Manufacturers of COVID testing kits, protective gear struggle with transportation after lockdown

On 25 March, the first day of a three-week lockdown across India to contain the deadly COVID-19 virus, it became clear that the decision was ill-planned and poorly implemented, as manufacturers of testing kits and personal protective equipment began facing difficulties in transporting the urgent medical materials to hospitals. The previous night, after weeks of Indian health authorities denying community transmission, which led to the country recording the lowest tests per million across the world, Prime Minister Narendra Modi had directed the populace of 1.3 billion to stay inside their homes during a televised address. But the centre’s failure to foresee predictable consequences of the lockdown has put several patients in danger by disturbing the continuous supply of these materials to hospitals.

The ill-thought out move caught the nation off-guard, as the government had consistently underplayed the seriousness of the pandemic in the weeks leading to the lockdown. While citizens scrambled for supplies, the medical-device industry, which is expected to be working at a war-footing to supply health workers with testing kits and personal protective equipment, found itself with employees unable to travel to work, and without transportation to move the material to hospitals.

Several state governments, including those in Delhi, Punjab and Maharashtra, had declared a lockdown in their respective states that began two days before it was imposed across the nation. The pharmaceutical industry, which bears the heavy burden of ensuring the availability of essential drugs and medical devices, was the first to feel the impact. On 23 March, after various requests from medical-device industry representatives, the department of pharmaceuticals had stepped in. That day, PD Vaghela, a secretary in the department of pharmaceuticals, under the ministry of chemicals and fertilisers, wrote to chief secretaries across the country to allow opening of manufacturing units. Vaghela noted that these manufacturers were supposed to be exempt from restrictions, as per a meeting between the cabinet secretary and principal secretary to the prime minister and the state chief secretaries on the previous day. In the letter, accessed by The Caravan, Vaghela noted that “drugs play an important role in public health care delivery system” and that they were “all the more critical in pandemic situation.” He wrote, “As it is the responsibility of the government to ensure the availability of medicines to the public, it is vital that manufacturing, import, sale and distribution of the drugs takes places without any impediment so as to ensure continuous availability of the drugs.”

The next day, Dr GSK Velu, the chairman and managing director of Trivitron Healthcare—a company selected to manufacture COVID-19 testing kits—found itself lacking employees to make testing kits. On 24 March, Velu wrote to Rajiv Nath, the founder of the Association of Indian Medical Device Industry, requesting the industry body to approach the government for special permission passes in order to move raw material, supplies, and medical devices during the lockdown. In his letter, Velu requested that “movement should be permitted through all domestic courier services and other modes of transportation by road on production of documents in favour of or issued by Trivitron HealthCare Pvt. Ltd.” He further sought “Permission to work for employees of Trivitron HealthCare Pvt. Ltd. at different plants, offices within India on production of their Identity Cards.”

Yet, instead of addressing these problems, Modi’s announcement appears to have compounded them. Nitin Mahajan, the managing director of Mitra Industries, which makes blood bags that are necessary for many critical-care procedures, especially dialysis, told me that the lockdown had made things worse. “Our workers are the spine of our company. I employ around 4,000 people and only 20 percent could get to our unit in Faridabad,” Mahajan said. “We need to assure financial, emotional, and physical safety of our employees. He explained that the “logistics of moving the goods, or getting raw material to my company” had become impossible. For instance, the raw material had to come from Mumbai. “Our suppliers have refused to take orders because they are not clear how they will move it across states,” Mahajan added.

“Every company we deal with has refused to take our things,” he said. “At this point, we have to ensure the patients don’t suffer. A blood bag is required in so many procedures. The unplanned lockdown is affecting business badly.” In his letter to the state chief secretaries, Vaghela had requested them to issue entry passes to validate the movements of people who are necessary for the continuous production of materials needed by India’s healthcare workers. The central government did not, however, ensure that the same had been implemented before announcing the nationwide lockdown. “I’ve been to the local police station for two days to get a curfew pass, and it has been chaotic,” Mahajan told me. “They have called me again tomorrow.”

The inter-state lockdown has also triggered a new crisis. “My trucker told me he cannot move the material because he may pack some food for the first day, but with eateries along the highway shut, how is he expected to eat?” an industry representative told me, on the condition of anonymity. “The lockdown should have been better planned.” Meanwhile, people with chronic illnesses and health workers are also struggling to reach hospitals. The lack of public transport has proven very difficult for individuals needing time-sensitive care that is not emergency medical intervention, such as pregnancy-related consultations and tuberculosis patients who have to present themselves at a clinic to get their daily dose of medicines.

“If common-sensical exceptions are not made, the lockdown will end up causing more harm than good,” Dr Yogesh Jain, a physician and the founder-member of Jan Swasthya Sahyog, a public-health initiative in rural Chhattisgarh, told me on 25 March. “The shutting down of out-patient services and public transport is going to hurt us in the long run. The lockdown has made it impossible for people to get routine care. We usually see between 350–400 patients. Only 50 people came today. We may save people from COVID-19, but we will let them die from other  ailments like TB, and cancer, or hunger because of this lockdown.” Jain added that the lockdown may mean nothing without a humane public-health response, which tests more people. “This is going to result in a temporary suppression, which will erupt in a much worse manner whenever the lockdown is removed,” he added.

The failure to prepare the health sector was not the last of the poor planning for the lockdown. He appealed for people not to panic, but also gave the citizens a four-hour notice before directing them not to leave their homes. “Every state, every district, every lane, every village will be under lockdown,” Modi said. He mentioned that there would be a plan for essential services, but failed to give any sense of how it would affect the daily needs of the people. Through his thirty-minute address to the nation, he did not state in simple, clear terms that essential services, grocery shops and pharmacies would remain open. As could have been predicted, the panic on the streets was immediate and overwhelming, forcing the prime minister to tweet clarifications within minutes of his speech.

Modi warned the country that if India does not “handle these 21 days well, then our country … will go backwards by 21 years.” But at the end of the first day of this lockdown, Modi’s administration was yet to share a mitigation strategy with the public, or the details of a financial package he promised during the address.

As of 8 pm on 25 March, the health ministry reported 553 active COVID-19 cases, 42 cured or discharged cases and ten deaths. As the pandemic takes off in the Global South, its course will depend on India’s response. “The future of this pandemic, to a great extent, will be determined by what happens in very large, densely populated countries,” Michael Ryan, the executive director of the World Health Organisation’s Health Emergencies Programme, said during a press conference on 23 March. “So it is really important that India continues to take aggressive action at the public-health level and at the level of society to contain, control and suppress this disease and save lives.” While aggressive actions such as a lockdown are necessary to curb the spread of the infection, it is completely counterproductive if they are implemented with poor planning and without prioritising the health sector.