Tamil Nadu

Chennai a challenge

Print edition : June 05, 2020

Greater Chennai Corporation officials checking the details of those who were associated with COVID-19 patients, at Ripon building in Chennai on May 16. Photo: B. Jothi Ramalingam

Despite a high rate of testing, Tamil Nadu is getting bogged down in its efforts to contain the pandemic.

In Chennai city, with a population of close to a crore and a density of around 26,553 people per sq km, the spread of COVID-19 was largely confined to manageable clusters until the flare-up of cases linked to the wholesale vegetable and fruit market in Koyambedu. As of May 20, the total number of positive cases in Chennai was 8,228, around 60 per cent of the 13,191 cases in Tamil Nadu. The number of cases in the State had breached the 10,000 mark on May 15 itself. As many as 5,882 persons have so far been discharged from hospitals, for a recovery rate of 44.60 per cent. The government can also draw solace from the fact that the death rate, with 87 deaths as on May 20, was at 0.65 per cent.

The swift spread of the virus is evident from the statistics the State Health Department and the Greater Chennai Corporation have been providing to the media on a day-to-day basis. Royapuram and Kodambakkam divisions in the city crossed 1,000 cases each, while many other divisions recorded over 500 cases. “The government is trying to close the stable door after the horses have been bolted,” said a senior physician in a city hospital. That 44 pregnant women in a government hospital in Royapuram were tested positive was a clear indication that the disease had spread in the community.

Costly lapse

The government’s COVID-19 strategists grossly misread the lurking danger from the Koyembedu market. Nearly 6,000 identifiable primary and secondary contacts were traced to it. It is an irony of sorts that when the entire State was under lockdown, the market remained open under the excuse of selling essential commodities, with thousands of people visiting it every day. Neither the Chennai Metropolitan Development Authority (CMDA) which manages the market infrastructure nor Chennai’s civic body that is empowered to put in effective screening and sanitising mechanisms in the city carried out any concrete measures. Hundreds of traders, labourers and buyers roamed around the market, without any regulation and restriction.

That was a costly lapse. A senior Corporation official told Frontline that the origin of the infection at Koyembedu was from the crew of a vehicle that brought onions from Maharashtra. Though the source from Koyambedu led to a spike in Chennai and other northern districts of Tamil Nadu, it did not make any discernible impact in the western, central and southern districts of the State, which have been doing extremely well under the guidance of the respective District Collectors.

Chief Minister Edappadi K. Palaniswami has appointed senior bureaucrat J. Radhakrishnan as special nodal officer for Chennai and other special officers for wards that have reported above 50 cases. Half of the total number of cases in the city have been reported from 34 wards. The Chief Minister blamed the traders in Koyembedu for their reluctance to heed the government’s advice to “split and shift” the market elsewhere for better monitoring.

The State is now gearing up for yet another challenge when its citizens stranded in other States and abroad start returning.

Struggling to cope

With its back up against the wall, the government is using all the resources at its disposal to contain the spread of the virus. This includes ramping up the facilities at the three premier government hospitals in Chennai and other districts, besides the make-shift coronavirus care centres to treat around 7,000 patients. A postgraduate medic in one of the government hospitals told Frontline that the isolation wards were overflowing and testing centres were struggling to cope with the steady stream of people who came in panic for testing. “Even positive cases are bunched first and later segregated as ‘severe, moderate and mild’ before being sent to designated centres. Many who tested positive but prefer to go to their houses for isolation are being allowed to do so,” the intern said.

What happens in hospitals and coronavirus care centres too is a matter of concern. A journalist who went for testing had a harrowing time. He had to wait for nearly six hours to get into the hospital where “everyone seems to be a positive patient”. “The doctors and paramedical staff such as nurses, technicians and pharmacists, besides other sanitary and health workers, looked tired. I was told they were working at a stretch for weeks together,” he said. It is not a surprise that many doctors and medics, besides paramedical staff, had turned positive, putting pressure on the already overburdened health care system.

Rate of testing

Health Minister C. Vijayabaskar has maintained that the State continues to do “high testing and proper clinical management”. It is not far from the truth. Tamil Nadu’s testing rate is the highest in the country, with 3.5 lakh tests carried out already, between 10,000 and 12,000 tests on average daily.

But the government’s initial overemphasis on the “Tablighi Jamaat” cluster for nearly a month left its prevention strategy wanting. It remained preoccupied with travel-specific and cluster-specific infections, thus confining for long to tracing primary and secondary contacts and leaving out random community testing.

Another flaw in its prevention strategy was when, in March, the authorities just screened foreign nationals for temperature and asked them to quarantine voluntarily. A senior epidemiologist said that despite their pleas, the State did not test them.

Petitions in court

An element of confusion and indecisiveness has plagued the government’s decision-making and strategy-designing from the beginning in its fight against the virus. Every strategy and move had its share of controversies and indecisiveness, whether it was the direct bulk purchase of rapid testing kits from a Chinese firm or the non-availability of personal protective equipment (PPE) for front-line workers. This led to a serious erosion of the government’s credibility. “As a result a series of PILs [public interest litigation petitions] are filed against the State mainly to ferret out the facts in the COVID-19 situation,” said Chennai-based S. Jimraj Milton, a lawyer-cum-activist who has filed a PIL in the Madras High Court in this regard.

In his petition, Milton said that the State government had not taken comprehensive action as prescribed by the World Health Organisation (WHO) and the National Centre for Disease Control. He said that the measures the State had taken to tackle the pandemic were far from satisfactory. “Still the people are not aware about the current emergency situation,” he said.

Justice N. Kirubakaran, while lauding the services of doctors and other paramedical staff, sanitary workers and policemen, asked the State to provide all necessary protective equipment to them and subject them to periodical testing. The judge ruled that free medical assistance be provided.

Tamil Nadu government’s Additional Secretary of Health and Family Welfare K.S. Selvakumar, as directed by the court, filed a status report on the State’s handling of COVID-19 and its preparedness on May 13. In that he claimed that as on May 8,17,757 PPE kits and 32,708 N-95 masks had been distributed to health care personnel. With regard to doctors getting infected, he said that a few postgraduate students had tested positive for infection and the hostel they stayed was closed for a few days as per the containment policy of the Greater Chennai Corporation. He further claimed that as on May 8, the State had 2,19,377 PPE kits and 1,54,309 N-95 masks.

Milton said the status report did not contain sufficient data on the query relating to the frequency of distribution of such safety measures, types of equipment and the number of front-line workers who had suffered COVID-19 despite the supply of safety equipment to them. He pointed out that the government had filed a vague report on this vital issue of PPEs provided to front-line workers. “The status report does not disclose the truth about the risk faced by health care professionals while treating highly infected patients. If the PPE is of poor quality it will spoil the entire health care efforts,” he said.

He told Frontline that doctors had said that they were not provided with quality and prescribed PPE kits. “This will not only cause high death rate but also create risk for doctors, nurses and other paramedical staff. The government’s status report has also not disclosed how many persons have been given ventilator treatment. The present PPEs issued by them are not actual PPEs of WHO standard but only surgical aprons,” he said. Milton has submitted his observations on the status report before the court.

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