On October 11, a team of professors led by Prof Manindra Aggarwal of IIT Kanpur released a study on Uttar Pradesh government’s successful model to manage Covid-19. It explained how Chief Minister Yogi Adityanath-led UP Government ensured economic activities and controlled the spread of the infection with the Test, Track, Treat and Tackle (TTTT) approach. Despite being the most populous state in the country, UP managed to shrink the unemployment rate from 11% to 4% during the pandemic from March 2020 to July 2021. Notably, UP’s unemployment rate is currently lower than the national average.
India has till now seen two waves of the coronavirus pandemic. The first wave touched its peak on September 11, 2020, with 97,655 new cases in a day. The second wave, however, brought an unprecedented number of cases and touched the peak on May 6, 2021, with single-day high of 414,280 cases. Uttar Pradesh had its own share of a high number of cases. During the first wave, UP saw a peak at 7,016 cases. However, in the second wave, the numbers were over five times high, and the peak was reached on April 24, 2021, with 37,944 cases reported in a single day.
While determining how UP did in terms of numbers, one has to keep in mind that in terms of population, it is the most populous state in India. During the past one and half years, the state administration stepped up Covid management tactics on war footing to curb the numbers while ensuring the business activities in the state did not stop. In fact, the study pointed out that UP had issued 2.67 lakh No Objection Certificates (NOC) during the last one-and-half year that shows the government was determined to sustain the economic activities.
The main objectives of the state government
While planning the Covid management strategies, UP Government had a few objectives in mind to ensure lesser stress on the general public.
- The first objective was to ensure that the livelihood of the citizens, especially the marginalised and migrant workers, does not get adversely affected.
- For the state government, it was important to ensure to sustain economic activities to maintain economic growth.
- It was essential to curb the spread of virus and stop it from spreading to the nicks and corners of the state.
- Lastly, the government worked extensively on augmenting healthcare infrastructure to manage the increased load of the infection.
How did UP control the spread of the virus?
UP govt wanted to ensure businesses run smoothly in the state. Interestingly, during the second devastating wave of the virus, smaller containment zones were closed down, but the rest of the business went forward as usual. It is understandable that when businesses run during a pandemic, there is always a chance of a faster spread of the virus. Thus, it was important for the UP govt to arrest the spread at the time it started to sprout.
Our report on handling of Covid second wave by GoUP is available at https://t.co/Y8T3b3F1yV. A thread highlighting key points will follow soon.
— Manindra Agrawal (@agrawalmanindra) October 11, 2021
The study revealed that the UP govt distributed over 33 lakh of immunity booster kits based on AYUSH recommendations during the pandemic. For the mild cases, the government formed home management strategies that allowed the patients to recover quickly and efficiently at home, reducing the pressure on the hospitals. Extensive testing and surveillance played an important role in tracing the spread of the infection and controlling it before it went out of hand. Smart management of containment zone also helped in ensuring that the infection fades away quickly. Last but not least, ramped up vaccination program despite excessive propaganda against vaccination by the opposition leaders helped in controlling Covid-19 in the state.
The efforts made by the UP Government showed positive results, and the study showed that UP recorded the highest recovery ratio at 98.6% among the top ten states with a maximum number of cases reported. Similarly, as the state emphasised on TTTT approach, the positivity ratio of the state was less than 0.0%. Notably, the state conducted 6.6 crores tests during the pandemic till July 31 2021. UP also had the lowest active cases per million (3) and deaths per million (97).
The Migrant Workers Crisis in UP
After the pan-India lockdown was announced in March-April 2020, migrant workers started to go back to their native states as soon as they got a chance. The study pointed out that around 35 lakh migrant workers came back to UP from different states during the first wave of Covid. Multiple strategies were conceptualised by the state government that included both short term and long term solutions to provide a livelihood to the migrant workers. Also, it was important to ensure the workers stay back after the first wave so that in future, no such hardships are faced.
To ensure migrant workers get healthcare and the state prevents any further outbreaks, multiple testing facilities and testing kiosks were established across the state. Immediate financial assistance of Rs. 1,000 was provided to the migrant workers to ensure they were able to stay at home under quarantine as mandated by the central health authorities. The state not only distributed free ration under national and state schemes but also established community kitchens to ensure no one was left hungry.
Secondly, the state created an innovative skill mapping initiative for migrant workers. It helped in providing them with the jobs as per their skills under different schemes. The study shows that the state did skill mapping of around 16 lakh migrant workers. UP also created an online platform so that the workers can find jobs on their smartphones rather than going to the labour mandis. While maximum number of jobs provided to workers during both waves of Covid were in the construction sector, other jobs included painting, carpenter, driver, plumber, cook, child caretaker, electrician and more.
Some of the jobs that the migrant workers did under the MGNREGA program were drought proofing, fisheries, micro-irrigation works, land development, rural infrastructure and more. The study suggests around 18 districts, 40-95% of jobs were given to women migrant workers under MGNREGA.
Financial support in the form of food grains and monetary benefits via DBT were provided to the poor people, including daily wagers, labours, street vendors, coolies, rickshaw pullers, migrant workers and more during both waves of Covid-19. Additional food grains were also provided free of cost to each member of such families in May and June during the second wave, in addition to the basic allotment under the PMGKAY scheme.
Covid management under resource-constrained settings in UP
There was a period during April and May this year when UP was reported over 30,000 cases per day. The health infrastructure was overwhelmed, and the state worked on war-footing to meet the demands of hospital beds and medical oxygen. The state rapidly augmented health infrastructure, increased healthcare manpower, addressed critical issues like oxygen shortage, ensured a steady supply of critical medicines, tested extensively to identify positive cases and created micro containment zones rather than going for state-wide lockdown.
Healthcare workers played a very important role in detecting and stopping the spread of the virus. In both urban and rural regions, these workers helped in breaking the transmission chain by testing and treating infected people. They also followed up with recoveries and helped in setting up healthcare facilities. Under the TTTT model, the state employed two ASHA workers, one Anganwadi worker, and one Anganwadi helper per 1000 people.
The state developed special training modules to train these workers via audio and video with voiceovers. The experts also created cascade models to train healthcare workers who worked in the field. District level and block level officers were oriented centrally for better management. Technical support from the centre, UPTSU, WHO and UNICEF also helped UP in Covid management.
The safety of the healthcare workers was a priority for the state. The government not only provided them sufficient personal protective gear like PPE Kits, masks, gloves, sanitisers etc. but also enrolled them under different schemes like PMJJBY, PMSBY and AKBY.
Hospital infrastructure
Not only state ramped up the availability of ICU beds in the state, but it also reported the highest number of ventilators. While making beds, ICUs and ventilators available for Covid patients, the state also made sure to sustain non-Covid services. While the government provided all the support for home isolation, they made sure that it was not allowed for the patients suffering from problems like HIV, transplant recipients, cancer therapy etc. For patients above the age of 60 or those who have co-morbid conditions like hypertension, diabetes etc., proper evaluation was done before allowing home isolation.
It is noteworthy that the state has been ramping up pediatric facilities for the possible third wave of the pandemic to ensure there is ample medical infrastructure for the children contracting the disease.
Immunity booster kits
While homoeopathic kits were most famous in the state, Ayurvedic kits like Ayush Kit, Ayush 64, Ayush Kadha etc., were extensively distributed across the state.
Oxygen supply chain
During the period of April end to May mid in 2021, due to a high number of positive cases, the oxygen demand was at its peak in the state. During this period, many hospitals across India reported a shortage of medical oxygen, including Uttar Pradesh. Though oxygen was available, the supply chain was not adequate. Government of India had provided funds to establish Oxygen plants in the states across India, but the study suggests only UP, and Assam pushed forward in setting up those plants. Uttar Pradesh formulated an extensive supply chain using GPS trackers for the oxygen trucks to ensure it reaches to all hospitals in time.
With a 78-member strong team, the integrated command and control centre of UP’s supply chain management monitored 15 oxygen plants along with 133 oxygen tankers that moved liquid medical oxygen (LMO) from these plants to various locations across the state. Indian Railways also provided support via trains to carry oxygen to UP. Indian Air Force airlifted the empty tankers to the oxygen plants to reduce the time spent in supplying LMO.
Notably, under different schemes, 549 oxygen plants were allotted for the state of UP. By July 31 2021, 238 plants had already been established.
Vishesh Surveillance Abhiyan Initiative
Vishesh Surveillance Abhiyan Initiative (VSAI) is a house-to-house surveillance program started by the UP government. The main aim was to detect and track cases at household levels. A two-member VSAI team visited households and educated them about infection prevention and control, detected symptomatic patients and identified people with co-morbidities. They collected samples, if required, and sent them for testing. The program helped in containing the spread in rural areas. The study revealed that the UP govt had deployed 141,610 such teams along with 21,242 supervisors in all rural areas.
Vaccination drive
The state ramped up vaccination drive to curb the spread. By July 31, 4.06 crore people had received at least one dose of the vaccine, while 86 lakh were fully vaccinated. As per current data provided by the Ministry of Health and Family Welfare, 9.16 crore have received at least one dose, while 2.48 crore are fully vaccinated in the state.
Sustenance packages
The study showed that the UP govt distributed 3876962.97 MT of ration during the second wave of Covid-19. The average distribution per person stands at 16.29 KG. The distribution was done under PMGKY that has been extended till November 2021. Five KG of Wheat/Rice is being distributed by the state government free of cost to 3.6 crore families.
During the second wave, Jan Dhan accounts of women beneficiaries were credited with Rs. 500 per month for the months of April, May and June. Further, Rs. 1000 were provided to BPL persons, senior citizens, widows, and disabled individuals. The government also provided Rs. 1000 to construction workers who lost their jobs due to stoppage of work in containment zones.
Task Team 9
Headed by medical education minister Suresh Khanna and health minister Jai Pratap Singh under the supervision of CM Yogi Adityanath, Task Team 9’s main function was to manage Covid beds across the state ensure availability of human healthcare resources and continuing the vaccination drive. The study pointed out that 73,000 monitoring committees under the team conducted door-to-door screening in around 97,000 villages. Around 1,00,000 tests were conducted daily in rural areas.
Observations made by the study for the possible third wave
The study suggests UP may see a very slow rise in the cases, with its peak in February 2022 with 1,200 infections per day at most. In case a new variant shows up, the state may see a faster rise with a peak in November with around 10,000 infections per day. In any scenario, the demand for beds would likely not go beyond 10,000; thus, it would not put pressure on the health infrastructure like it did in the second wave. Also, with vaccination going in full swing, the serious cases would be lesser in number compared to the second wave.
