a multitude of responsibilities including procuring essential supplies and reporting day-to-day operations to the higher authorities. Further, the impact of months of lockdowns had hit all supply-chain pipelines affecting both medical supplies and the availability of food for all in the city; livelihoods of people in the lower economic strata; human resources both in hospitals and on the front line of emergency services; educational opportunities – specifically for children from marginalised sections of the society; mental health issues etc. Managing the pandemic thus needed simultaneous efforts on many fronts, and cooperation and support from all sections of the society. Furthermore, since decision making benefits from inputs from different stakeholders including academia, industry, and civil society, wide ranging consultations had to take place on a continuous basis. Such collaborations between local authorities and diverse stakeholders can help to deal with a crisis in a more humane way. Such integration of civil society with the authorities legally tasked to handle the situation needs take place with trust and commitment to work towards the goal, otherwise the outcome would be less effective and sometimes counterproductive.
In Pune, government authorities, NGOs, corporate houses, individuals with expertise and specialisation in various domains of public health and social issues, forged such an exemplary collaboration. Most importantly, the coordination among them was seamless and with full ownership, responsibility, and accountability. Prominent among such collaborations is the Pune Platform for Covid-19 response (PPCR) set up by MCCIA involving prominent industrialists of Pune city, philanthropists, heads of hospitals and experts in various essential products, services, and supplies. They have been at the forefront to form an alliance and helped procure Covid-19 essentials such as PPE, hospital beds and ventilators. A notable achievement of PPCR was to quickly recognise the need for oxygen in the region during the current surge in cases and the rapid formation of Mission Vayu in conjunction with the government. Mission Vayu raised funds within and outside India to procure oxygen concentrators and managed logistics including delivery of these supplies to public and private hospitals in less than three weeks from the time of conceptualisation.
Uniform data collection and analysis of data in real-time is important to not just understand the natural course of the Covid-19 pandemic, but also to identify areas of a region or sub-region that need greater attention. During a fast-spreading infection, it is challenging for the local authorities to analyse and make sense of data that comes out of the health care sector. In this context, Pune city officials were proactive in partnering with data scientists, drawn from organisations representing the Pune Knowledge Cluster (PKC), IT companies, MCCIA etc. to help understand the Covid-19 data being compiled in the city. City officials were generous in providing their time for discussions with data scientists and to seek their opinion as and when there was a surge or to find practical solutions to deal with certain situations. City officials also collaborated with PKC to conduct a Serosurvey in Pune city, which was one of the better planned surveys in the country and was based on granular testing data, and to deploy a large number of kiosks for rapid antigen tests when the city was seized by exponentially increasing cases during the first wave.
Data scientists curated, collated and analysed the granular data made available by the Pune city officials. They developed web interfaces for public visualisation of city’s Covid-19 data in real-time. As a case study of the utility of such a partnership, during the first wave, there was evidence of higher case fatality ratio in certain Prabhags (city is divided into 41 Prabhags for electoral and other administrative purposes) in Pune. Data scientists alerted the local officials to the possibility that early access to medical care may be delayed in these Prabhags, leading to higher deaths. The city officials promptly increased testing and surveillance in those Prabhags. Curated, collated and anonymised data made available by PKC was also the basis of a large number of analyses, simulations, and predictions for Pune from across the country/world, which also had useful information for other large cities.
To be on the top of healthcare preparedness, authorities need to know the number of Covid-19 tests, number of hospital beds, ventilators and so on that are likely to be needed in the coming weeks. Computational modelling is a widely used methodology to make these projections. Many data scientists, representing PMC, MCCIA, PKC, IT companies etc were involved in the analysis of available data in May-June of 2020 and used computational modelling to help predict the number of tests and cases that would occur in subsequent months. This, in turn, formed the basis for the Covid-19 response and Pune city was ready for the September peak of the first wave. Arguably, Pune district now has the highest number of Covid beds, oxygen beds and ventilators in the country per million people. Other activities of data scientists included digital twin project and simulations of various non-pharmaceutical interventions such as lockdowns and staggered economic activities of different kinds (such as malls, restaurants, cinema theatres etc.).
Availability of expert doctors and large number of health care personnel, well-managed hospitals, a sense of service to the society and philanthropy among citizens and organisations is key to manage a public health crisis of this scale in any city. In addition, Pune also benefited by the presence of all large, and small, old and new industries who not only provided funds and products, but they also repurposed their units for producing essentials needed to fight the pandemic. The role of MCCIA in bringing all players on one platform, and coordination and cooperation among all players lead by the city authorities was key to the integrated approach to the ongoing fight against the pandemic.
The office of the Principal Scientific Advisor to the Government of India conceptualised knowledge clusters in several cities in the country a few months before Covid-19 hit us. Pune’s knowledge cluster quickly forged several ties with over 10-12 local institutions and industries and joined in the efforts of the city officials to mount a rapid response to the pandemic. Currently, five such knowledge clusters (Pune, Delhi, Jodhpur, Hyderabad and Bengaluru) have been established. There is a need to expand the programme to more cities and empower them to collaborate, partner and implement solutions that address the unique challenges that each city faces today and will face in the future.
Dr LS Shashidhara is a professor of Biology at Ashoka University, Delhi and IISER Pune; Dr Vidya Mave is an Infectious Disease Expert and Epidemiologist, Johns Hopkins India, Pune and Dr Joy Merwin Monteiro is a Climate Scientist and Data Scientist at IISER Pune.
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