How the Trinamool government failed to prepare for and respond to the COVID-19 second wave

Election campaign hoardings for the All India Trinamool Congress with the West Bengal chief minister Mamata Banerjee outside a shuttered pharmacy in Kolkata, on 28 April 2021. Numerous doctors and health activists said that Banerjee’s government had failed to prepare for the second COVID-19 wave, or even respond to it efficiently after it began. Arko Datto / Bloomberg / Getty Images
03 June, 2021

“We knew that the second wave was coming and that it would be more devastating, but still the state government failed to be prepared for it despite warnings from us doctors,” Manas Gumta, the secretary of the Association of Health Service Doctors, West Bengal, told me. The AHSD is a body of the state’s public-service doctors, and Gumta is one of several health workers who believed that the All India Trinamool Congress government’s lax approach to the COVID-19 pandemic had exacerbated the severity of the second wave. While there was a general consensus on the central government’s responsibility for the disastrous vaccination policy and the eight-phased state elections, most did not blame the centre alone. Numerous medical and policy experts said the chief minister Mamata Banerjee’s government had failed to prepare for the second wave, or even implement any strategic response after it began.

As the second wave began to spread across the country, West Bengal was no exception. On 1 March, the state saw 198 new coronavirus cases, with a total of 3,293 active cases. The elections were held from 27 March to 2 May, over eight phases, with extensive campaigning through March and April, turning a complete blind eye to the deadly pandemic sweeping the country and the state. By 1 April, the number of active cases had risen to 6,513, and the state witnessed 1,274 new cases that day. On 2 May, the counting day, the state saw 17,515 cases, with 1,18,495 active cases. The second wave appears to be slowing down, but it is still a far way off from ending, with 9,424 new cases on 1 June, and over 78,000 active cases. In this three-month period, West Bengal witnessed over 5,000 deaths due to COVID-19.

“The period before the election, when the cases had come down, the doctors’ bodies have continuously requested the government and also appealed to the political parties that they should not allow these mass conventions,” Dr Punyabrata Goon, the convenor of the West Bengal Doctors’ Forum, told me. “We have written about seven–eight letters to the government. However, we never got a response from them.” Despite the surge in cases through March and April, the state announced a lockdown only on 16 May. According to Shamik Lahiri, a senior leader of the Communist Party of India (Marxist) and a member of the party’s West Bengal state committee, “The state government has not particularly done much apart from announcing the lockdown.”

This is emblematic of the state government’s response to the second wave, which experts said has been marked by hasty policies that respond to the worsening situation, but do little to better equip the state to deal with the pandemic. As of end May, doctors and hospitals in West Bengal still complained of a lack of COVID beds, inadequate testing facilities and a shortage of vaccines, oxygen cylinders and trained healthcare staff. Phone calls, messages and emails to officials in West Bengal’s health department and the state’s cabinet committee on COVID-19 management went unanswered.

Many doctors told me that not enough tests were being conducted in the state. Expressing concern over the pandemic surge in the countryside, Gumta said the state government immediately needed to increase testing at the district levels. “Till now in West Bengal, the testing numbers are stuck between 60,000 to 70,000 and most of them are rapid antigen tests,” he said. “In most cases, the reports are coming in five–seven days and they need to wait for two–three days to get the tests done as well. So, it is making it difficult for a lot of people to receive proper treatments. It is necessary to test everyone who has symptoms and those who test positive, their contract tracing should be done but this has not been happening.”

Last year, the state recorded its highest daily rise in fresh cases on 22 October, with 4,157 new infections. The number of tests done then was about 42,000 and it has not increased much, Gumta said. The data supports his view. During the second wave, West Bengal recorded its highest single-day spike on 14 May, with 20,846 new infections—over five times higher than last year’s highest surge. That day, the state conducted 70,051 tests—less than twice as many as last year.

As has been the case with the second wave across the country, the infections appear to have moved from the cities to the rural areas. “Even though the cases are coming down in Kolkata and urban areas, we think the cases are increasing in rural Bengal,” Goon told me. “But you cannot get that reflected from the official statistics. WBDF has been running a telemedicine service for about a month now. Earlier, we used to get maximum calls from Kolkata which has come down now. Now the maximum number of calls are coming from rural areas.”

Goon gave the example of a call they received from a family where one person had tested positive and the other members were showing symptoms. “When we asked them to get tested, they said that they stood in queues from the morning but got to know that the testing centres had run out of testing kits by afternoon. So adequate number of testing is not being done and that is why the government do not have the exact number of people who are infected.” He added, “WBDF has appealed continuously to the Health Secretary, Chief Minister to allow RAT tests widely, which would have led to the decrease in the number of RT-PCR tests. The government hasn’t responded to our appeal yet.”

According to Lahiri, one of the reasons behind the low testing was the prohibitively high cost of the tests. “Why hasn't the state government regularised the price of the tests? Paying Rs 2,000–2500 for getting tests done is not black market?” He also emphasised the need to speed up the work on free vaccinations, with a special focus on second doses. “Mamata Banerjee said from 5 May vaccination will start—on what basis did she promise? People are going around looking for vaccines.”

Lahiri acknowledged the role of the centre in the vaccine crisis across the country, but pointed out that the Trinamool Congress-led state government, too, had been inactive. “Even though the central government has the primary responsibility in the vaccination programme, the state government should have a plan. Other state governments have already called for global tenders whereas they are still planning,” he told me.

Goon pointed to the high costs of vaccination in the state. “In Kolkata, nursing homes like Woodlands are buying vaccines directly from the providers and giving them for Rs 1500 for a single dose,” he said. “So, if one dose is for Rs 1500, two doses are for Rs 3000. This is not feasible for people who live on daily wages.” In a recent article, The Caravan pointed out that India is the only one among the ten countries worst affected by COVID-19 not to ensure free vaccination. The BL Poddar Hospital in Kolkata, the article noted, was charging the highest among Indian hospitals for the vaccine—Rs 2,000 per dose.

According to Gumta, the health infrastructure is equipped for adequate vaccination. “For the pulse polio programme, we vaccinated lakhs of children at bus stands, railway stations and even remote areas. So our infrastructure is not the problem—it’s the unavailability of vaccines. Our infrastructure permits vaccinating 4 lakh people per day, but due to not getting enough vaccines, the vaccination drive is not happening at a certain speed. We cannot utilise the capacity we have organised for inoculation.”

Gumta noted that there was a vaccination crisis in the state. “There is no supply, people are not getting their second doses, there is no certainty about getting the first dose,” he said. “We do not know when and which vaccines will be supplied. There is extreme confusion and chaos regarding this every day at the vaccination centres in the hospitals. People are waiting in queues from 3 in the morning and still not getting the vaccines.”

In addition to the lack of vaccines, Gumta said that the state is also suffering from an acute shortage of oxygen beds in government hospitals. Keeping the current scenario in mind, doctors’ associations and health activists have demanded that COVID blocks be opened in all medical colleges and general hospitals in the state, for COVID beds in private hospitals to be made available and for an increase in the number of government beds.

Sreyan Ghosh, a researcher on infectious diseases at Jawaharlal Nehru University’s Centre for Advanced Scientific Research, highlighted how the state government’s failure to act was more acute in the second wave. “During the first wave, the state government was a bit more proactive because even if there were a couple of problems initially, their response was good,” Ghosh said. He said that during the first wave, the state government reserved beds in private hospitals for the public using the state’s health schemes, but the reimbursement has not been completed yet. This has led to a lot of hospitals preventing the government from procuring beds for COVID treatment this time, multiple doctors and activists told me. “This time, they have given up and people have to rely on private sector hospitals,” Ghosh said. “That has become very difficult for the common people.”

Mohit Ranadip, a psychiatric social worker and Kolkata-based health activist, echoed Ghosh. “Last year, while combating the COVID-19 crisis in West Bengal, the state government handled the situation quite efficiently, even though they were a little late,” Ranadip said. “They set up a high-profile committee to deal with the COVID crisis in the state, which consisted of public-health experts, economists like Swarup Sarkar, Abhijit Vinayak Banerjee, and carried out their advice very efficiently. Also, the government took over a lot of hospitals—private, voluntary service hospitals. However, we haven’t seen this initiative this year.”

Ranadip gave the example of the Sramajibi Hospital in Serampore, a city in the state’s Hooghly district. Ranadip said that the hospital “provided excellent service during last year COVID.” He continued, “However, the government did not procure that hospital this time. Moreover, the state government has not paid them the due of Rs 8 crore from last year yet. This time, they functioned as a private hospital and charged all the patients, which made it difficult for a lot of people to access treatment.”

Gautam Sarkar, a joint secretary of the Sramajibi Hospital, confirmed to the local media in mid April that the hospital had not yet received the money owed to them by the state government. “We are yet to get the money from the government from last time, I hope we will get it,” Sarkar told the Bengali daily Anandabazar Patrika.

Gumta, too, spoke of the state government’s failure to address the lack of hospital beds. “There has been an extreme lack of management. That is why during the last one and half months, when we saw the pandemic unfold in its extreme form, people suffered extensively,” he said. “There were no beds, no ambulances. The ambulances needed to be procured by the government, the beds in private hospitals needed to be procured. In order to control the private hospitals from bankrupting the common people, the government needed to transform them into public COVID hospitals. But none of that has happened so people are still struggling to find beds, getting admitted to hospitals, getting ambulances, oxygen, and other treatment facilities.” Gumta added that outside the Medical College and Hospital, Kolkata as well as other COVID hospitals, “you can find people sitting outside in the hospital premises with oxygen cylinders because of the unavailability of beds.”

“So there has been a lot of lack of preparation,” he said. In early May, the state government announced that the Salt Lake stadium in Kolkata would be converted into a 250-bed hospital. Around the same time, a hostel in the capital city’s Jadavpur University was turned into a quarantine centre—or safe homes, as they are called in the state—for individuals who tested positive for the coronavirus. Gumta acknowledged these developments, but noted that these were “extremely delayed.” He added, “If we had taken this preparation one, one-and-a-half months before then we would not have faced so many problems.”

Ghosh, the researcher, also wondered why these steps weren’t taken earlier. “Why is it happening so late when the medical system is on the verge of collapsing?” he asked. “Why didn’t they do it in those three months when the number of cases were low? This is the state government’s failure, this is the central government’s failure.”

Lahiri, the CPI(M) leader, accused the government of not having a comprehensive strategy. “If the number of people getting infected per day is 17,000–20,000, then what percentage or number of beds do you need in hospitals and how many of those beds do you need in safe homes?” he asked. “Does the government have any such calculations and data? They are taking each day at a time without any planning.” According to the daily health bulletins released by the state government, the state currently has 200 safe homes with 11,507 beds—the same as it was in October last year. As of 1 June, there were only 2,042 patients in the safe homes, according to the bulletin.

The doctors and health activists I spoke to also raised the issue of the hoarding of oxygen cylinders and the state’s failure to address the situation. “Oxygen is not an issue in our state, the amount of oxygen produced is enough,” Lahiri told me. “The main problem is deficiency of the oxygen cylinders.” Ghosh told me, “Even if the government is directly not supporting them, there are people who are selling an oxygen cylinder for Rs 50,000 and that is not coming under the radar of the government—it is a little difficult to believe that.”

“There has been massive hoarding of cylinders and concentrators,” Ghosh continued. “What needs to be done to stop the hoarding of oxygen cylinders is rationing new cylinders, create a state-level database of the same. This should have been done by the state government from December because a buffer period of two months was needed for that to be completed. Due to the lack of a central database, over the counter sales have been happening. It becomes an auction—whoever pays the maximum price gets it.”

Another major issue plaguing the state’s healthcare system was a lack of trained healthcare workers, according to doctors and activists. “In order to provide treatment for so many people we need a large number of trained healthcare workers—doctors, nurses, ASHA workers,” Gumta said. “So even though hospitals are opening up COVID beds, that is not enough. No new recruitment is happening. Even if it is, people are not joining because they have to work in COVID wards.” He added that the state government had not made “any efforts to train healthcare workers in order to treat this huge number of patients. So, if the cases continue to increase, you cannot provide the required treatment even if you want.”

Dr Yashesh Paliwal, the head of the critical-care unit at Fortis Hospital in Kolkata, reiterated these concerns. “We are facing problem with the number of healthcare staff, number of skilled staff, especially in ICU, where it is extremely difficult to get skilled nurses and doctors,” Paliwal said. “When it comes to critically ill patients you need specially trained healthcare workers. This is the biggest challenge we are facing in treating patients.”

Goon, the convenor of the West Bengal Doctors’ Forum, pointed out that a large number of healthcare workers had contracted and died of COVID-19, and received little assistance from the state government. “Our demands about the treatment of healthcare workers, immunisation programmes have also not been met by the government,” Goon said. “Narendra Modi had announced compensation of Rs 15 lakh for families of healthcare workers who died in the frontline—none in our state has received it yet. Mamata Banerjee has also announced Rs 10 lakh compensation for healthcare workers' families who died. But only four families of doctors received the money till now.”

According to Ghosh, the need of the hour is to decentralise the monitoring and pandemic response down to the block level. “I was trying to get a colleague’s father admitted to a hospital in Budge Budge after looking for a COVID bed for a long time,” Ghosh said, referring to the town in the state’s South 24 Parganas district. “He had to travel to Budge Budge from Purba Bardhaman—this means that this person had to cross five districts to get to a hospital. So if we can monitor the situation at a district level that would have been the best.”

Ghosh continued, “In Kolkata we still have enough data, call-outs on social media about oxygen, beds, but if someone falls sick in the interiors of Bankura district like Indas village, there is no way I can ask someone if they have any oxygen arrangement. The person will expire before reaching Bankura medical college from Indas. This is why, in those interiors we are not able to carry out volunteering because the whole thing has not been decentralised yet,” he told me.

Randip, the health activist, pointed out that even the decentralisation efforts were more efficient during the first wave. “There was no announcement of the names of any nodal officers this time,” he said. “Last time, from every municipality, panchayats, they announced the names of the nodal officers. They could have helped throughout the whole procedure which was absent this time. Even if a few names were given—but they were nowhere to be found.” Randip added, “There is an extreme lack of coordination. You cannot handle a pandemic with this workforce and health budget.”

None of the state health officials responded to my queries or requests for an interview. Calls and messages to Firhad Hakim, the chairperson of the Kolkata Municipal Corporation who is also a member of the state’s cabinet committee on COVID-19 management, went unanswered. Emails to the health minister, Chandrima Bhattacharya, and the health secretary, NS Nigam, also went unanswered. 

I spoke to Manoj Tiwary, the newly elected member of legislative assembly from the Trinamool Congress about the state’s pandemic response. Tiwary sought to lay the blame squarely with the central government and the eight-phase polls announced by the Election Commission. “If you remember, our chief minister asked the Election Commission to conduct the election in one phase which was denied by the EC, so you got to ask this question to the central government and the EC,” he said. “We as AITMC party wanted it to happen in one phase so that we are not exposed to the virus.” Tiwary also blamed the centre for the vaccine shortage in the state. “They have not sent enough vaccine dose and a lot of money is also due which has not been cleared by the centre.”

When asked about the state’s lack of preparation and poor response to the second wave, Tiwary spoke of some of the efforts by the Trinamool Congress government, all of which other doctors and activists had criticised as being too little, too late. “We announced a lockdown,” Tiwary said. “Lot of safe houses, isolation centres have been set up. We have also taken over a couple of stadiums for COVID care unit and there are a lot of hospitals which have been taken over.” He continued, “People at the ground level also—party people, workers and all the MLAs, MPs are working very hard to make sure that each and every constituency they belong to is following the instructions of our chief minister so everybody is on it.”

Goon feared that the government would become complacent as the second wave recedes. “The oxygen bed crisis has not decreased in the state because the infrastructure has improved, it’s because the natural course of COVID-19 is plateauing at the moment,” he said. “This is not because the government has increased the number of oxygen beds.” According to Goon, it was still imperative to develop the health infrastructure. “When the second wave came, we saw an extreme crisis of oxygen beds in the state as well. Now, that crisis has started decreasing but if the government doesn’t build up the infrastructure even now and ramp up the vaccination process then we cannot predict how many people will die during the third wave. We cannot speculate how bad the third wave is going to be—is it going to be like the first wave or worse than the second wave, we do not know.”

Gumta expressed the same fears. “Maybe when all of the arrangements for COVID beds in every block hospital, ICU beds, will be set up, the number of cases will come down,” he said. “Even if they set all these up, it will not be of much use during this second wave. Probably will come handy in the future.” With a sigh, he added, “But had we prepared in advance for this time then people wouldn’t have suffered so much and we could have saved more lives.”