West Bengal’s COVID-19 Strategy: Beyond the Hype

By Arghadeep Saha

Introduction

As the fourth-most densely populated state with the third most densely populated metropolitan area in Kolkata as its capital, West Bengal was always going to be one of the key players in handling India’s COVID-19 crisis. However, despite having the sixth-largest gross state domestic product (GSDP), West Bengal’s state finances have perpetually been in poor shape. Poverty levels according to the World Bank data is one of the worst among all major states in India at around 20 percent with per capita income continuing to lag below the national average. Poor revenue mobilisation coupled with one of the highest debt-to-GSDP ratios has been chronic features of the West Bengal economy with both tax and non-tax revenues lower than almost all other major Indian states. As an obvious result, development, as well as social expenditure, has continued to be stagnant as a proportion of GSDP over a significant period.

Moreover, for the first time in history, the Bharatiya Janata Party (BJP) has made serious inroads into the political landscape of the state by capturing 18 of the 42 seats in the 2019 Lok Sabha elections. With the Assembly elections scheduled for 2021, political tensions between the BJP-led Centre and the ruling Trinamool Congress (TMC) government at the state have been electric.

Given these two significant contextual factors of struggling state finances and increasing centre-state conflict, the article would attempt at explaining how West Bengal has managed to respond to the threat of coronavirus. The number of infected cases in the state has continued to be low, especially considering other comparable states, but a palpable fear, that it is primarily due to inadequate testing, looms. The deep sense of mistrust between the two administrations has not helped the state’s ability to address the impending crisis. While testing rates, among other things, have begun to gradually pick up, a significant more remains to be achieved to ensure that the damage is contained.

The devastation caused by the Super Cyclone Amphan has in many ways dealt a body blow to the administration struggling to contain the pandemic in already challenging circumstances. Incidentally, the cyclone-affected areas are also the most affected by the coronavirus. Going forward, it would be imperative for the central and state administration to work in tandem to overcome the double-edged sword that has cut across West Bengal to ensure lives are saved and the economy put back on track.

West Bengal’s preparatory response

While the initial case of coronavirus was identified in December in the Wuhan province of China, it took some time before the scale of the apparent crisis could be fathomed by authorities around the world. On January 30, at 7818 confirmed cases worldwide with the majority of these in China, and 82 cases reported in 18 countries outside China, the World Health Organisation (WHO) declared the novel coronavirus outbreak a Public Health Emergency of International Concern (PHEIC).

By the end of January, West Bengal had started its efforts of spreading awareness and informing citizens on the recommended measures of hygiene and social distancing, travel restrictions, home quarantine, and screening protocols for foreign returnees. The government’s promptness to disseminate the advisory received from the WHO and the Centre was immediate, and all the guidelines were also made available online. From February onwards, the state government also started releasing daily bulletins to share updates on the measures that were being taken to safeguard citizens and contain the disease.

By the first week of February, a 24×7 control room with two helpline numbers for the public had been set up in Kolkata along with designating two hospitals, one in Kolkata and other in Siliguri for isolation facilities in the state. Until the end of the month, 25 tests had been conducted with all of them coming negative. At the Kolkata and Bagdogra airports, 37566 travellers had been screened and 66749 persons had been screened at the seven Land Border Check Points along the Nepal and Bangladesh borders. Also, 2378 crew members of ships had been screened at the three state ports. The state administration had also identified 525 travellers from COVID-19 affected countries and placed them under surveillance.

Realising that the appearance of coronavirus within state boundaries is only a matter of time, the state government on March 2,  issued a circular for preparedness of government hospitals and medical colleges across the state providing detailed guidelines right from identification of patients to measures that need to be adopted for the management of (potential) COVID-19 cases at medical institutions. In less than a week, private hospitals were also sent a circular and were asked to be prepared.

All educational institutions and Anganwadi centres were first asked to be shut from March16-31, which was soon extended till April 15. The inter-state movement was also put on surveillance from March 16 with guidelines issued for necessary medical facilities to be set up at inter-state checkpoints for the screening of all incoming vehicles. Those who exhibit all conventional symptoms of the disease or had visited a foreign country or had encountered a COVID-19 patient were required to be shifted to an isolation facility of the district. The samples for all such cases were to be collected as per protocol and sent for testing. The district surveillances teams were required to compile reports on the status of these operations daily and share with the concerned authorities at the state level.

On the same day, the West Bengal government also notified the West Bengal Epidemic Disease COVID-19 Regulations, 2020 which detailed out all measures to be taken by hospitals, health departments to handle detected or suspect cases of COVID-19 and empowered the district administration under the leadership of the district magistrate to take necessary steps for the prevention and containment of the disease. Places that pose high threats of transmission such as movie theatres, swimming pools and shooting activities were all closed. A Rs 200 crore corona fund was also set up by the state government with meetings held at the CMO with attendees not just from departments but officials from the Army, Railways, Border Security Force (BSF), Central Industrial Security Forces (CISF) among others to ensure that all efforts are collaborative. As preparatory measures, the government had already placed orders of 2 lakh Personal Protective Equipment (PPE) kits, N-95 masks, 10,000 thermal guns and 300 ventilators. Health workers and all other government staff at the frontlines of handling the crisis were provided additional health insurance worth Rs 5 Lakhs.

The Chief Minister had conducted multiple press briefings and conferences emphasising the importance of preventive measures and the need to be extremely cautious. She went out in public to demonstrate how to practice social distancing and emphasised the need to wear masks. Measures were also being taken up by departments such as the state transport department with regular disinfection of buses and distribution of masks. However, officials did constantly express concerns around the inadequacy of good masks available in the market. The state judiciary also issued guidelines for only emergency hearings with only half of the staff in attendance across all courts in the state.

Chief Minister, Mamata Banerjee demonstrating social distancing

COVID-19 outbreak in West Bengal

Pre-Lockdown phase
On March 17, West Bengal reported its first case of coronavirus. A 19-year-old student had returned from Oxford University in the United Kingdom on March 15 and was diagnosed as positive on March 17. Immediately, he was taken in for treatment and his family and driver were put under quarantine. The state administration shared his travel details with the Centre to conduct contact tracing.

However, the first case in the state was not without its share of additional trouble. It soon emerged that the young man was the son of a senior state government official and his father was a doctor. After landing in Kolkata and till his symptoms became visible, he had visited multiple public places (ignoring guidelines on self-quarantine), such as malls and theatres and had met his acquaintances. The official herself attended work till her son’s tests came positive. The media and the opposition, of course, were quick to pounce on this and WhatsApp texts began to spread fear and anxiety around the state government’s supposed failure to tackle the situation.

The Chief Minister expressed her deep displeasure at what had happened and sternly announced in a media interaction that protocols apply to everyone and that necessary action would be taken against the official. She asked the police to be vigilant of violations and, media houses and the public to not spread fear and that any rumourmongering would attract strict action. She also issued an appeal to all individuals who had travelled from other states or had a history of recent foreign travel to self-isolate and act responsibly. With the disease making an appearance within state borders, health officials immediately sprang into action and reported that while 163 beds had already been earmarked for isolation, the state could designate 1900 beds for isolation anytime. A circular on March 19, went out to districts to involve the Panchayats in generating awareness around COVID-19 in rural areas and how the existing rural health resources should be utilised for the same. However, the fear of a sudden spike was a reality with officials acknowledging the same. While the state in total had about 777 beds for intensive care, as on March 18, 528 were occupied by patients (with non-corona ailments). Moreover, the state only had 382 doctors and 737 nurses trained for handling critical care patients, hence, a sudden spike in cases is something the government wished to avoid at all costs.

Around the same time, the state Finance Minister alleged in the Assembly that the Centre had not been providing a fair share of the state’s tax revenue it is supposed to receive. As a result, the state was forced to borrow additional funds which could potentially worsen its fiscal position. The state government in the following few days constantly reported that it had reached out to the Centre for support on ensuring the availability of kits, masks, and other equipment with little response. While the state government was interested in pushing for increased testing capacity in the state from just two laboratories, the Centre allegedly was delaying its approvals and not providing sufficient testing kits.

On March 21, the state government announced the prohibition of all non-essential social gatherings such as restaurants, clubs, museums including the closure of all government offices engaged in non-essential services and requesting staff to work remotely. To contain the surge of cases that might come from outside the state borders, all trains and inter-state buses were also stopped.

Lockdown phase
The state government decided that containment of the spread was the first strategy to be employed and everything else would need to be built on that. On March 22, an initial lockdown was announced across the state (even before the Centre announced the national lockdown) applicable from the next day with exemptions for essential services, manufacturing units involved in the production of essential commodities and transportation services for essentials. The suspensions included public transport, commercial establishments dealing in non-essentials, factories, and offices. Any congregation of more than seven people in a public place was deemed punishable.

On the same day, the state government also announced that several private hospitals had been requisitioned by districts for the treatment of patients with COVID-19 and other severe respiratory illnesses (SRIs) free of cost. The costs incurred by these hospitals were to be reimbursed by the state government. The next day, the government announced the creation of ‘West Bengal State Emergency Relief Fund’ for combating emergencies not related to a natural disaster. The fund intended to mobilise additional resources to address the growing costs of handling the pandemic and its impact.

With the Centre announcing the first 21-day national lockdown on March 24, guidelines on exemptions were revised and movements of goods and services accordingly regulated. Exemptions included agriculture and related activities, tea garden operations. Strict actions against hoarding of masks and sanitisers were also imposed. On March 25, a ‘Pass’ system was introduced to regulate the movement of persons supplying essential goods and services. However, given the Centre’s guidelines, movement of all goods and commodities could be transported without disruptions.

On March 26, the emerging health crisis in the state prompted the administration to form a specialised committee of experts for ensuring quick and efficient guidance on measures that need to be taken for quarantine, testing, isolation and other health and necessary medical interventions. Another task force was also set up to ensure coordination with district administrations on a range of activities such as transportation, provision of health equipment, municipal affairs, power services and the supply of essentials, among others. Police stations were asked to ensure that the supply of essentials is not hindered. District administrations and police were also asked to monitor the elderly, especially those living by themselves, ensure the supply of medicines and tend in case of emergencies.

Chief Minister, Mamata Banerjee also wrote to her counterparts in 18 other states for support and coordination in helping migrant workers stuck in those states. Given the sharp increase in the need of hand sanitizers, micro and small enterprises were involved, and the state was producing about 6000 litres of hand sanitisers daily. By the end of March, more than 1000 beds were earmarked for isolation across 87 government and private hospitals with more isolation beds being set up as well.  Hotels and guesthouses near hospitals treating COVID-19 patients were also taken over to provide accommodation to doctors and nurses.

The massive unorganised sector in the state meant that a significant proportion of the population would be badly hit by the economic shock that came with the lockdown. The state allocated resources for the provision of subsidized ration for almost 9 crore beneficiaries. These beneficiaries who used to get rice for Rs 2/kg but would get it for free for the coming six months. One-time assistance of Rs 1000/- was also provided to workers of the unorganised sector through the newly launched Prochesta scheme on applying online or an app. Old-age pensions were released two months in advance and 27 night-shelters were set up in Kolkata and Howrah to accommodate the homeless and those living on pavements.

However, support from the Centre remained a critical bone of contention and the alleged negligence made things difficult for the state administration. In an all-party meeting in Kolkata towards the end of March, the Chief Minister mentioned that given the crisis, the state should have at least gotten a moratorium on interest payments. In more ways than one, the state government had consistently voiced how fund mobilisation was the biggest challenge and urgent assistance from the Centre was the need of the hour.

The following month of April saw a series of circulars and notifications that announced a slew of measures and advisories for combating the spread of the disease in the state addressing key areas.

• Revised guidelines for handling of COVID-19 patients and safety precautions needed, to be ensured
• Mandatory wearing of masks or cloth to cover nose and mouth in public spaces
• Provision of supplies and health check-ups in relief camps
• Constant updating of COVID-19 hotspots and protocols for activities in such areas, including details on cluster containment strategies
• Revised list of exempted activities allowed in the state based on the severity of infection prevalent in different areas
• Gradual resumption of non-corona related hospital services in government medical institutions
• Guidelines and directives around home quarantine and increased testing facilities
• Guidelines around the opening of sweetmeat shops and flower markets from mid-April with restricted timings and mandatory social distancing measures

A new scheme, Sneher Paras, of one-time assistance of Rs 1000/- for migrant workers from Bengal stuck in other states was also announced.

From May onwards, the focus was on better management of logistics necessary for addressing the crisis, smoothening out process inefficiencies around payments and procurements, allowing privately run health services and improving the daily reporting and data management practices of COVID-19 figures. By May 6, the West Bengal Police confirmed over 40,000 arrests and over 3,500 vehicles seized for defying lockdown norms. On 8 May, district level expert committees were set up to guide and provide strategy on containment activities in both rural and urban areas. A helpline number operating from 8 AM to 8 PM every day was also set up by the health department to address all issues around the non-availability and insufficiency of PPE and other medical supplies in medical institutions.

Another concern that had been persisting was the issue of returning migrants from other states. Until early May, West Bengal had allowed only two trains from Rajasthan and Kerala carrying migrant workers back home, drawing some criticism. There was a fear among the state administration that a sudden surge of reverse migration could make the infection spread rapidly in rural Bengal, a situation that could quickly go out of hand. However, on May 14, Chief Minister, Mamata Banerjee announced that the state government had arranged for 105 special trains from different states to bring back migrants, setting up quarantine facilities in schools and community centres.

A sentinel surveillance plan with sample testing from low-risk non-SRI patients who visit district healthcare centres as well as high-risk healthcare workers was launched on May 15. This was intended to understand the trends of infection across all areas in the state and the readiness of medical facilities to respond to such cases as lockdowns gradually lifted. A crackdown on fake news had also been carried out with over 1.3 lakh social media posts promoting fake news around COVID-19 and spreading communalism taken down by May 18. Many of these were attributed to BJP leaders and while the state administration accused them of spreading fear and rumours, the state government was accused of restricting free speech.

Testing and treatment: A tale of challenges and confusion

The above discussion was intended to show the range of measures and actions that the government undertook to contain the spread and ensure necessary support to handle and treat COVID-19 cases given the larger socio-political reality of West Bengal. We also saw that the government was proactive in ensuring the supply of necessities and regular updates for public awareness. All these measures would have yielded intended results if they were coupled with massive testing and a well-equipped healthcare system. However, this key area is where West Bengal seems to have struggled. By the end of March, West Bengal had completed less than 600 tests. The graph below shows the trend of testing since then.

Source: https://www.covid19india.org/state/WB

As on May 30, West Bengal has 5,130 confirmed cases of which 2,851 are active, 1,970 recovered and 309 deceased. As is evident, tests picked up only towards late April and the daily testing rate exceeded 1,000 on April 26. The low figures of testing (and consequentially, low number of cases) and high mortality rate were a major cause of scrutiny and controversy nationally. The current fatality rate of about 6 percent is, in fact, a sharp improvement as until the beginning of May, this was at over 13 percent. However, the numbers and whether they are high (or low) appear to be as much a political issue as a health issue. Testing numbers were indeed quite low in West Bengal until most of April with tests per million around only 200, one of the lowest. Until March, the state had been complaining of inadequate testing kits and delay in the Centre’s approval of more testing laboratories in addition to the two initially approved in Kolkata (ICMR-NICED, IPGMER). However, with five additional testing centres approved by early April, testing rates did not pick up as sharply as was expected with the state government claiming the kits supplied by ICMR-NICED provided inconclusive results. The ICMR-NICED, on the other hand, went ahead and stated around April 12 that the state government was sending them fewer samples. Soon though, on April 19, ICMR-NICED agreed that the kits indeed had glitches and were in the process of being replaced by April 27. As is evident, testing rates did pick up since then with the state testing almost 2,500 samples daily within a week, 5,000 samples a day since mid-May and currently testing over 9,000 samples daily. Testing laboratories have also risen to 40 across the state, including multiple private labs.

While issues around testing gradually got resolved, the state’s handling of the data around deaths and the general reporting of statistics generated fears of suppression of information.

By early April itself, many potential COVID-19 related deaths were reported in the media with the official figures remaining unchanged. The daily bulletins that were being released since February 4, were not published on April 2 and 3. The next bulletin on April 4 had a different format with the number of new cases and deaths replaced with ‘number of active cases’. The reports were revised, and death figures were again provided from April 7 onward. This delay and confusion were because the state administration had formed an ‘audit committee’ of doctors on April 2 to ascertain the cause of death and official figures were published only after the approval of this committee. However, soon questions were raised on the low death count (which by April 30 was 33), the unusual step to form a committee to ‘confirm’ cause of death and confusions around reporting. This reached a peak when an inter-ministerial central team (IMCT) deployed by the central government to review the status of measures allegedly reached Kolkata on April 20 without informing the state government. This led to a series of angry exchanges between the two administrations gaining national attention.

What emerged by the end of the month was that the audit committee had not been including deaths due to co-morbidities. With some back and forth and heated exchanges the state included such cases and the death figures shot up to 122 by May 3. While the state government received widespread criticism, the administration responded that dissecting comorbidities in pandemics is not ‘technically’ incorrect. The growing number of cases and the fear of spread has now also begun to reveal the limited capacity of the health system in the state. News reports of ailing public health infrastructure, poor working conditions, overburdened human resources in medical institutions in Kolkata have been emerging. The public health infrastructure is even thinner in other districts and rural areas, and with the incoming surge of migrants already connected to a bout of new cases, the challenge has increased manifold. If this was not enough, Super Cyclone Amphan wreaked havoc in Kolkata and neighbouring districts of South and North 24 Parganas including Sundarbans, East Midnapore, Howrah, Hooghly between May 19 -21 with billions worth of infrastructure and livelihoods lost, and disruption of essential services causing chaos in the region. The state government, however, with support from the Centre, Army and disaster management teams has been working overtime in restoring normalcy. Tough times lie ahead for the state that currently seems to have more on hands than it can deal with.

Conclusion

West Bengal’s early response to address the coronavirus crisis was in many ways prompt, thoughtful and thorough. The reason why coronavirus spread comparatively later in the state and did not spread as rapidly could be attributed to these measures. However, with the virus finally beginning to spread, the challenges facing West Bengal have emerged one after another. Poor condition of state finances, an ailing public health system and a bitter rivalry between the State and the Centre, made a health crisis into a political one. The state government also took a few questionable administrative decisions that could have been avoided. However, despite these challenges, the situation has been handled well at the state level and urgent efforts by both the state and central administrations to plug some of the gaps plaguing the current response measures, including putting politics at bay, for the time being, could ensure that moving forward, the losses are as low as possible.

AUTHOR
Arghadeep Saha is an alumnus of the MA in Development programme at Azim Premji University (2014-16). He’s currently based in New Delhi and works on providing research and monitoring support to rural development programmes as a Senior Researcher with Bharat Rural Livelihoods Foundation, an agency under the Ministry of Rural Development.

Disclaimer: The views and opinions expressed in this article are those of the author/s and do not necessarily reflect the official policy or position of Azim Premji University or Foundation.