184th AGM Bombay Chamber of Commerce and Industry Guest of Honor Dr. Swati Piramal Vice Chairperson, Piramal Group

1. Dr. Swati Piramal
Vice Chairperson, Piramal Group
Bombay Chamber of Commerce and Industry
Revisiting Global Healthcare
in a COVID & Post COVID World

2. Pandemic 1918

3. India is
Rebooting
Again!

5. Covid-19 virus can make people
infectious before they develop
symptoms of illness. Studies now
consistently indicate that:
• Infectivity starts before
symptoms do
• It peaks right around the day that
they start
• It declines substantially by five
days or so.

7. Differentiator for Success:
Good Leadership

9. Waves of the virus

10. Regimen for Re-Opening
• Mass General Brigham: 75k doctors had few workplace transmissions - Atul Gawande
Strategy for Success: 4 Pillars
1. Hygiene
2. Distancing
3. Screening
4. Masks
Will not return us to normal life, but when
signs indicate that the virus is under
control, they could get people out of their
homes and moving again.
5th Element to Success: Culture.
It’s one thing to know what we should be
doing; it’s another to do it, rigorously and
thoroughly.

11. Five Part
Public
Health Plan
Fighting the virus with a
durable, five-part public-health
plan is the greatest challenge
I can imagine. It’s also a
fundamental moral imperative
for our generation.

12. • Hygiene measures
• Screening
• Distancing
• Masks
• Culture
• Skip one, and the treatment won’t work. But, when taken together, and
taken seriously, they shut down the virus. We need to understand these
elements properly—what their strengths and limitations are—if we’re
going to make them work outside health care.
Five Part
Plan

14. Start with Hygiene.
• People have learned that cleaning your hands is essential to stopping the
transfer of infectious droplets from surfaces to your nose, mouth, and eyes.
But frequency makes a bigger difference than many realize.
• A study conducted at a military boot camp found that a top-down program
of hand washing 5 times a day cut medical visits for respiratory infections
by 45%.
• Research on the 2002 SARS Coronavirus outbreak found that washing hands
more than 10 times a day reduced people’s infection rate by even more.
• The key is washing or sanitizing your hands every time you go into and out
of a group environment, and every couple of hours while you’re in it, plus
disinfecting high-touch surfaces at least daily.
Stop
the chain

15. Social Distancing
• SARS-CoV-2, the virus that causes COVID-19,
spreads primarily through respiratory droplets
emitted by infected people when they cough,
sneeze, talk, or simply exhale; the droplets are
then breathed in by others. (Loud talking has
been shown to generate measurably more
droplets than quieter talking.)
• We have all now learned the six-foot rule to
prevent transmission of contagion-containing
droplets.
• Elevators and work stations.

16. Auditoriums and closed spaces.
• Take, for instance, the now infamous
Skagit Valley Chorale practice, on March
10th, at a church in Washington State. It
was pre-lockdown, but there’d been
enough coronavirus news to lead the
group to suspend the usual hugs and
handshakes and to sit farther apart than
usual. According to choir members who
were present, no one seemed ill at the
start of the rehearsal. No one coughed.
The singing was as powerful as ever. And
that may have been the problem. There
was an index patient who had been
experiencing cold-like symptoms for three
days, which worsened after the rehearsal
and led to a diagnosis of COVID-19.
According to an investigation by the Skagit
County Public Health department, fifty-
two of the sixty other choir members in
attendance subsequently fell ill. Thirty-two
choir members tested positive for COVID-
19. Two died.

17. Masks
• Overwhelming evidence of the benefits of mandatory masks.
• Combine distancing with masks. They provide “source control”—blocking the spread of
respiratory droplets from a person with active, but perhaps unrecognized, infection.
• So how effective are surgical masks?
– A study published in Nature last month shows that, if worn properly and with the
right fit, surgical masks are effective at blocking ninety-nine per cent of the
respiratory droplets expelled by people with coronaviruses or influenza viruses.
– The material of a double-layered cotton mask—the kind many people have been
making at home—can block droplet emissions as well.
– And the SARS-CoV-2 virus does not last long on cloth; viral counts drop ninety-nine
per cent in three hours.

18. N95 Masks N95 respirators:
• Masks specifically designed not only to protect others
but also protect the wearer from infection
• Masks designed to fit tightly around the nose and
mouth, so that the air you breathe comes entirely
through the mask, not around it.
• They use a filter material with a higher electrostatic
charge that blocks at least 95% of airborne particles as
small as 0.3 microns.
• Used for healthcare workers.

20. Changing Culture
• Culture : 5th and arguably the most difficult pillar of a
new combination therapy to stop the coronavirus.
• People tend to focus on two desires: Safety and
Freedom; keep me safe and leave me alone.
• In contrast : Culture of the operating room. It’s about
wanting never to be the one to make someone
else sick.

21. Drug
treatments

22. Within hours of a viral invasion, the body’s immune system swings into action. The “innate” immune system,
which recognizes protein structures common to many pathogens, reacts first, by releasing a family of
chemical distress signals called cytokines. They spread from the site of the infection, instructing the body to
raise its temperature and divert blood flow to the affected area; they also activate other immune-system
cells, which begin developing antibodies specifically targeting the invaders. Without cytokines, the immune
system would slumber while infections wreak havoc. But the cytokine system has a weakness. Some
pathogens can provoke it in a perverse way, so that it goads the immune system as a whole into overdrive. In
what’s known as a cytokine storm, fever and inflammation spike out of control
The
Cytokine
Storm

23. The World Health Organization (WHO) welcomes the initial clinical
trial results from the United Kingdom (UK) that show
dexamethasone, a corticosteroid, can be lifesaving for patients who
are critically ill with COVID-19. For patients on ventilators, the
treatment was shown to reduce mortality by about one third, and for
patients requiring only oxygen, mortality was cut by about one fifth,
according to preliminary findings shared with WHO.
The benefit was only seen in patients seriously ill with COVID-19, and
was not observed in patients with milder disease.
“This is the first treatment to be shown to reduce mortality in
patients with COVID-19 requiring oxygen or ventilator support,” said
Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This is
great news and I congratulate the Government of the UK, the
University of Oxford, and the many hospitals and patients in the UK
who have contributed to this lifesaving scientific breakthrough.”
WHO welcomes preliminary results about
dexamethasone use in treating critically ill
COVID-19 patients

24. Favipirir
An influenza drugs
Got approval
As well as
Remdesivir

25. Reopening Wuhan- five weapons
• And so the health officials in Wuhan adopted a more aggressive
approach. They began widespread testing, finding the people who
were infected. They found out whom those people had been with,
got in touch with those individuals, and tested them. They
quarantined people who they thought might have the virus and
hospitalized those who were sick. And they scaled up their health-
care system, building more than a dozen new hospitals dedicated to
treating patients in the early stages of coronavirus infection. Five
elements, five weapons: social distancing, contact tracing, testing,
isolation, and treatment. After Wuhan began using these weapons
simultaneously, the transmission rate dropped again, to the point
where any single case led to less than one more. Once that
happens, an epidemic dies.

26. Zoonoses-predict
and survive.
Domestication of animals
More than 100 diseases
Swine flu. Bird flu

27. Mental health and migrant crisis –two diverse problems

28. Lessons from history
Democracy ordictatorship

29. 4 CRISIS OF Covid 19
Health Crisis
Moral Crisis
Financial Crisis
Leadership Crisis
President of Harvard
University
Larry Bacow

30. Innovations in Design,
Urban Planning &
Architecture

31. New way of making pickles
New
Ways of
Working

32. Under-Investment in Healthcare
Features of Healthcare Sector in India
• India accounts for more than 20% of global maternal and child deaths; and Highest maternal death toll in the world
estimated at 138,000.
• United Nations calculations show that India’s spending on public health provision, as a share of GDP is the 18th lowest in the
world.
• Access to medicines stands at less than 35% in many Indian states, with important medicines unavailable in both public &
private pharmacies
• Excessive pressure of patients on the hospitals :
~600 district hospitals in India; On an average 1500 patients visit these hospitals daily.
• Development of healthcare services in India is clearly biased in favour of urban areas. There are 2.2 beds per 1000 persons
in urban areas as against only 0.19% beds per 1000 persons in rural areas.
• 75% of the medical consultants are concentrated in the urban areas while remaining 25% are in semi-urban and rural areas.
• Infant mortality rate for India in 2019 was 30.9 deaths per 1000 live births, a 3.36% decline from 2018.
• India's Maternal Mortality Ratio (MMR) has seen a decline from 130 per 1 lakh live births in 2014-2016 to 122 per 1 lakh
live births in 2015-2017
• Anaemia :
– 79% of the children between the age of 6-35 months, and more than 50% of women are anaemic
– 40% of the maternal deaths during pregnancy and child-birth relate to anaemia and under-nutrition.

33. Private Health Sector:
• At the time of Independence only about 8% of all qualified modern medical care was provided by the
private sector.
• Over the years, the share of the private sector in the provision of health care has about 80% of all
outpatient care and about 60% of all in-patient care.
• Dominant presence in all the submarkets – medical education and training, medical technology and
diagnostics, pharmaceutical manufacture and sale, hospital construction and ancillary services and,
finally, the provisioning of medical care.
• Over 75% of the human resources and advanced medical technology, 68 % of an estimated 15,097
hospitals and 37% of 623,819 total beds in the country are in the private sector. Of these most are
located in urban areas.
Today, the private sector provides almost 75% of health services in India (NRHM, 2005-12).
Lockdown Shut Private Healthcare

42. Lower transmission
after lockdown

43. Piramal Foundation
• Public-Private Partnership (PPP) Model : works with various Governments (Central & State) to create impact
in Aspirational Districts & the remotest parts of the country through its 3 initiatives:
Piramal Swasthya
Primary healthcare
and nutrition
Piramal School of Leadership
Education leadership, youth
and women empowerment
Piramal Sarvajal
Access to safe
drinking water
43

45. 45
Health Advisory & Outreach Programs:
• 104 Health Helpline in Partnership with 8 State Govts.: Bridge between the Govt. & communities:
o Attended to 1.8Mn calls

46. 46
ASARA Tribal Health Program: Araku Valley, Andhra Pradesh:
• Tracks pregnant women in remote areas to capture high risk or
COVID-19 symptoms
• Provides safe transportation to expecting mothers to the nearest
healthcare centers
Sanjeevani - Village Health
Outreach Program in Assam:
• Screening and COVID-19 case tracking
through paramedics

47. NITI Aayog partners with Piramal Foundation to launch ‘Surakshit Dada-Dadi Nana-Nani Abhiyaan’
(SDDNNA) across 112 Aspirational Districts:
• Virtual campaign to safeguard senior citizens for early
detection & tracking of Covid-19 symptoms
• Tagline: ‘Apne Saath Apno Ka Dhyaan’
• Volunteers: ~35,000

48. Piramal School of Leadership 48
NITI Aayog’s SATH-E Program in partnership with Piramal School of Leadership (PSL) & Boston
Consulting Group (BCG):
• During the lockdown, enabled students in Govt. schools to continue their education via online, television and radio
platforms in Jharkhand and Madhya Pradesh, during the lockdown
SATH-E: Children learning via mobile & radio
during the lockdown

50. 50
Access to Safe Drinking Water in Urban Slums & Rural Areas
• Benefits ~6 lac people daily via contactless smartcard water ATMs for safe drinking water
Social Distancing Measures Extensive Sanitization Drives

51. Reboot
after Corona

52. Piramal Group 52
Piramal Group: Supports Government efforts to fight the Pandemic
• Classified as essential services and critical manufacturing, our Pharma and Glass manufacturing facilities
globally, have been operational throughout the lockdown
• Actively supports the Govt. of Maharashtra, along with like-minded corporates,
NGOs and philanthropists to:
o Channelize resources for effective utilization of existing hospitals and to create isolation facilities
o Ensure availability of critical hospital supplies : medicines, equipment, ventilators
o Distribute fresh cooked daily meals, food grains, pulses and hygiene kits in the slums of Mumbai

53. Thank You