The big vaccine hack🕴️

And with it come the exclusions

This is edition 276 of Beyond The First Order, a premium daily newsletter that demystifies the hidden models, incentives and consequences of the most significant events across India and Southeast Asia

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Good morning,

As the second wave of Covid-19 washes over us, it’s teaching newer lessons, but ones that involve several Catch-22s. The IPL finally gets a dose of reality. India’s geeks unite to find a way to get that vaccine jab, but as with all things Covid, it creates a greater divide between the haves and have nots. 

Hacking your way to a vaccine

A Pew Research survey in 2018 said that only 24% of India owned a smartphone. 

Still, when the pandemic first struck India, the solution to contact trace was an app—Aarogya Setu—which came with its own set surveillance and privacy issues. Obviously, it worked only on smartphones.

That was exclusion number one.

On 1 May, India opened up vaccination to adults aged 18 and above. Everyone wanted that first jab, myself included. But the CoWin website, used for scheduling vaccine appointments, was down and India’s favourite user authentication method, One Time Passwords (OTPs), was not functional either. 

Gaurav Sabnis, as Associate Professor of Marketing at the Stevens Institute of Technology in the United States, tweeted about this OTP ‘system’ yesterday.

The same Pew Research quoted earlier pointed out that only 64% of India even owned a mobile phone. And only 36% of India’s population has internet access, as per the India Internet 2019 report by the Internet and Mobile Association of India and the market research company Nielsen. 

That was exclusion number two.

With it being impossible to find available slots for vaccinating those in the age group of 18-44, the National Health Authority (NHA), the nodal agency managing the CoWin platform, opened up its APIs to the public.

An open API refers to a publicly available application programming interface (API) that provides developers access to a proprietary software application. For instance, you have a Google Maps API that integrates with food delivery or travel portal, or the UPI API used by a range of apps to enable easy payments.

In this case, the NHA has allowed anyone to access a set of requirements needed to communicate and interact with the CoWin platform. This has enabled developers to build third-party tools that allow users to set alerts for slot availabilities according to various parameters. People can use these third-party tools to enter their details and they will get an alert whenever a slot opens up.

This has become the only way to get a vaccine appointment (it does not guarantee stock of vaccines, though) and plenty of trackers have already mushroomed. As my colleague Praveen, who writes the Saturday newsletter The Nutgraf, tweeted:

And that was exclusion number three.

Yesterday afternoon, I joined a group on Telegram that pulls up the open slots for vaccines via the open API. Within two hours of my joining, the number of members had doubled. By the time this lands in your inbox tomorrow, I’m guessing it would have doubled again. This is just a subset of that 24%. 

As the country faces an acute vaccine shortage until July, the divide between the haves and have nots keeps worsening. The fact that it has come down to this, for getting access to what is supposed to be a universal right, is a problem of epic proportions. 

The ingenuity of India’s software geeks notwithstanding, it was the government’s job to ensure that it didn’t have to come down to this.

What does the rest of India have to do to get a vaccine?

Covid and Catch-22s

I write from the nation’s capital, Delhi, which has been decimated by the second wave of Covid-19. The biggest fallout of this is undoubtedly the lack of oxygen supply to critically-ill patients. Hospitals are constantly short on oxygen supply, plasma, medicines, and every day is a new battle to keep patients alive. By several accounts, many of these lives could have been saved, had our healthcare infrastructure not snapped under pressure.

But hospitals may just be the tip of the iceberg. India recorded a total of 392,000 positive cases on Saturday. Not all, or most cases, are severe. But the second wave has taught us two very hard lessons about itself:

  1. It’s spreading faster than the first wave
  2. It’s disproportionately attacking the lungs, with more patients relying on oxygen than in the first wave

Combine these qualitative factors with the sheer number of people now battling Covid at home, and we’ve built ourselves a ticking time bomb. For almost two weeks, India has been recording over 300,000 cases every day. By several accounts, these are likely 3-5 times fewer than the actual number of cases. Also, people getting infected today are only going to show symptoms after 7-10 days—with slowed down or “curbed” testing, this wave is likely to rage longer and burn through the population faster.

Caring for a severely ill Covid patient at home, even in the most well-resourced metro cities, is a daily and cruel grind. Most of us, by now, have experienced the sheer run around for oxygen refills, medicines and cylinders. And that’s just management. Recovery is a whole other issue. 

But the crunch on resources means that most care-givers are stuck in an endless Catch-22—can’t take the patient to overflowing hospitals, which in turn will absorb the maximum allocation of resources. 

Delhi’s oxygen supply was increased from 490 metric tonnes to 590 metric tonnes a day last week, after a contentious battle between the state government, affected hospitals and the Centre. The move came after the central government faced pressure to turn the tap on. But what about places off the political map? Especially in smaller towns and rural areas, where testing is scant and patients mostly have to recover at home? The real, on-ground number might elude us:

If anybody can say that this is nothing except Covid-19, it should be labelled as a suspected case. In chikungunya, we had two levels of definition: suspected and confirmed. So for Covid-19, two or even three levels of definition – probable case, suspected case and confirmed case – are needed. Probable means not a doctor but a health worker confirms the case.

Suspected is when the doctor sees and confirms in a pro-clinical diagnosis and confirmed is with laboratory diagnosis. Somehow we have missed this whole spectrum of Covid-19 cases and that is why many people who may be positive are missed, especially in rural areas. Sometimes the rural samples have to go to the next district to get tested. And of course, there are asymptomatic cases.

The next few months are going to be a unique opportunity to ramp up a healthcare-at-home plan. While various central agencies have already released guidelines for home care for mild to moderate cases, the demand for critical care is going to increase. 

This means that instead of caregivers stringing together a list of WhatsApp numbers, nursing services and essential medicines, a public or private system (yes, we love that word now) to disseminate appropriate care at the local level, even if hospitals are still struggling with admissions. The state of Kerala, for instance, is trying to put a local strategy in place, by inviting trained medical volunteers like nurses, pharmacists and physiotherapists, among others, to keep track of patients at home. 

With every wave, we learn something new about Covid. The first wave was about the rigour of mask wearing and social distancing. The second wave’s lessons are clear—care needs to be local, disaggregated and, most of all, immediate.

The IPL, Covid, and futile expectations

Finally, it took a breach of the biosecure bubble for the Indian Premier League (IPL) train to halt in its tracks, even if briefly.

Reports emerged on Monday that five people, including players and staff, across two IPL teams have tested positive for the virus. One match has been postponed, but it seems like the popular cricket tournament will go ahead. For now. 

It’s been a whirlwind week for the IPL, and I’m not talking about the on-field action. The record-breaking second Covid wave in India has resulted in a full-blown humanitarian crisis, with a severe shortage of medical oxygen, hospital beds, and vaccine doses.

But even as funeral pyres clouded the skies, the IPL matches went on, sometimes just metres away from overflowing hospitals and crematoriums, sparking debates. One side argued that the entertainment was a welcome distraction, while others said the tournament must end immediately. 

After all, there was some precedent. 

When World War I broke out in 1914, the English Football Association offered to abandon soccer and hand over clubs' stadiums for the government to use for whatever purposes it chose. But the War Office said that was not necessary, so the clubs blithely played on.

At least the English FA offered to stop. The IPL, which is worth US$6.7 billion, carried on, seemingly without batting an eyelid. There are dozens of cricket stadiums across the country that aren’t being used for IPL matches, which could double up as makeshift hospitals. 

Indian cricketers have also largely remained silent, even though there was no pause on social media posts about their matches and endorsements. Just two months ago, the same cricketers had tweeted about the farmer protests in India and toed the government’s line. Four years ago, when the Indian government rendered 86% of currency worthless to wipe out unaccounted wealth but ended up wiping out at least 1% from the country’s GDP, along with over a million jobs, Indian cricket captain Virat Kohli called it “the greatest move” in Indian political history. The same man was largely silent about Covid, even as his counterpart from Pakistan, which Indians love to hate, tweeted his support.

It took the actions of an Australian cricketer, Pat Cummins, for the IPL to acknowledge the Covid crisis. On 26 April, Cummins donated US$50,000 “specifically to purchase oxygen supplies for India’s hospitals”. It was the first semblance of humanity that had emerged from the IPL bubble.

Cummins’ gesture fortunately opened the floodgates, as cricketers and franchises all took a cue and started announcing donations, which continue to the day. But one can’t help but wonder why they couldn’t have thought of this earlier. 

There’s no disputing that the IPL is a means of livelihood for thousands of people apart from cricketers, and the revenue it generates benefits the grassroots. But you’d expect more from the Board of Control for Cricket in India (BCCI), one of the richest sports governing bodies in the world, than just an email reassuring players of their safety and telling them that they’re playing “for humanity”. Especially just months after inaugurating the world’s largest cricket stadium, which cost US$110 million to build. The Narendra Modi Stadium, named after India’s prime minister, will host the IPL final.

Those who defend Indian cricketers say they are gagged by the all-powerful BCCI, whose current secretary, Jay Shah, is the son of India’s home minister, Amit Shah. But they only need to look towards the United States, where sportspersons have taken political stands for years and spoken out against the president on countless occasions. 

Last August, when the National Basketball Association (NBA) in the US had set up a US$180 million bio bubble, George Hill urged his Milwaukee Bucks teammates to boycott their match after the police shooting of a Black man, Jacob Blake, in Wisconsin. 

George Hill is no Virat Kohli equivalent in the world of basketball. Nowhere near. But his move “inspired one of the broadest political statements across sports leagues that the United States had ever seen: walkouts involving hundreds of athletes in professional men’s and women’s basketball, baseball and soccer, as well as one of the world’s biggest tennis stars,” reported the New York Times

The protests even led to a rebuke from then US President Donald Trump. Not that anyone cared.

India, however, is a country where demigod cricketers are given parliament seats and face no repercussions even with attendance as low as 7%. Perhaps it is futile to have similar expectations.

That’s a wrap for today.

Don’t forget to write in with your thoughts and observations on how this pandemic is reshaping businesses, societies, and economies. We will be back tomorrow.

Stay safe,
Arundhati
[email protected]

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