My apologies for RTing this forbes article earlier.
Except for the conclusion paragraph quoted below, rest can fully be skipped.
The author talked to 35 people and tried to play politics instead of actually coming up with policy options. https://twitter.com/oommen/status/1350812158276210690

Let’s be honest about what really transpired.
GoI was mostly not able to figure out what exactly was happening because the usual primary institution for support, WHO, was dancing to the tunes of China. Let’s never forget Tedros was communicating like he was the spokesperson of

Despite conflicting reports, GoI started with what seemed to be sensible option: quarantine all inbound travellers for 14-21 days. This is like an expected response once GoI knew it’s some kind of corona virus, most likely a SARS like virus.

Despite WHO claiming that Wuhan virus is not human transmissible, India had already cancelled all flights from China, and ran special flights to evacuate people from China.
It’s very important to note that pandemic in india didn’t come directly from China.

Entry of virus to India came mostly from travellers from the Gulf states(Kerala got a lot), Europe and even USA.

The pandemic was still pretty much controlled. There was already the well-tested Test-Trace-Isolate-Treat model implemented. This is the same response used by others.

The whole while GoI was battling with Wuhan virus, the administration was also battling with opposition in the parliament budget session.

During the whole time, NONE OF THE PARLIAMENTARIANS EVEN UTTERED A SINGLE WORD ABOUT WUHAN VIRUS PANDEMIC.

Let me repeat:

While Parliament was in session, none of the MPs uttered anything about the pandemic. No one asked in zero hour, how India is planning to deal with the upcoming pandemic that was already killing people in Italy.

NO MP ASKED FOR INCREASED HEALTH BUDGET.

Let me be absolutely clear again:
Not a single opposition MP talked about anything for the nation.

Instead what we apparently had was parliamentarians skipping the house. There was some tacit understanding to just get budget approved.

There was more about Kashmir and CAA.

I see a lot about complaining that lockdowns were unplanned, unnecessary.
There is now enough data (SAIR model by Prof Vidyasagar @stellensatz, et al) that already show that the lockdown was the right option.
Anyone saying it wasn’t should argue with data(and they won’t find it).

The most critical and repeated point about India’s handling of pandemic is the alleged internal migrant crisis.

Let me now clarify why i say “alleged”:
A crisis is when things go wrong. It’s not a crisis when someone forces things to go wrong. It’s then called SABOTAGE.

People say that India got a shocker due to lockdown.

Seriously ?

GoI was not the first to lockdown.
Many state governments including GoMah, had declared a lockdown prior to national lockdown.

While invoking NDMA and section 144, GoI had amply communicated that essential goods and services will be available.

Who manufactured the pandemic?

What was media’s role in it?

What was state governments’ role in it?

If you are an independent observer, you wouldn’t blame GoI for what happened.

What was the objective of the first lockdown.

A) break the chain. If enough care was taken, the chain should have broken in those 21 days. PM explicitly said it as the ideal outcome.

B) give enough time for states to build the required infrastructure to support.

All of us know that lockdown 1 wasn’t properly enforced. We had too many “heroes” roaming around, many without masks.
We had too many “VIPs” who broke quarantine and jeopardised the life of others.

We had many states that didn’t do anything to shore up resources.

State government babudom was more intent on controlling the private doctors,viewing them as bloodsucking opportunists, instead of including the private medical infrastructure as part of pandemic response. Anyone who knows indian medical infrastructure knows that private is larger

Despite calls by medical professionals like @amitsurg to include private sector in the pandemic response, even big states with poor medical infrastructure ignored these sensible suggestions.
Private labs were not initially allowed to do testing for covid, even ones like NIMHANS.

India already had a lot of BSL 3 labs in private sector which were consciously avoided.
In fact, the babus were more interested in punishing doctors than in including them.
Only when government hospitals failed, private hospitals were “hauled” as heros and included in the fight.

India had serious shortcomings and these got resolved, or started to get resolved in the initial lockdown.
We imported all our PPEs, ventilators, or adequate oxygen supply.
When the need arose, everyone put their hands up.
Now india has more than enough N95 masks, PPE kits.

For us, the pandemic was an evolving situation. After our educational institutions did their best to kickstart ventilator companies, we found out that patients don’t exactly need oxygen. A respirator was enough.

But, a nation that had abysmally low number of ventilators, got it!

Now, let’s come to lockdown 2.
Who demanded lockdown 2?
All states.
Why?
Because they spent 21 days of lockdown 1 to find ways to blame the centre. They found themselves grossly inadequate only when local media made wuhan virus as the main story.

So, what exactly did state governments do after they demanded lockdown 2.
Of course, some states started building infrastructure.
Railways(thanks to @PiyushGoyal) converted rakes to Medical facility.

How many states actually used those medical rakes?
Essentially none.

Next, let’s cone to the “migrant crisis”.
Sabotage was written all over it from the very first day.
Who was responsible for smooth migrations? It was the states. How many actually made provisions for it:
States like UP, MP, Bihar.
All happened to be large migrant states.

But we had the likes of @bdutt(sorry, i have to call a spade a spade) who were more interested to see BJP-nonBJP here. They tried their best to first instigate a panic. All poor workers who were already stressed due to the inherent uncertainty, got panicked.

Then the “enlightened media” and opposition parties did everything in their power to ensure there was enough panic and a “migrant crisis”.

No one demanded that those employers who didn’t pay salary or landlords who demanded rent during that period were questioned.

Not even a namesake interview of job givers.

Meanwhile, we had enough sources in SM( @ShefVaidya etc) who were repeatedly saying that MSMEs and large corporates were paying salary. Money was not the main problem.
Most people trying to go back home were driven by boredom/stress.

“One nation one ration” was not announced during the pandemic. Late @iramvilaspaswan had already announced it and some states had already joined it. But, how many journalists asked other states to immediately join it? None.
We still have WB who haven’t joined it.

GoI had already announced support for the poor and vulnerable by way of extra ration, and free rations.
Already sufficient money was pumped in to support the lower two quintiles.
When Mr Pai writes in forbes about lack of GoI support, i can only laugh at his ignorance.

Let’s not forget about the Kerala model hype.
To be fair, kerala has structurally the best health infrastructure in the country. The only side it lacks is in testing facility. GoKer has been sending samples to Karnataka every year during the dengue, chickengunya, rat fever season

Meanwhile, we had something amazing happening.
A whole group of volunteers came together to built @covid19indiaorg. This is unique.
This was the first time common citizens from throughout the nation cane together for a common cause: get covid data straight.

Meanwhile, GoI did the best for proper communication.
The daily covid updates in the centre was done by experts, and not politicians. (Many state CMs used the opportunity to increase their media time.)
We had, for the first time, seen the use of powerpoints in pressers.

The ugly indian media started doing their mischief again. They started hyping things up because they wanted to show how high the total cases count was.
No one bothered to highlight that the active cases were diverging fast from total cases. In fact,active cases were half of total

That’s when GoI came up with the hack called “Recovery rate”.
Let’s be very honest. Recovery rate is perhaps the worst possible meta parameters that our statisticians could have come up with.

But even with the negative publicity, it did its job to tone down panic.

Another thing that people found out:
Our lack of proper record keeping in things like births and deaths, despite a supreme court order and a GoI notification demanding all states to promptly register all births and deaths.
In fact, many states used the excuse of covid to stop it.

(If you didn’t notice it or you don’t remember it, it’s ok. Only people who were into number crunching were at the lack of data).

Even response in media to many states were frankly absurd.
The top-5 states in terms of contribution to covid count also happen to be the ones that were least in media focus. We had this funny thing going on about media in erring states focusing on other states. Not their CM.

Even now, the top-3 states in terms of active cases are not questioned by media. Not the national media. Not the state media. Not even the local leader of opposition.

Let’s be honest here: the apathy cuts across party lines.

Now let’s shift to policy.

Health is a state subject.
Health, unfortunately, is a state subject.

NDMA, for health hazards, is grossly inadequate.

As health is under state control, GoI practically couldn’t do anything except release frequent letters to the states. States, in their own wisdom, royally ignored it or misinterpreted to suit their convenience.

India’s healthcare spending had been pathetic even before the pandemic. (Check out @oomen in @orfonline)
Most states have empty PHCs. Many states survive only because of private medical infrastructure, many a times in their neighboring state.

Ideally, we should have seen all states to have significantly ramped up their health infrastructure.
Just count the number of new hospitals, new ICU wards that were created post-pandemic.
In every state, one hand is enough to count them. In many states, they are shutting it down

Let’s look at non-covid hospitals.
Again, far less is available.
Many small clinics haven’t yet started.
Reason: stupid state government policies with all those threatening letters to doctors who wanted to start their clinics and get back to making their ends meet.

NDMA can only tell states what to do.
There is no way for them to take actions at the micro level.
When there is a crisis of the scale of Wuhan virus pandemic, what we want is one person who calls all the shots, from national level to village level.

Unless we shift Healthcare from state list to concurrent list, there is no way NDMA can manage everything from such a level.

Another thing that our NDMA lacks: a health disaster expert.

We still don’t have an NDMA person who can handle a national health disaster.
We were using ICMR head instead.

I often talk about Indian exceptionalism.
It so happened that we had the right set of people at that time.

What does india lack:
Doctors
Nurses
Clinics
Hospitals
Medical colleges
Bio Safety labs.(only one top lab at Pune)
Medical equipment industry

What India has:
Dedicated medical fraternity, most in private space.
A very vibrant pharma industry
Worlds top vaccine manufacturers.
World’s best vaccination programs.

What we needed like yesterday:
More medical colleges.
Good faculty in medical colleges.
Dumping unnecessary rules like a govt doctor can’t also do private practice and vice versa.
Cutting cost of medical education in real terms.
Raw material/API manufacturing

What more do we need now:
National medical insurance. (We have an Arogya Sanjeevani, but it’s not universal and people are still getting rejected in it).
A national medical insurance grid that ensures all hospitals have cashless facility.
More medical colleges(GoI announced it)

What we need now(contd):
A national health card that stores full medical history. (Ideally, this should be integrated with aadhar).
A national Council of Health Ministers(like GST Council)
A national Health Infrastructure Development Bank.

I hope economists like @bibekdebroy @sanjeevsanyal push for the Health Infrastructure Development Bank.
We can’t build the Health infrastructure and support system we want by only using budgeted amount. We simply can’t afford to pay for it from consolidated funds.
(contd)

What we want is the HIDB that can get cheap bonds(sovereign backed), probably tax-free and some extra exemptions, that can borrow money from the markets. We can also ask medical insurance units to park some of the premiums in it. We can allow pharma/API cos to use it.

Essentially, make the HIDB self-sustainable with enough scope of market borrowing, corporate lending and deposits so that we can then fund building hospitals, medical colleges, Biosafety labs, research institutes, PLI for companies, operating National Health cards, etc

The other thing that we want:
A solid medical data resource

Whenever a pandemic happens, we are mostly in the dark. We need a central repository that automatically takes medical data from all parts of the world, from a simple fever to rare genetic diseases.

The body can take care of patient information anonymisation.
Some research that need non-anonymous data or partially anonymous data can always be done in-house then.
We can then have a national medical dashboard so that all Indians can see health status of india (like vidyut app)

To summarise in a tweet:
Bring Health to Concurrent list.
Start a new Health Infrastructure Development Bank to fund all shortcomings.
Bring National Health Cards.
Ensure universal cashless medical insurance
Build a central medical repository.
Look outside Budget.

@UnrollThread please unroll. Thank you.