Comparison of the three models of Maharashtra, Delhi, and Uttar Pradesh’s handling of Covid-19 (second wave) and a potential way forward.

Introduction
Following Tuesday’s Health Ministry press conference, Press Trust of India (2021) reported that 18 states and union territories, especially Uttar Pradesh, Maharashtra, and Delhi have now been showing a steady decline in reported cases, since the beginning of May 2021. At this stage of the second wave for COVID-19, this comes as a relief. It remains unclear how this decline will reflect in national COVID-19 statistics given that 16 states and union territories such as Karnataka, Kerala, Tamil Nadu, West Bengal, among others continue to show a steady rise in infections (ibid), it is still worth exploring how the triad of Uttar Pradesh, Maharashtra, and Delhi plateaued their waves by taking a look at their varying models.
Between themselves, the three states share 32 crore Indians, according to the Census of India (2011), a number which has increased since. Uttar Pradesh and Maharashtra are India›s two most populated states, and Delhi its most populated Union Territory. As the second wave began towering over the country in late February, the three regions adopted separate models to fight it.

The Uttar Pradesh Model
Much is always written in the news about one of the most densely populated regions in the world – Uttar Pradesh (UP) with its multiple socio-economic challenges. If the state were a country, it would be the world’s fifth most populated nation.
At this stage the state has considerably curbed its mortality rate, with the cumulative death count reportedly 16,043 (Ministry of Health and Family Welfare 2021). At its peak on 24th April 2021,the state recorded 37,944 cases with 16,03,886 tests administered.


Many have located UP’s “Team 11” at the centre of agile decision-making and constant course correction in UP’s battle against the COVID-19 virus. Team-11, as Gupta (2021) reports, was “a centralised power-structiure, led by the Chief Minister comprising ten of the topmost officials in the state”. The team was later abraded down to Team-9working on the state›s COVID-19 response. Seven of the current members have been or are COVID-19-positive themselves and the team continues to hold virtual meetings every day since early March to tackle the situation at hand.
Besides this political task force, in a recent tweet the World Health Organisation (2021) has also acknowledged that the state government›s active house-to-house case finding teams, working in rural areas, help in curbing transmissions by way of testing, isolation, management, and contact tracing.
House to house surveillance and medicine distribution continues to be managed by the (COVID-19) Vigilant Committees (NigraniSamiti).Over 1.41 health teams with over four lakh members of 60,000 surveillance committees are working to ensure that every Uttar Pradesh home is visited, every locality is cleaned and every individual is screened. This will be followed by identification of the potential COVID-19 infection among local communitiesand those infected will beadmitted to medical facilities. With misinformation and rumours on the rise, this is a gargantuan task in remote areas with low access to healthcare, education and awareness. A total of 1.5 lakh medical have already been distributed so far to those living in isolation/ quarantine. Beginning from the 5th of May, the teams started traveling through UP’s 97,941 villages in 75 districts over the course of 5 days. The UP government is said to have stationed 141,610 teams and 21,242 supervisors to carry out the task of testing citizens in rural India with the help of Rapid Antigen Test (RAT) kits.
By creating a capacity of almost 100000 beds in hospitals, and tripling the oxygen supply – from 350 MT earlier to 1050 MT the state has also been able to lower the total number of reported active cases in the state by over 1,06,000since the beginning of May. As the reported cases saw a decline beginning May with the number of cases coming down by over one lakh since May 1 the positivity rate has also lowered while (to below 10) while the recovery rate continues to ascend.
Tracking–testing–tracing– treating have remained central to the Uttar Pradesh model as it tackles the second wave of COVID-19 with vaccination being the exit strategy that the government aims to carry out over the coming months on war footing – the state has committed to vaccinate its residents free of cost.UP is also the first state to look for international suppliers of the COVID-19 vaccine and has took out a global tender for the purchase.
Reportedly 1563235 people are so far affected in Uttar Pradesh by novel coronavirus COVID-19. 1340251 out of 1563235 have recovered.
While the pandemic has posed the most critical public health challenge of our times,economic challenges also continue to shape political priorities. Unlike Maharashtra and Delhi, UP has imposed a partial curfew across the state, allowing some essential businesses and industry activities to continue in shifts. Uttar Pradesh Chief Minister has adopted the ‘Jeevan Bhi, JeevikaBhi’ philosophy (life as well as earning of living) for each and every citizen of the state. The curfew was implemented on April 29, and remains operative till 7 am on May 17.

The Mumbai Model: Infrastructure
Maharashtra was one of the first and worst hit by the second wave with a 6.3% mortality rate, which was twice the national average of 2.8%. The state accounted for 20% of India’s total case count and 43% of its death toll before even hitting its peak (Yadavar 2021). At the wave’s zenith, on 24th April 2021, the state recorded nearly 67,000 new cases with 16,25,771 tests taken in total.
In response, the Maharashtra government imposed a hard lockdown on the 22nd of April which was extended again. Although the full success of its strategies is yet to be seen, Prime Minister Narendra Modi praised Maharashtra Chief Minister Uddhav Thackeray›s handling of the crisis. Even the Supreme Court hailed the «Mumbai Model». The Maharashtrian paradigm centres around one main thing, healthcare infrastructure.
Bose (2021) reports that Maharashtra, having learnt from the last wave›s resource crunch, increased its COVID-19 centres from 2,665 to 5,595 and hospital beds from 3,36,384 to 4,31,902. The state boosted its oxygen-producing capacity to 1,270 Metric Tonnes [MT], to get closer to the state demand of 1,615 MT.
The Delhi Model
In contrast to Maharashtra, Delhi had almost the same number of active cases but requested nearly triple the amount of oxygen as Mumbai. At its peak, 23rd April 2021, Delhi reported 24,331 new cases in one day with 15,67,004 tests taken in total and by some estimates a death every four minutes (at the peak of the second wave).
However, during the first wave in 2020, Delhi initially emerged as a success story. The city of 1.9 crore people only recorded 8,593 cases at its worst. Delhi’s Chief Minister, Arvind Kejriwal, maintained that the city’s model owed its success to high rates of testing. At one point, Delhi had the highest national testing rate. For every 819 tests done per million, the union territory carried out 3,000 tests (Goswami 2021). Much of Delhi’s triumph would not have been possible without rapid testing. Chief Minister Kejriwal pointed out that no other state or country had, at that point in time, tested 10% of its collective population.
Conducting a higher number of tests emerged as one of the clearest ways of battling COVID-19. More tests allow for more accurate data thereby enabling the authorities to efficiently contact trace, implement quarantine, provide resources, and stop the spread of the virus. Tests also decrease the likelihood of super spreader events by detecting the virus early, even in asymptomatic carriers, and restricting an infected person›s access to others.
Although a high testing rate was one of the clearest reasons behind Delhi›s initialvictory against the virus, up until the last two months, testing, or the lack thereof, may also be the reason behind the state›s current 18% positivity rate. Delhi›s RT-PCR testing has declined from 99,230 on 17 April 2021 to an average of approximately 45,000 per day over the past week. The decline in testing combined with the problem of false negatives and the mutating strains of the virus has led to the region currently depending on a hard lockdown approach in its fight against the disease.

Conclusion
All three states, especially their citizens, have shown unmatched resilience, unity and courage in braving the brutality of the second wave. Critical learning from all three states and timely government action on “Tracing, Testing and Treatment”, combined with a robust vaccine rollout underway, will be the answer to avoiding another devastating wave of the magnitude India is facing right now.
While all three states especially UP have begun to see success in arresting the COVID-19 reported statistics, the legacy of bad healthcare infrastructure, large population sizeand multiple other socio-economic challengescontinue to be critical levers in the current crisis.
Despite the colossal challenges at hand, the Uttar Pradesh government has adopted an agile and innovative approach to fight the second brutal wave of the COVID-19 pandemic in India – acknowledged both by the WHO as well as the NITI Aayog on social media.
The efforts of state government officials to build back betterdraws heavily on the personally lived experiences ofthe Team-9 taskforce (including Chief Minister Yogi Adityanath himself) with battling the virus. This has now been translated into the state’s action plans using expertise and infrastructure to reach underserved parts of the population as well as large urban clusters, while not leaving industrial development and the economy in a lurch. With over 43 million tests conducted already, the maximum in the country the efforts of the UP model appear to be most comprehensive, timely and could be replicated by other states in their efforts to flatten the curve this time around and save millions.

Research and information collation undertaken by Social and Political Research Foundation–a think tank based in New Delhi.