States' response

Caught in a lockdown

Print edition : April 24, 2020

Health department personnel at an apartment where a person was found infected, in Thane on April 2. Photo: Vibhav Birwatkar

People waiting to receive free grain from a ration shop in Ahmedabad on April 1. Photo: AMIT DAVE/REUTERS

Lockdown violators forced to clean a street in Kalaburagi on March 26. Photo: ARUN KULKARNI

Shangshak village in Manipur wears a deserted look on March 22. Photo: Yirmiyan Arthur/AP

The road outside the generally busy CST terminus in Mumbai on March 22. Photo: Prashant Nakwe

The farmers’ market functioning from the Central Bus Stand in Tiruchi on March 28. Photo: M. Moorthy

Reports from some States show how governments responded to the health crisis and people’s livelihoods and how businesses coped during the three-week nationwide shutdown.

Growing apprehension

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You can hear and smell the fire brigade truck before it appears. The announcements over a loudspeaker warn pedestrians to cover their faces or move into building entrances. It smells like a swimming pool zone; only that the odour is stronger because of the pure chlorine being sprayed into the air. High fountains of spray gush out of a pressure hose as a man in full protective clothing walks down the centre of the street fanning the hose from side to side.

This disinfecting procedure, or sanitising, started in south Mumbai after a scare that three persons had tested positive for COVID-19 in the slum colonies of Colaba. While that was dismissed as a rumour, it seemed to be enough for the Brihanmumbai Municipal Corporation (BMC) to begin the daily chlorine spray.

But does public spraying of chlorine really help eradicate the virus? An article in National Geographic’s Science section titled “Why soap is preferable to bleach in the fight against coronavirus” by Sarah Gibbens offers an answer. “In countries hardest hit by the novel coronavirus, photos show crews in hazmat suits spraying bleach solutions along public sidewalks or inside office buildings. Experts are dubious, however, of whether that’s necessary to neutralise the spread of the coronavirus. Using bleach ‘is like using a bludgeon to swat a fly,’ says Jane Greatorex, a virologist at Cambridge University. It can also corrode metal and lead to other respiratory health problems if inhaled too much over time. ‘With bleach, if you put it on a surface with a lot of dirt, that [dirt] will eat up the bleach,’ says Lisa Casanova, an environmental health scientist at Georgia State University. She and other experts instead recommend using milder soaps, like dish soap, to easily sanitise a surface indoors and outdoors.”

Spike in cases

On March 13, the State government declared coronavirus an epidemic in Mumbai, Pune, Pimpri-Chinchwad and Nagpur. With the invocation of the Epidemic Diseases Act, 1897, the government had the right to forcibly hospitalise people with suspected symptoms. Instances of quarantined people running away resulted in the State rubber-stamping wrists of people placed under quarantine from airports and hospitals.

On March 17, the first case of death linked to the virus was reported in Mumbai. From March 18 all shops, except grocers and chemists, in major cities were shut. On March 20, Chief Minister Uddhav Thackeray said only essential services would function and public transport would be on skeletal services. Mumbai’s ionic local trains were at a complete standstill instantly. On March 22, Section 144 of the Code of Criminal Procedure (prohibiting the assembly of four or more people in an area) was imposed across Maharashtra, and the next day Thackeray announced the sealing of district borders.

The very first case of COVID-19 in the State was detected in Pune on March 9 on a couple who had returned from Dubai. The next day three more who had been in touch with them tested positive. Two days later, two Mumbai-based people, who also knew the Pune couple, tested positive.

By March 16 the State had 37 positive cases, which rose to 45 two days later and to 48 on March 19. By March 23 three people had died and the number of infected people was 97, with Mumbai leading the list. By March 25 the count of detected cases rose sharply to 122. By March 29 eight people had died.

On March 30, Maharashtra had 302 positive cases with the highest number in Mumbai. The district-wise break-up of positive cases was: 151 in Mumbai, 48 in Pune, 36 in Thane region, 25 in Sangli, 16 in Nagpur, eight in Ahmednagar, four in Yavatmal, three in Buldhana, two each in Satara and Kolhapur, and one each in Aurangabad, Sindhudurg, Ratnagiri, Gondia, Jalgaon and Nashik.

On April 1, Maharashtra had 335 confirmed cases of coronavirus. Of the increase, 30 were in Mumbai, two in Pune and one in Buldhana. The death toll rose to 16 after four patients died in Mumbai. Forty-two patients have recovered. Among the new cases, 12 were from the central Mumbai region of Prabhadevi in a chawl where a woman who had died from the virus. The 65-yeard-old had tested positive on March 24 and died three days later. She had no history of foreign travel or contact with any known affected person.

The BMC said that seven of the woman’s family members and five neighbours in the building had tested positive. All of them were admitted to the municipality’s Kasturba Gandhi Hospital which deals with infectious diseases.

Of further worry to the authorities was that the victim ran a mess service. One of her clients was a neighbouring business centre. The BMC has undertaken a cluster screening, but tracking down all those who have had any interaction with her is impossible because of the nature of her business. Sharad Ughade, Assistant Municipal Commissioner, G South ward, announced that those who ate at her mess should come forward to be tested. The sitting Shiv Sena corporator, Samadhan Sarvankar, said 180 residents had been screened for symptoms and they would be monitored for a fortnight.

On March 30, the detection of three cases in Worli Koliwada resulted in the sealing of the locality with 35,000 residents. The day before this, four cases had been detected, forcing the authorities to intensify a thread of contact tracing. The sealing of the locality and a nearby colony made it Mumbai’s first no-go zones. The area is Cabinet Minister of Tourism and Environment Aaditya Thackeray’s constituency and he tweeted: “Late last night 2 am onwards, Koliwada and Janata Colony have been sealed off. Disinfection and fumigation is on along with contact tracing.”.

By the evening of March 31 there were more cases. The BMC’s C ward, which is the heart of old Mumbai—heavily populated localities and with many chawls—announced that it was sealing off pedestrian and vehicular traffic on three arterial roads because “corona-affected patients [were detected] in two buildings”.

Later that evening, Rajashree Shirwadkar, Municipal Councillor for Ward 172 in the central zone of the city, acted responsibly by informing local residents saying, “We have 2 COVID19 positive cases in Sion.” She named the building societies and went on to assure the people that the whole area had been sanitised and necessary precautions taken and advised them to step out only if necessary.

On April 2, a man tested positive in Mumbai’s Dharavi slum. He had apparently attended the Tablighi Jamaat conference in Delhi. His family is in isolation and contact tracing is on, but it may be a futile exercise given that he travelled all the way from Delhi and that Dharavi residents lived in extremely cramped conditions.

When the first case was reported, Maharashtra had only one testing centre, at Kasturba Hospital. Within 20 days three more centres were set up, at Haffkine Institute, KEM Hospital and J.J. Hospital.

Health Minister Rajesh Tope said the Indian Council of Medical Research (ICMR) had so far approved starting 28 testing laboratories, including private ones. “We are following the 3T formula—trace, test and treat—in this challenging time,” said Tope. He said that all 15 medical college hospitals in the State would have laboratories to conduct swab tests by the end of March.

Testing is the first step in the strategy of identifying, isolating, tracing contacts and containing the spread. However, social fears of ostracism often stand in the way of testing and isolation. There have been cases of people being boycotted by neighbours and housing societies. For example, an IndiGo air hostess who was not detected with the virus said she was stigmatised just because her job involved travelling. In a heartbreaking viral video, she said shops refused to sell her mother groceries while she was away on flights.

Control room

In its initial stages, the Maharashtra government’s response to the situation was lauded. The generally held view was that the State government was performing well despite the hurdles people faced post-lockdown. At the very start, Uddhav Thackeray set up a special control room “to fight a battle with the pandemic” and put 11 senior bureaucrats in charge of it.

The shutting of district borders following the announcement of the 21-day lockdown was the start of a brief period of panic buying, black marketeering and hoarding for commercial Mumbai, which depends completely on the districts for supplies. “Trucks were loaded and waiting at district borders,” said Gordhandas Shah, a trader from the Vashi Agricultural Produce Market Committee (APMC). “But they were not allowed to cross.” The APMCs were finally reopened on March 27, but by then daily-wage labourers had left and, once again, fully loaded trucks waited while queues of panic buyers continued.

The cruelest blow of the lockdown was the impact on daily-wage earners, both local people and migrants. In a typical scenario of their lives in Mumbai, a “kholi”, or room, can be as small as six square feet, enough to store possessions and sleep outside. Physical distancing becomes a sick joke; living, cooking, sleeping, relaxing are all done cheek by jowl.

And then there is the rent which a non-earning daily-wage earner obviously cannot afford. With necessary ingenuity, migrants have found a way to minimise spending. They form a group of, say, 12 people and rent lodgings meant for six. Six will work a night shift and six a day shift, ensuring that only six use the room at a time. Furthermore, many migrants mostly eat from street food vendors. With these closed, their only option was to head home.

The State initially failed to notice this segment of the population, but once it did camps were set up to accommodate them. According to the government’s own statistics, about two lakh migrant workers have been affected by the lockdown—the figure is of those who tried to return to their home base. More than 80,000 of these are construction workers of which 50,000 are in Pune, 25,000 in Mumbai and 11,000 in Thane.

As many as 1,000 relief camps have been set up to accommodate them and they are being maintained by the Rs.45 crore sanctioned by the State. The State’s Shiv Bhojan thali, which was launched on January 26 in pre-coronavirus times, at Rs.10 for a full meal has now been brought down to Rs.5. As many as 25,000 thalis used to be served per day, but this has been upped to 1,00,000 now. The Chief Minister has said it will be increased if required. While the camps may see to their daily needs, there are no provisions made for their families in the villages who used to depend on money being sent regularly.

Contract workers have also faced rough weather. Dharampal Valmiki, a contract worker with a dairy products company, had a salary of Rs.20,000 and responsibilities that kept him close to his boss’ side. But this made no difference when it came to the crunch. Valmiki lost his job despite Maharashtra’s Labour Commissioner Mahendra Kalyankar issuing an advisory to public and private companies not to cut wages or retrench workers. This was backed up by Uddhav Thackeray’s public appeal on the same lines.

Despite the advisory, the law is partially on the employer’s side. The Industrial Disputes Act allows companies to temporarily suspend workmen during a “natural calamity” with 50 per cent wages for up to 45 days. Uddhav Thackeray has extended a helping hand to industry by cutting the electricity tariff by an average of 8 per cent for a period of five years.

The possibility of a continuing lockdown to slow down community spread of the virus has kept Mumbaikars in a state of tension, and there is growing apprehension that the Centre is shooting in the dark instead of formulating a strategic plan with advice from experts.

Many hotspots

 

Gujarat recorded 82 positive cases and six deaths by April 2 and Ahmedabad was declared one of the 10 COVID-19 hotspots in the country. Several of the reported cases were of people with no personal history of international travel but with histories of contact with people who travelled.

In a “preemptive and proactive” move, the State Health Ministry also declared Rajkot, Surat, Vadodara and Bhavnagar as COVID-19 hotspots. Gujarat Principal Health Secretary Jayanti Ravi said: “We took this step for districts that are reporting higher number of cases or showing signs of clustering. The hotspot classification does not necessarily mean increased testing, but that strategies such as cordoning off areas with high population densities and increased surveillance in areas with reported positive cases can be deployed.”

The State government, which was initially slow to react to the crisis, has now started an aggressive campaign that includes a door-to-door health survey for the entire population. Started a few days into the lockdown, the survey has apparently completed surveillance and tracking of 3.98 crore people in a population of 7.3 crore for fever or respiratory infection. The idea is to find undetected cases, which are expected to trigger an explosive outbreak, the Health Secretary said.

The State government has launched a smartphone app called SMC COVID-19 Tracker which every quarantined person is required to install in his/her phone. Once every hour, the quarantined person must punch a “send location” button so that the government is able to monitor his/her whereabouts. If they leave their homes, they will be moved to institutional quarantine.

As of March 31, 19,026 people were in quarantine in Gujarat, in both home and hospital isolation, said Jayanti Ravi. She said six medical colleges and two private laboratories now had testing facilities, with a combined capacity of about 1,000 tests daily. Four hospitals in Ahmedabad, Surat, Rajkot and Vadodara were equipped to treat COVID-19 cases and would be able to accommodate up to 2,200 patients.

There has been a lot of travel between Ahmedabad and cities in China in recent months following Chinese President XI Jinping’s visit last year. Gujarat also has a significant number of business travellers who visit from abroad. The Gujarati diaspora also keeps travelling back to their hometowns, especially during the winter. Resident Gujratis are also known to enjoy a fair amount of international leisure travel and move around in large tour groups. News reports from Gujarat reflect an assumption that the State is under-reporting cases. But the Health Ministry says the survey should reveal more data, which will be shared.

Some aspects of the State government’s aggressive COVID-19 campaign have not gone down very well. The State has decided to name the infected people and those in quarantine, and stickers have been pasted on the doors of people placed in house isolation. This is a purportedly precautionary measure, but local residents believe naming is shaming. Another controversial move has been deploying the Rapid Action Force and five companies of the State Reserve Police Force to implement the lockdown. Local residents say such heavy-handedness is unnecessary.

A professor from the Indian Institute of Managament, Ahmedabad, said: “During the first few days of the lockdown, we saw a policeman upturn a vegetable cart and beat the vendor. Not only was the physical hitting unacceptable, but the waste of food was pathetic, particularly at a time like this. I think the authorities need to be more empathetic. Force is not the solution.”

Gujarat has a significant number of migrant labourers who work in the agricultural sector, the numerous small and medium scale industries that the State is well known for, textiles and infrastructure projects. Ninety-three workers were arrested in Surat when 500 migrants took to the streets in protest against not being able to travel home. Migrants in Gujarat are largely from neighbouring Rajasthan, and many of them eventually started walking home.

“I know that people of the Godhariaya tribe, who make up 95 per cent of the construction labour force, were picked up by tempos sent from their villages,” said a Dakxin Chhara, film-maker and activist based in Ahmedabad. “It was the only way, even if it was not safe. They live on construction sites. Where would they have gone? More disease will spread if you leave people on the road.”

Divided Cabinet

The first person to die due to COVID-19 in India was in Kalaburagi in northern Karnataka. On March 10, a 76-year-old person who returned from Saudi Arabia passed away. His samples tested positive for the dreaded coronavirus a day after his death. At the time, there were unverified allegations that he was denied treatment in hospitals in Hyderabad where he had been taken for treatment and that he died on the way back to Kalaburagi in an ambulance. On the day P6, as the patient is now referred to in official notifications, died, there were only six COVID-19 cases in Karnataka. Since then, there has been an exponential increase in the number of cases in Karnataka. On April 3, the figure was 125, the sixth highest in the country after Maharashtra, Tamil Nadu, Kerala, Delhi and Andhra Pradesh.

B.S. Yediyurappa was the first Chief Minister in the country to declare a partial State lockdown. As part of this directive issued on March 14, congregations were forbidden. But the Chief Mnister also flouted his own directive when he participated in the massive wedding celebration of the daughter of a Member of the Legislative Council in Belagavi.

As the number of cases increased, Yediyurappa completely locked down the State on March 23. In spite of this precautionary measure, the number of COVID-19 positive cases in the State has continuously increased. There was a sudden spike in the numbers after the return of those who had participated in a Tablighi Jamaat gathering in Nizamuddin in Delhi. The northernmost district of Karnataka, Bidar, which had seen zero positive cases so far until then, suddenly had 10 cases, all linked to the Delhi congregation. Kalaburagi district, which was lauded for bringing the number of positive cases down to zero, thanks to a proactive district administration, suddenly saw a jump in numbers; there were five positive cases in the district, all linked to the returnees from Nizamuddin.

Bengaluru, which saw a significant number of returnees from the United States and European countries, has the largest number of positive cases—51 on April 3— followed by Mysuru, Dakshina Kannada and Uttara Kannada.

There have been two major criticisms of Karnataka’s response to the crisis. The first is that the State government has not provided adequate relief to the economically weaker sections. Vinay Sreenivasa, a lawyer working with the Alternative Law Forum in Bengaluru and the author of a report prepared in collaboration with several organisations on the living conditions of the marginalised during the lockdown, says: “The situation is dire among the working classes. Vulnerable communities are starving or on the verge of starvation. Daily wage earners are fast running through their meagre savings or borrowing small amounts of money at high interest rates, monthly wage earners are wracked by the anxiety that their employers may not pay them full salaries for the month. No assurances from the state or the employer is forthcoming.”

The report was based on a survey among agarbathi workers, Zomato/Swiggy and other app-based workers, conservancy workers, hospital workers, street vendors, auto-rickshaw drivers and residents of different slums.

The State government has announced supply of free meals at 260 Indira Canteens in the State, but this is highly inadequate. Sreenivasa said: “Cooked food through Indira canteens is not reaching all. The immediate need is to set up community kitchens involving street vendors. In addition to Indira Canteens, anganwadis and government schools must also become centres of food distribution.”

R. Kaleelumllah, a member of Swaraj Abhiyan, who works among migrant labourers in Bengaluru, said that the situation of the approximately 3.5 lakh migrant workers in the city was extremely distressing. “There are migrants here from West Bengal, Assam, Jharkhand, Bihar and Uttar Pradesh apart from rural parts of north Karnataka. They have somehow slipped through the net of relief being provided by the State government as many of them do not have ration cards and are completely dependent on support from non-governmental organisations, which is erratic,” he said.

A second criticism of the State government, particularly Yediyurappa, is that he is unable to resolve the serious differences that have arisen between the two Ministers in charge of handling the COVID-19 crisis in Karnataka. This is affecting policy formulation at the Vidhana Soudha as there is no single person heading the “COVID-19 Taskforce” in the State, for the responsibiity has been split between B. Sriramulu and K. Sudhakar.

Part of the blame for this state of affairs lies with Sriramulu who neglected to pay attention to the seriousness of the coronavirus crisis in early March as he was busy with his daughter’s wedding. In the meanwhile, Sudhakar, a medical doctor himself, emerged as the go to person to deal with the situation.

With Sriramulu missing, reporters turned to Sudhakar for updates on the COVID-19 situation in Karnataka initially. When Sriramulu eventually emerged, there was also a tussle between the two ministers on who would head the ‘COVID-19 Taskforce’ in the state with Yediyurappa finally dividing responsibility between the two Ministers.

While Sudhakar would be in charge of the situation in Bengaluru, Sriramulu would be in charge of the districts. With both the ministers insisting that there must be one person heading the taskforce for better co-ordination, things deteriorated to such an extent between the two ministers that both of them were giving contradictory information on the COVID-19 situation in Karnataka.

According to sources in the Health and Family Welfare Department, the Ministers are not even talking to each other at meetings with the Chief Minister to monitor the situation.

Realising that this was seriously affecting policy formulation, Yediyurappa has finally asked a third Minister, Suresh Kumar, the Minister of Primary and Secondary Education, to address the media on issues related to the novel coronavirus pandemic and has forbidden Sriramulu and Sudhakar from speaking to the media.

Delayed response

 

A government largely in denial, a seemingly complacent Health Minister and a health system that did not heed early warning signs put out worldwide meant that Tamil Nadu had not taken seriously the grave and present danger posed by the coronavirus infection until very late in March. On March 31, as many as 57 new positive cases were added to the 67 confirmed cases until then. “Been a tough day for TN but let’s keep containing while responsibly isolating, washing hands and maintaining social distance,” tweeted Beela Rajesh, Tamil Nadu’s Health Secretary, at 10:54 p.m. on March 31.

The Tamil Nadu cases, despite low levels of testing (3,272 as of April 2) was nearly doubling each day: 67 to 124 to 234. There was a slight reduction at the end of April 2, when only 75 new cases were positive, pushing Tamil Nadu to the second position in the number of positive cases, behind Maharastra.

The State police and the government were well aware of the Muslim congregation at Markaz in the Nizamuddin area of New Delhi from March 8 to March 20. The first case of local transmission was also from a migrant worker who travelled from New Delhi to Chennai on the Grand Trunk Express. Yet, there was no attempt to trace those who came from Delhi until March 30, when there was a disturbing spike (17) in coronavirus positive cases in the State.

Some of these people had picked up the infection possibly from the religious congregation in Nizamuddin. The congregationhad participants from Thailand, Indonesia, Kyrgyzstan, China and other countries. Every district in Tamil Nadu sent 20 to 50 people, possibly adding up to a total of 1,500 people from the State (later reports indicated 1,131 persons from Tamil Nadu attended it). The State government has a list of those who have attended and is aiming to trace each of them. An official said that out of the 17 samples tested from members of the group, 16 returned positive.

Beela Rajesh told the media on April 1 that 1,103 persons who attended the conference had been traced and isolated.

A total of 658 samples had been tested. Of these, 190 persons tested positive. She also said that 515 of those who attended had been identified and that the government was working to track down the rest. In the Andamans, of the nine persons who tested positive, eight were part of the conference. Hence, the State government prioritised tracing these people apart from launching a concerted effort to trace those whom they had come in contact with.

However, many in the government believe that it did not act quickly enough in this case, probably because it did not want to be seen as going against one community. In fact, Salem, one of the districts from where quite a few had gone to Delhi, is Chief Minister E. Palaniswami’s home district.

On March 28, Sri Lanka termed Chennai a COVID-19 high-risk zone, after four persons who had returned to Colombo from Chennai tested positive. According to The Hindu, the Sri Lankan government asked all those who returned from Chennai in the past 14 days to report to the health authorities. As on March 28, of the 113 confirmed cases in Sri Lanka, eight had originated in India. Despite this, the Tamil Nadu government’s testing fell way behind that of Kerala or Karnataka.

On March 26, Tamil Nadu’s Public Health Directorate claimed that measures to prevent the spread of COVID-19 had been in place since mid-January. “The first strategy was to prevent the entry or delay the entry of the virus into the State, region and district,” said Dr. K. Kondalaswamy, Director of Public Health, in an interview to The Hindu on March 26. Apparently, the “strategy” was to screen international air passengers with a thermal scanner on arrival. This was done cursorily for domestic air passengers.

The seemingly casual approach to the WHO-declared global pandemic was reflected in the government’s reluctance to shorten the ongoing session of the Legislative Assembly. The Chief Minister’s first pronouncement about the disease was on the floor of the House on March 12, but it was apparent that neither he nor the All India Anna Dravida Munnetra Kazhagam (AIADMK) government had comprehended the enormity of the threat and of the task facing the State.

Although the main opposition party, the Dravida Munnetra Kazhagam (DMK), demanded, in the third week of March, a closure of the Budget session, the Chief Minister declared that there was no need to do so. Earlier, soon after the presentation of the Budget, the Business Advisory Committee resolved to hold the session until April 9. This was later curtailed so as to end on March 31. Even after three suspected cases tested positive in the State, the government decided to go ahead with the Assembly session, and the Chief Minister declared in the House that there was no need to further curtail the truncated sitting.

Finally, after an extended meeting with officials of various departments, including the police, on March 16, the Chief Minister decided to shut down educational institutions, malls and other public places, including entertainment venues, until March 31, and set up quarantine facilities adjoining the four international airports in the State. The Assembly session was brought to a close on March 24. Just a day before this, the DMK whip, R. Chakrapani, handed over to the Speaker a letter stating that the party would be boycotting the rest of the session because of the threat posed by the pandemic.

Apparently, the Chief Minister was keen on passing all the Bills for Demands for Grants for all Ministries before the closing of the session. The government’s view was that it would not be able to appropriate money for various departments ahead of the new financial year. But both opposition politicians and bureaucrats pointed out that there were many instances where post facto approvals had been given.

Palaniswami ignored any suggestion made by the opposition, including adjourning the session, holding a meeting of all political parties to discuss the issue, or even acknowledging the DMK’s offer to give its spacious headquarters on Anna Salai in Chennai for housing patients.

“Here is a ground zero report from a clutch of panchayats in Tiruvarur district in Tamil Nadu. Each panchayat has a few small villages. No one in the villages has got any part of the money announced by the central government and TN government,” tweeted Congress leader P. Chidambaram on March 31. “If this is so in a reasonably governed state like TN, imagine what the situation will be in the poorly governed States,” he said. Again, there was neither a rebuttal nor an attempt to figure out what exactly the issue was by anyone in government at the time of publishing this piece.

“This attitude [of keeping the opposition away] is not good for the country,” said T.K. Rengarajan, Member of Parliament and Communist Party of India (Marxist) Central Committee member. “When the country is facing such a major challenge, it is important that all political parties stand united. Neither the Central government not the State government has taken any effort in this direction. Even the requests of the opposition parties are not heeded to,” he said.

Public health specialists and bureaucrats were appalled by the lack of adequate testing in Tamil Nadu. According to statistics released by the ICMR on March 21, Tamil Nadu had sent only 333 samples to test for coronavirus until the previous day. As many as 303 of these turned out to be negative while the results of 27 samples were pending. In the same period, Karnataka had sent 1,207 and Kerala 3,436 samples. Many infectious diseases specialists in Chennai had been asking the Tamil Nadu government to test more to get a headstart over the infection and its spread into the more vulnerable pockets. Despite the inputs, the State did not test enough or ramp up its facilities. All the gains of having a robust health system and a set of dedicated staff in Tamil Nadu were being lost by three factors: the secrecy surrounding the data on COVID-19 cases; the lack of adequate testing, at least for surveillance purposes; and the people’s lack of adherence to basic safety norms which were publicised in the media.

Tamil Nadu refused to ramp up testing even for the nearly two lakh people who had travelled abroad and come back, despite the WHO saying that testing was the only way to find if someone had the virus. Kerala and Karnataka tested much more people than Tamil Nadu, but officials in the Tamil Nadu Health Department, and Health Minister C. Vijayabhaskar himself, gave statements that there was no community spread of the disease. Later, the Chief Minister claimed that Tamil Nadu was still in Stage 1 of the spread of the infection. The Health Minister announced the preparedness of the State every day and said that the State had enough ventilators and all other equipment needed.

Former President Abdul Kalam’s secretary, Ponraj, asked what the need was to prepare for Stage 4 when the government should be concentrating on preventing the progress of the infection to Stage 3, that is, community transmission. “What is the need for buying so many ventilators and such expensive equipment? What is the motive behind buying such equipment now? Why is the State not doing enough testing?” he asked.

Finally, on March 27, the government constituted nine committees to oversee various aspects of the lockdown and the spread of the disease. Even with this, accurate, real-time information on the progress or control of the infection was not available. On March 30, the State had a total of 67 positive cases, mostly located around the Salem-Erode belt and Chennai. Despite low testing, the many positives made the authorities sit up.

On March 29, Sunday, massive crowds thronged Chennai’s fishing harbour at Kasimedu and the city’s main vegetable and fruit market, Koyambedu, for supplies. In the process, all norms of physical distancing were thrown to the wind. Similar stories of people congregating at one spot or the other came in from other parts of the State too. Police resorting to beating up those defying prohibitory orders, seizing the vehicles of those moving around for no particular reason, and imposing fines had only a limited effect on people. Until March 29, the State police had imposed fines totalling over Rs.5 lakh and seized over 15,000 vehicles.

By April 3, the police had booked 55,427 persons for curfew violation, registered 49,303 FIRs, seized 40,903 vehicles and collected over Rs.17 lakh in fines. There was no let-up in how serious the police were through the period. Responding to inputs from across the State that people were moving about, sometimes after getting curfew passes, Chief Secretary K. Shanmugam on April 2 wrote to all District Collectors and Municipal Commissioners that the “delegation of power to issue passes from Collector and Commissioner of Corporations to Tahsildar and Dy. Commissioners was not working satisfactorily. Too many people are on the roads”. He announced that all delegation of power was being cancelled with immediate effect.

No implementation gap

Where Tamil Nadu scores over many other States is that there is hardly an implementation gap once an order is issued. Anecdotal evidence abounds on how much force the State police used to enforce the lockdown. The police have been helpful too, in many places in the State, including in the burial of suspected COVID-19 cases and offering transport, food and water to stranded people.

Physical distancing in shops was enforced, markets moved to open-air playgrounds and empty spaces and local body authorities worked round-the-clock to ensure proper hygiene and sanitation levels across the State.

Even with the lack of adequate testing and barely enough personal protection equipment, government doctors and other medical and paramedical personnel across the State were working round-the-clock. “In the earlier epidemics corporate and private hospitals barely admitted anyone. This time around, the situation is not too bad,” said a doctor who did not want to be identified.

The Health Department said that it had engaged 2,271 field workers in 12 affected districts to go on a house-to-house visit to determine if any member of a household was suffering from fever, cold, cough or breathlessness. On March 31, it announced that field workers had visited 1.08 lakh households and had sought details from 3.96 lakh people.

In Chennai, residents of a few apartments narrated how the field staff made enquiries on the number of people in the house and took down details of any illness in the house. The process depended on self-declaration and the residents Frontline spoke to said that they would not have revealed anything even if they were ill for fear of being taken to a hospital or having a sticker with “house under isolation” pasted in front of their house. This would creating panic in the neighbourhood and lead to the family being ostracised.

Unresponsive Centre

Like many State governments, Tamil Nadu, too, announced relief packages for the people. The Chief Minister raised his concerns in two letters to the Prime Minister. “All governments will suffer substantial reductions in tax and revenue receipts and it would not be possible to step up revenue raising for a while. However, the expenditure needs and responsibilities will not wait. I had specifically requested you in my letter dated 25th March, 2020, that as a one-time measure, the fiscal deficit limits of 3 per cent of GSDP [gross state domestic product] may be relaxed for the financial years 2019-20 and 2020-21 and additional borrowing of 33 per cent above the level permitted for the fiscal year 2019-20 may be allowed for 2020-21, to enable the States to meet the additional expenditure requirements,” he said in a letter to Prime Minister Narendra Modi on March 28. “While this will certainly help the States to immediately incur expenditure, States naturally have a limitation on how much they can borrow in the markets and will be crippled by massive repayment obligations if they borrow too much. But the onus on reviving the economy by fuelling consumption and investment falls on the governments at this time,” the letter stated.

Palaniswami requested the Central government to provide at least Rs.1 lakh crore as special grant to State governments to combat the virus and its aftermath. “This needs to be in addition to the other forms of financial transfers to the States envisaged in the Union Budget and can be financed by the Government of India borrowing from the Reserve Bank of India. The funds can be distributed in proportion of the size of each State’s GSDP to the national GDP, since the expenditure out of this grant will also pump prime the economy and lead to its revival. I request that Tamil Nadu may be given a grant of Rs.9,000 crore,” he added.

Despite the lack of response from the Prime Minister, the Chief Minister repeated his request for funds in the videoconference on April 2. He demanded Rs.3,000 crore for procuring personal protective equipment and ventilators. There was no response from the Prime Minister.

Preparing for surge

 

THE risk of COVID-19 spreading exponentially in a short time is extremely high in West Bengal, which has one of the highest population densities in India (2,670 per sq mile according to Census 2011), a huge migrant labour force, and an international border (with Bangladesh, Bhutan and Nepal) stretching over 2,000 kilometres.

Even though the spread in West Bengal was initially slow when compared with other States, the sudden surge in end March set alarm bells ringing. The first case in the State was reported on March 17; until March 24, the number was still below 10, with one casualty (March 23). However, by the afternoon of April 1, the total number of cases went up to 37 and the number of deaths to six (two deaths on March 30, two on March 31, and one on the morning of April 1). The State government’s bulletin on the night of April 1, however, maintained that only three people had died, but added: “Two male persons, both aged 57 years, and one male person aged 62 years, all having Severe Acute Respiratory Illness, expired. One of them had chronic renal failure, another had respiratory failure and the third one had hypertension and other co-morbid conditions. They had all reportedly tested positive, which is subject to confirmation.”

In the case of at least three deaths so far, there is no certainty that the deceased had any recent history of foreign travel. The administration is trying to find out if they had come in contact with anyone with recent travel history. This uncertainty has led to a fear that the contagion has spread to a certain extent within the community as well.

On account of the lack of testing kits and the infrastructure to carry out large-scale testing, only 543 samples had been collected from those suspected of having contracted the virus as of March 31, of which 512 were found to be negative. The first three cases reported in the State have recuperated and been discharged from the hospital.

One of the main problems the State government has been facing is a reluctance on the part of the general public to adhere to the quarantine regulation and the tendency to conceal information. The eminent Kolkata-based doctor Tamal Laha told Frontline: “Unless a person having the symptoms comes clean about his condition and his recent social history, the spread of this virus cannot be stopped.” The State administration has put up notices on the doors of those houses whose members are under quarantine in order to ensure that there is no violation of quarantine.

As early as March 20, when only three cases had been reported, the Trinamool Congress government began a phased shut-down process as a pre-emptive measure. It directed that all restaurants, bars, nightclubs and amusement parks remain closed until March 31; postponed the West Bengal Higher Secondary examinations, which was mid-way through; and by official order put a curb on all “non essential social gathering”. The anti-CAA protest at Park Circus maidan—the Shaheen Bagh of Kolkata—reduced the number of protesters sitting in dharna to just seven.

In fact, West Bengal was in lockdown even before Prime Minister Narendra Modi declared the nation-wide lockdown. On March 22, the West Bengal government, invoking the provisions of the Epidemic Disease Act, 1897, issued a notification for the lockdown of municipal and rural areas, including Kolkata, beginning 5.00 p.m. on March 23. The shutdown was to continue until the midnight of March 27.

Despite the lack of equipment and infrastructure to deal with the coronavirus outbreak, the Trinamool Congress government has left no stone unturned in spreading public awareness and has, to some extent, been successful in enforcing the lockdown. Chief Minister Mamata Banerjee even roped in Nobel laureates Abhijit Vinayak Banerjee and Esther Duflo to spread awareness about COVID-19.

Right from the beginning, essential food commodities have been made available, and even sweet shops have been allowed to remain open for four hours a day. Mamata Banerjee directed all the District Magistrates to ensure that every single person got adequate food. In a video conference meeting on March 30 with the district administration heads, Mamata Banerjee said: “Let the doctors and nurses face no problems in discharging their duties and let no person die of starvation.” The State has created a separate fund of Rs.200 crore to combat the situation and has sought donations from corporates and individuals through the West Bengal State Emergency Relief Fund.

Mamata Banerjee also announced that for a month, rations under the public distribution system would be given free of cost. She directed that every district have at least one hospital dedicated to treating only coronavirus patients. “These hospitals should be away from a populated place and should have separate entrance and exits for people who have not been infected,” she said. She instructed the administration to set up more isolation wards. The government also came up with an insurance policy of Rs.10 lakh for doctors and health care workers treating coronavirus patients. The insurance benefits will also include private health/sanitation/allied workers and their families, as well as the police.

The government has also roped in private hospitals. “It’s not a time to do business and not follow rules. It’s a time to help each other,” Mamata Banerjee said at a meeting with representatives of private hospitals. However, in spite of the government’s directive to not turn away patients, there have been reports of the reluctance of certain private hospitals to take in those showing signs of COVID-19.

In order to deal with the immediate situation, the government increased the number of beds by 300 in three of the government-run hospitals in Kolkata—Bangur, R.G. Kar Medical College and Hospital, and the Infectious Disease Hospital, Beleghata. Isolation facilities with a total of 1,317 beds (as of March 31) were arranged in 100 government-run hospitals across Bengal, and a 24x7 control room was set up at the State headquarters.

However, the government has had to make do with very limited resources. Initially the State had only 40 testing kits, which was subsequently increased, but the number is still “far from what is required,” according to a source in the health sector. Moreover, doctors themselves have expressed concern over the dearth of proper equipment. “Instead of surgical masks and PPE (personal protective equipment), many of us are wearing raincoats and cloth masks. If the doctors, nurses and health workers get infected, the virus will spread further,” said a doctor who did not wish to be named. Mamata Banerjee has sought a Rs.1,500-crore package from the Centre to combat the COVID-19 outbreak.

Public reaction

The catastrophic scenario has brought out the best and the worst among the people. Alongside irresponsible behaviour, there has been quiet discipline; cavalier attitudes have been silenced by sagacity; displays of selfishness and greed have been shamed by those of generosity and kindness; and most importantly, the imminent danger has forged a sense of fellow feeling. Local youth, workers from political parties and NGOs have reached out to those in distress.

That said, there have also been instances where doctors, nurses and health care workers have been ostracised by their own neighbours, with landlords and housing society committees refusing to allow them to continue to stay in their residences. Mamata Banerjee made it clear that such behaviour would be dealt with severely.

Interestingly, in most cases, it was the rural poor, rather than the educated urban, who showed the proper way to deal with the crisis. A village in Purulia constructed temporary quarters on trees just outside the village to serve as a comfortable quarantine place for the migrant workers from the village returning from other States. They had the foresight to realise that if the workers returned to their single-roomed huts, they might be putting their families at risk.

In regions such as Murshidabad, Jangipur and Farakka, which have a high percentage of Muslims. the lockdown is turning out to be a particularly trying period. A large section of the population in these parts is dependent on the unorganised labour sector. In Murshidabad alone, more than 12 lakh people are solely dependent on the beedi industry. Imani Biswas, a prominent Trinamool leader from Murshidabad, and one of the biggest beedi barons in the State, told Frontline: “The situation is particularly bad for the beedi workers, as the whole industry is now shut. There are also a large number of migrant labourers who are stranded in different States…. We are trying to send money to them.”

Those living in the tea gardens of North Bengal are also facing a crisis. With the tea industry in the doldrums, a large number of people from the tea estates have had to seek work elsewhere. Habil Bara of Vijayanagar Tea Estate in Darjeeling district, who is now stuck in Tamil Nadu’s Erode district, told Frontline: “I have now only Rs.300 left. When that finishes, I do not know what I shall eat.” It will be a long, lonely haul for people like Habil, and the ordeal has just begun.

Isolated, yet vulnerable

THE north-eastern region, which shares borders with China, Bangladesh, Myanmar and Bhutan, witnessed a spike in COVID-19 cases in the second week of the lockdown. The region now has 20 cases, 16 in Assam, two in Manipur, and one each in Arunachal Pradesh and Mizoram. The Assam government said that all the 16 cases in the State were linked to the Tablighi Jamaat congregation at Hazarat Nizamuddin Markaz in Delhi.

The low test number makes it difficult for the States’ health authorities to form a scientific assessment of their preparedness in preventing a serious outbreak and also to decide whether the region’s geographical isolation will turn out to be a blessing.

At the time of filing this report, fewer than 1,000 samples had been collected for testing in the region with a population of 45,587,982 people. Assam alone accounted for over 600 tests, followed by Tripura with 100 tests. Of the region’s nine government laboratories approved and supported by the ICMR, five are in Assam, two are in Manipur and there is one each in Tripura and Meghalaya. Sikkim and Arunachal Pradesh have one collection centre each, while in Mizoram one testing laboratory is in the pipeline. There is no private laboratory equipped for COVID-19 testing.

On March 31, the Assam Health and Family Welfare Department swung into action to identify, quarantine and collect samples from 347 people who had returned to the State after taking part in the Nizamuddin congregation.

The move followed the reporting of the State’s first COVID-19 case—of a 52-year-old cancer patient from Karimganj district who had attended the Tablighi Jamaat gathering. He returned home by train, having stopped for two nights in Guwahati on March 11 and 12.

On April 1, Assam Health and Finance Minister Himanta Biswa Sarma said four new cases were confirmed that day. “We have been able to identify 230 of the 347 who have already returned, but 117 have not yet been traced. We have collected samples from 196 of them and sent these to the five testing laboratories in the State. Four of the 44 samples tested at the Guwahati Medical College and Hospital laboratory have been declared to be positive. The process of tracing and identifying all those who came into contact with all the 347 people who have returned to the State and 68 people who are yet to return is on,” he told journalists. He reiterated his appeal to the so-far untraced participants of the Tablighi Jamaat and urged them to come forward for voluntary testing.

The north-eastern States are now rushing to create facilities for the critical care of COVID-19 patients and for quarantining persons suspected to be carrying the infection.

Assam has reserved three medical college and hospitals, in Guwahati, Dibrugarh and Silchar, and two government hospitals at Sonapur and Dadara in Kamrup district for COVID-19 treatment. These hospitals have ceased to operate for regular patients except for emergencies and cases of cancer, cardiology, burn injury and maternity.

The total bed strength of these five hospitals is around 5,000. Assam’s Health and Family Welfare Department estimates that the State will need 20,000 beds, including 1,000 Intensive care unit (ICU) beds, in the event of a COVID-19 epidemic in Assam. The State has around 200 ICU beds at present. Sarma said Assam had mobilised 9,000 PPE sets, 80,000 N-95 masks and eight lakh triple layer masks for doctors, nurses and other frontline workers.

The State government has signed Memoranda of Understanding (MoUs) with 85 private hospitals and nursing homes (36 in Guwahati, 27 in Dibrugarh and 22 in Silchar) for the treatment of patients who will be turned away by the three medical college and hospitals at Guwahati, Dibrugarh and Silchar. The State government will reimburse these private hospitals against free and cashless treatment of beneficiaries of the Atal Amrit Abhiyan and the Pradhan Mantri Jan Arogya Yojana at the Ayushman Bharat rates.

Assam has also identified sites for setting up over the next two months five 300-bed, prefabricated hospitals for COVID 19 patients. These will continue to be used as regular hospitals for five years. A 700-bed quarantine centre has been set up at the Sarusajai Sports Complex in Guwahati.

Manipur and Mizoram

In Manipur, which reported the region’s first COVID19 case on March 24, another case was detected on April 2. The latest case was linked to the Tablighi Jamaat.

As on March 30, altogether 1,85,270 people in the State had been screened at entry points and 486 kept under home surveillance; 76 samples had been tested and one found positive; and 205 people had been quarantined at government facilities. On March 9, the State prohibited movement of people across its border with Myanmar and ordered closure of the gates at Moreh and other border-crossing points.

On March 30, Chief Minister N. Biren Singh inspected a site at Langthabal Phumlou Loukon in Imphal West District for setting up a 200-bed quarantine centre within 10-15 days. This will be in addition to the quarantine facilities already functional in the State.

Mizoram, which shares a 40- kilometre international border with Myanmar and a 318-km one with Bangladesh, has one reported case of COVID-19 infection. Altogether 61,221 people were screened in the State, 2,449 advised home quarantine and eight isolated. Forty-three samples were collected for COVID 19 tests and one sample was found to be positive.

Twenty-eight Indian citizens who had been stranded at the Indo-Myanmar Bridge at Zokhawthar in Champhai district since March 21 were allowed to enter Mizoram by March-end.

An official release issued by the Directorate of Information and Public Relations said: “The Champhai district administration immediately informed State government of matter, who then took the humanitarian issue with the Union Ministry of Home Affairs (MHA). After the MHA granted permission, 26 stranded travellers were allowed to cross the border late night while two travellers were allowed the crossing on 28th March.” Twenty-five of them have been quarantined at the District Panchayat Resource Centre Keifangtlang, while the other three are at the Zokhawthar Land Custom Station. The release also said that 434 people were under strict home quarantine in Champhai district.

The State government chartered an Air India Cargo aircraft on March 27 to transport from New Delhi to Lengpui airport 10,900 PPE sets, 10,000 N-95 masks, 200 infrared sensors and 900 shoe covers to be used by frontline health-care personnel. The State has created 111 quarantine facilities with a capacity to accommodate 2,150 persons. Altogether 498 persons were admitted and 27 among them were discharged until March 29.

Meghalaya

Meghalaya had tested 52 samples by March 31 at the North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences in Shillong, and all of them tested negative. The State has 39 isolation beds with ventilators, 460 isolation beds without ventilators, 90 quarantine beds and 180 beds in “Corona care” centres. The State’s Health Department has trained 470 medical officers, 1,500 paramedical staff, 4,381 Accredited Social Health Activists and 1,743 ANM nurses. All the 6,000 or so people who arrived in the State until March 26 have been advised home quarantine.

By March 30, 2,072 PPEs were issued to various districts and 200 were in stock. The Centre on March 30 despatched 1,500 PPEs and 5,000 N-95 masks for the State after State Health Minister A.L. Hek requested Union Minister of Health and Family Welfare Harsh Vardhan for more masks, PPEs and ventilators.

Arunachal Pradesh, Tripura & Sikkim

Arunachal Pradesh recorded its first case on April 2. Delivering essentials and medical supplies in Arunachal Pradesh is difficult during a lockdown. State-run helicopters have been pressed into service to deliver supplies to air-maintained border villages with road connectivity. (The eight North-eastern States account for 167 border blocks in 55 districts.) The State government chartered two Air India cargo flights from New Delhi to Guwahati on March 29 and 31 to fly in PPEs, masks and medical items for sanitation. A consignment of 10,000 N-95 masks, 300 viral transport mediums (VTM; (one VTM for 50 tests) and 30 thermal scanners reached the State on March 30.

All the 100 samples collected in Tripura tested negative. Of the 7,944 people put under surveillance (67 in facility surveillance 67 and 6,694 in home surveillance) in the State, 1,183 completed 14 days of observation by March 31.

In Sikkim, 994 people were put under quarantine by March 31, 958 of them in home isolation. The State has one central referral hospital, one State referral hospital, four district hospitals, two community health centres, 146 primary health centres and 1,560 hospital beds.

A letter from the Editor


Dear reader,

The COVID-19-induced lockdown and the absolute necessity for human beings to maintain a physical distance from one another in order to contain the pandemic has changed our lives in unimaginable ways. The print medium all over the world is no exception.

As the distribution of printed copies is unlikely to resume any time soon, Frontline will come to you only through the digital platform until the return of normality. The resources needed to keep up the good work that Frontline has been doing for the past 35 years and more are immense. It is a long journey indeed. Readers who have been part of this journey are our source of strength.

Subscribing to the online edition, I am confident, will make it mutually beneficial.

Sincerely,

R. Vijaya Sankar

Editor, Frontline

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