Tamil Nadu

Mismanaging a robust system

Print edition : June 19, 2020

A crowded market in Chennai’s Nammalwarpet. Photo: B. JOTHI RAMALINGAM

The government-run Stanley Medical College Hospital in Chennai. Photo: B. JOTHI RAMALINGAM

A lack of coordination at the highest level in making the best use of the resources in Chennai is at the root of COVID-19’s rapid spread in the State.

With COVID-19 spreading fast in Chennai, hospital capacity is on every one’s mind. On May 4, Dr Narayana Babu, Director of Medical Education, who is also the Dean of Omandurar Medical College in the city, was quoted in The New Indian Express as saying: “There are 1,750 beds for COVID patients in Chennai government hospitals. Close to 1,200 beds have become full.’’

Other newspapers quoted Health Department officials as giving out similar statements. According to these news reports, asymptomatic patients were being shifted to COVID Care Centres (CCCs) set up in colleges such as Loyola and the Chennai Convention Centre to free up bed space.

Dr Babu’s assertion stems from a warped decision by the Health Department, headed by Minister C. Vijayabaskar and Secretary Beela Rajesh, to keep a sizeable proportion of beds vacant for non-COVID patients in all government hospitals. However, an investigation by this correspondent found that the number of outpatients and inpatients in all medical college hospitals and other hospitals in the city taking care of COVID patients was down to a trickle because of the fear associated with contracting coronavirus infection.

In fact, the data for May in Chennai area’s four medical colleges is instructive. As on May 18 at 8 a.m., the number of COVID patients admitted to Madras Medical College was 254 (another 350 were in CCCs). At Stanley Medical College, the number of inpatients was 212 (620 in CCCs). In Kilpauk Medical College, there were 319 COVID admissions (94 in CCCs) and at Omandurar Medical College Hospital, it was 300 (114 in CCCs). Altogether, the medical colleges in Chennai had 1,085 inpatients and 1,178 in CCCs, taking the total to 2,263.

According to information on the Internet, the total number of beds available in just one medical college hospital in Chennai, the Madras Medical College (also called the Rajiv Gandhi Government General Hospital, or RGGH), is 3,000.

Even after this discrepancy was pointed out by officials, there was no change over the next week. At 8 a.m. on May 25, the occupancy status at Madras Medical College was 334 (504 in CCCs), Stanley Medical College 174 (700 in CCCs), Kilpauk Medical College 315 (153 in CCCs) and Omandurar Medical College Hospital 196 (86 in CCCs). This works out to 2,462 (1,019 inpatients and 1,443 in CCCs). In short, all these patients could have been accommodated in just one hospital, the RGGH, if all its facilities were taken over for COVID care.

Peripheral hospitals

It is strange that a robust public hospital network run by the Chennai Corporation is not being effectively used. “There are five peripheral hospitals under the Chennai Corporation, each with about 200 beds. I wonder why these are not being used for COVID patients,” remarked a former Corporation official involved in COVID-related work.

Suddenly, by June 1, the Health Department woke up to reality thanks to the efforts of a few relentless fighters inside the Department and the concerns expressed by the Chief Minister’s Office. “An additional 17,000 beds have been raised,” said an official on the front-lines of the fight against COVID. It received good press coverage. One newspaper even highlighted: “Stanley Hospital to have 400 more beds for Covid-19.” No one had noticed the discrepancy about the previous assertions of lack of hospital beds.

A senior Indian Administrative Service officer in the Health Department, S. Nagarajan, who has repeatedly raised this and other issues relating to the handling of COVID, was abruptly transferred out to an insignificant post. The transfer barely made it to the news.

Apparently, mismanagement of the COVID crisis has taken its toll on the State. As the number of COVID cases kept rising, the Health Minister shifted his focus to cases of recovery and claimed that the death rate was low. Chief Minister Edappadi K. Palaniswami is on record saying that Tamil Nadu had handled the pandemic better than some developed countries. Both the leaders blamed the people for not adhering to social distancing norms in marketplaces.

But many see the Chief Minister himself as part of the problem. They point to the lack of coordination at the highest level among the Chennai Metropolitan Development Authority, the Chennai Corporation, the Health Department and the police in managing the situation. The infections cluster at the Koyambedu market, where people from across the town gathered on two occasions to buy vegetables and fruits, is seen as the direct result of this lack of coordination.

On May 31, a Sunday, yet another crowd gathered near the Kasimedu fishing harbour to buy fish, throwing all social distancing norms to the wind. It is in the midst of all these that the Tamil Nadu government blindly followed the Central government and decided to open up most of the State.

So, when Day 70 dawned since Lockdown-1, the number of cases was still high and the death count crossed the 100 mark.

A month after Tamil Nadu recorded its first case on March 7, the total number of positive cases was 124. At that time, the government was struggling to deflect the criticism that testing was low. With testing ramped up marginally, April saw a significant spike across the State, 2,199 cases, despite a harsh lockdown.

Following criticism that the State was not doing enough, the Health Department increased testing. This resulted in the number of positive cases going up nearly tenfold in May, that is 20,010 cases. If the number of cases in the first few days of the month are any indication, June is set to witness a record number of cases. As on June 2, there were 24,586 cases in the State (of this, 13,706 were discharged after treatment).

What is worrying is that since May 31, every single day has seen over a 1,000 cases, according to the Health Department statistics. In just three days the number of positive cases became 3,000 (1,149, 1,162 and 1,091 on May 31, June 1 and June 2 respectively). A large number of the cases were reported from the Chennai Metropolitan Area.

“This month will decide which way our State is headed,” said a health official. He said the trends were worrying and that the Health Department was still not dynamic enough to adapt and revise strategies, unless dictated by the Indian Council of Medical Research.

A break-up of the total number of cases is proof enough of how rapid the spread is. It took 61 days for positive cases to cross the 5,000 mark in the State whereas it took a mere eight days to cross the 10,000 mark, and another eight days to cross the 15,000 mark. Shockingly, in just another six days 5,000 fresh cases were added. On June 2, the State was at the cusp of two major negative milestones—of crossing the 25,000 mark and deaths crossing 200 (197 until June 2).

On June 3, the State crossed the 25,000 mark; there were 1,286 new cases on that day, taking the total to 25,872. With an additional 11 deaths, the death toll reached 208.

Faceless heroes

“Don’t worry about the numbers. As many as 22,000 babies die every year and 55 people die in accidents every day [in Tamil Nadu]. Our job is clear-cut. We need to manage the cases better, test strategically and contain effectively,” said a senior official who is a COVID warrior, regardless of his own known health complications. “When we look around, we can see that Hyderabad is barely testing, so is Kolkata. But there is no point competing with incompetence. We need to test more, reveal everything that we know and co-opt people into this fight,” he added.

Administrators accuse epidemiologists and specialist doctors of not trying enough to work out an effective combination of drugs based on symptoms, as is being tried out in many countries, including Bangladesh. But officials are heaving a sigh of relief that the death rate remains low and the recovery rate is high.

Tamil Nadu’s strength is its public health system; its officials and staff, who, regardless of the risks, turn up for work every day. “Let’s not understate it. Everybody is struggling, and everybody is working very hard despite the fear [of contacting COVID],” said a senior official, who confessed that he was indeed fatigued.

In fact, his assertion is borne out by many testimonials and anecdotal evidence. “I wish to thank Dr Senthilkumar in Stanley [Medical College],” a recovered COVID patient told a Tamil FM channel. “He came to our ward each day, spoke to each one, and assured us we would be fine.”

Tamil Nadu has thousands of such self-effacing, faceless heroes. They are carrying the fight forward despite the bungling at the highest levels of government.

While bureaucrats have, by and large, been working relentlessly in the field across the State, the leadership at the upper echelons, at the level of Chief Secretary, K. Shanmugham, leaves much to be desired. The implementation of dynamic, out-of-the-box, and multiple local strategies in dealing with the pandemic has been in fits and starts because of the lack of a forceful leadership from the Chief Secretary. But it appears that the All India Anna Dravida Munnetra Kazhagam (AIADMK) government is exceedingly satisfied with his approach to issues. It sought an extension for him from the Centre. On June 3, the Chief Secretary was granted a three-month extension of tenure—a rarity for a State Chief Secretary.

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