Testing regime

Andhra Pradesh’s strategy is to reduce the number of fatalities with community surveillance, identification of positive cases, cluster containment, contact tracing, quarantining and treatment.

Testing at Rajahmundry in Andhra Pradesh on June 16.

MORE than 7,000 people in Andhra Pradesh have tested positive for COVID-19 and nearly 90 have died. The number of new cases almost doubled in the first 16 days of June since Unlock 1.0, with new hotspots emerging across the State’s 13 districts. While it took the State nearly three months (March 9 to May 31) to register 3,571 positive cases, the figure went up by nearly 3,000 in just a fortnight. Kurnool, Krishna and Guntur continue to be the worst-affected districts, with 1,092, 791 and 671 cases respectively as of June 16, followed by Anantapur (513), Nellore (423), East Godavari (399) and Chittoor (363). The most number of fatalities have been in Kurnool (29) and Krishna (27) districts. Disturbingly, the problem has reached rural areas also. Health workers, including doctors, on the ground attribute this to the return of migrant workers, many of them from hotspots like Maharashtra.

With COVID-19 spreading its tentacles across the State, health experts and bureaucrats, including K.S. Jawahar Reddy, Special Chief Secretary, Health and Family Welfare, have predicted that Andhra Pradesh will have to be prepared for hospitalisation of 40,000 more people within the next two months. Plans are afoot to add 10,000 hospital beds to supplement the present 30,000. The 40,000 beds will be spread across 23 government and 60 private hospitals. Indications are that there might be a gradual increase in the number of cases first in Kurnool, Guntur and Krishna districts followed by Nellore, Chittoor and Anantapur.

Priority for testing

The Y.S. Jaganmohan Reddy-led Andhra Pradesh government has vowed to test, trace, quarantine and treat its citizens. With the emphasis on testing, officials from the State proudly proclaim that Andhra Pradesh has (as of June 16) conducted over 6,00,000 tests, a figure that includes both TrueNat (which was recently made a confirmatory test) and real-time reverse transcription–polymerase chain reaction (real-time RT–PCR) testing procedures. Officials also claimed that their “robust testing regime”, which has a testing capacity of 15,000 to 17,000 per day (currently 14,000 to 15,000 tests are being conducted per day), is gearing up for testing 20,000 samples per day. Said an official: “We are undertaking 9,500 tests per million of the population, which is one of the highest among all States.” The State has a population of 5.22 crore.

Speaking to Frontline, Jawahar Reddy said that testing on as large a scale as possible was essential for the chain of infection to be broken and for identification of people, communities and areas where the infection was prevalent and, most importantly, to reduce mortality. Said Jawahar Reddy: “Testing early is essential to bring down the mortality rate. Early testing will give doctors more time to treat patients. As things stand today many cases are being reported late, giving doctors very little time, hardly a day, to treat a patient from the time he has been declared COVID-19 positive. This increases the mortality rate. We are working to ensure that there is adequate time to stabilise a patient. I have also told all District Collectors and health officials to test more and identify as many people as they can and not to worry about the number of positive cases. The focus is on reducing mortality rates and saving lives rather than being concerned over the rising number of cases. Undetected cases are more of a worry since they can spread the virus in the community. This far we have tested 10 per cent of our target.”

At the behest of the State Health Department, the Speaker of the Legislative Assembly agreed to direct legislators attending the four-day session to undergo testing for COVID-19. Andhra Pradesh has also converted some of its State transport buses into mobile centres for collecting samples. Each district has four mobile collection centres.

Proactive measures

With community surveillance, identification of positive cases, cluster containment, contact tracing, quarantining, and treatment according to the risk profile of a patient, Andhra Pradesh has embarked on a number of proactive measures. Village ward communities have been formed and fever survey clinics conducted. The government also plans to screen 60 lakh people falling in the high-risk category—people over 60 years of age and those having abnormal blood pressure and blood sugar levels—in the State’s over 500 containment zones. In the first phase 70,000 people are to be screened for blood pressure and sugar levels, oxygen saturation, fevers and coronavirus-like symptoms.

The State has been testing people at random from different categories or walks of life. Testing for COVID-19 are being undertaken at industrial and wholesale market hubs and temples on people who have arrived from outside the State and among vendors, as they could be super-spreaders.

According to Jawahar Reddy, the State’s “Pharmacy App”, which helps pharmacists gather and collate information from customers purchasing medicines for fevers and then pass it on to the jurisdictional medical officer, has been a good source of data gathering. Explained Jawahar Reddy: “The respective medical officer then calls the customer and gets to know more about the illness.”

Testing on such a large scale has not been easy. The effort to set up testing facilities by convincing political bosses and the finance department has been a challenge. When the first COVID-19 case surfaced, Andhra Pradesh had no testing facility, and samples from Kurnool town had to be sent to a private laboratory in Hyderabad for testing.

Today every district has at least one COVID-19 testing laboratory. There are 18 centres for real-time RT-PCR testing and 48 (all in the government) for TrueNat testing. Testing has placed a huge burden on the State as it spends Rs.1.5 crore per day on testing. The figure is bound to go up as the State further opens up and the number of cases increase. For most people the cost of the test and related procedures, even at private hospitals, is paid for by the government through the Aarogyasri scheme. Around 20 private hospitals are registered under the scheme now.

However, the opposition does not think that the government’s testing initiatives have been successful. Said Sake Sailajanath, president of the Andhra Pradesh Congress Committee: “Cases are steadily increasing. In Vijayawada out of the 59 wards, 42 are containment zones. Quarantine camps are in a bad condition. And worst, the State has failed its migrant workers. These workers were the backbone of the mining, construction and many other industries. But the government failed to recognise and address their issues. We just dumped them. I have told Jaganmohan Reddy ‘try to rule the state, don’t try to deal away the state.’”