Out of the comfort zone

The number of COVID cases in Bengaluru has been increasing at a rapid pace, giving rise to doubts about community transmission.

Kalasipalayam main road after the Bruhat Bengaluru Mahanagara Palike sealed it off following the rapid spread of COVID in the city, in Bengaluru on June 23.

The surge in COVID-19 cases in Karnataka, Bengaluru in particular, is becoming a matter of serious concern in the State. Health Minister B.S. Sriramulu has stated that Bengaluru could be locked down again if the number of cases continue to rise rapidly as over the past fortnight. The total number of COVID cases in Karnataka stood at 7,000 as of June 13, of which 690 were in Bengaluru. The number rose rose to 10,118 cases by the evening of June 24, with Bengaluru alone recording 1,678 cases. As many as 6,151 patients in the State have been discharged so far and 5,39,247 samples have been tested. There have been 164 deaths.

Dr K. Sudhakar, Minister for Medical Education, who had been actively involved in strategising preventive measures in Bengaluru, has also been quarantined at home after his family members contracted the virus.

The spike in the number of cases came at a time when the State government was basking in the Union Ministry of Health and Family Welfare’s appreciation of it in tackling the pandemic. In a letter on June 18, the Ministry said two practices that Karnataka followed were “worth replicating” by other States: first, “the technology backed system involving multi-sectoral government teams for contact tracing of COVID-19 positive cases”; and second, Karnataka’s “physical/ phone based household survey covering 1.5 crore households across the State to detect vulnerable populations…”.

Trends in Bengaluru

Going by the numbers, one can still say that Karnataka and Bengaluru are faring relatively better than many other States and metropolises. It is 12th in the country in the number of State-wise cases, and Bengaluru’s tally is better when compared with that of metros like Mumbai, Delhi and Chennai. However, the sudden rise in the number of cases in Bengaluru where the contacts of patients cannot be traced is worrisome. Bengaluru is also seeing a higher death rate; 68 of the 78 COVID deaths in the city took place in June. Of the 796 fresh cases in Bengaluru, it is unclear how 522 of them contracted the virus. This would imply that Bengaluru has entered the community transmission stage where potentially anyone could be a carrier of the virus.

B.H. Anil Kumar, Commissioner of Bruhat Bengaluru Mahanagara Palike (BBMP), admitted that the recent spurt in the number of cases had “caused a little bit of concern” as “it has not been possible to trace how the ILI [Influenza like Illness] and SARI [Severe Acute Respiratory Infection] patients have contracted the disease and this could be the case of community transmission”.

Even members of the COVID-19 task force in the State, such as Dr C. N. Manjunath, director, Sri Jayadeva Institute of Cardiovascular Sciences and Research, have begun to acknowledge community transmission as a fact in Bengaluru. But Dr Manjunath adds that this is “not a massive case of community transmission but it is certainly growing”. According to him, the initial cases were international returnees; then there was a sudden surge in cases because of people coming from other States, particularly Maharashtra. “Now, the number of people coming from other States has come down and despite that, we are seeing a surge in cases.”

One of the reasons for this surge in Bengaluru could be the widespread violation of home quarantine norms since the lockdown in March. Of the 1.31 lakh violations of home quarantine rules in the State, 58,832 were reported from Bengaluru.

With the increase in the number of cases, disturbing stories have been emerging from government hospitals treating COVID-19 patients. In a video that went viral on social media, patients at the Rajiv Gandhi Institute of Chest Diseases are seen complaining of the lack of food and drinking water in the wards. “While we may beat corona, we will die of hunger here,” a patient can be heard saying. Even more troubling are reports that the designated hospitals are running out of Intensive Care Unit (ICU) beds. Dedicated public hospitals in Bengaluru such as Victoria Hospital and Bowring Hospital have run out of ICU beds for COVID patients.

Government’s response

The authorities have responded to the rise in cases in two ways. First, The BBMP has sealed five wards in the city along with two large markets that have perhaps emerged as clusters where physical distancing is hard to maintain. This is in addition to the 298 containment zones; unlike earlier when whole areas were sealed off, now only the house or the apartment of the identified COVID-19 patient is sealed off.

Secondly, the State Health and Family Welfare Department has invoked relevant sections of the National Disaster Management Act to ensure that private hospitals reserve 50 per cent of their beds for COVID-19 patients. According to the Suvarna Arogya Suraksha Trust, the nodal government agency tasked with the job of assessing bed capacity, 418 private hospitals, which have a total of 63,900 beds, including 4,467 ICU beds, and 1,264 ventilators, have been empanelled. Treatment charges at private hospitals have been capped at Rs.25,000 a day for an isolation ICU with a ventilator.

The Health and Family Welfare department intends to start dedicated fever clinics that would inform it about ILI and SARI cases. For this purpose, all community health centres and 50 per cent of the Primary Health Centres and Urban Health Centres in the State have been designated as fever clinics. Karnataka has also started wide-scale random testing of vulnerable populations and established COVID Care Centres for treatment of asymptomatic cases.

While ruling party politicians, senior bureaucrats and health officials have blamed Unlock 1.0 for the spurt in cases in Bengaluru, it was always clear that the lockdown was only a temporary measure to provide time for the Central and State governments to devise a strategy to deal with the surge in cases once the lockdown was lifted. Ideally, the government should have used that time to strengthen the public health infrastructure, but this has not been done in Karnataka.

Dr. Taha Mateen, the managing trustee of HBS Hospital in Bengaluru, said, “The approach of the government has been terrible. There are ten ventilators in Bowring (and Lady Curzon Hospital). How come more ventilators have not been procured? I have ten ventilators in my small hospital here and the leading treatment centre for COVID patients in the city does not have any more than that.”

There is a valid fear that if the situation is not controlled in Bengaluru at this point, it could go the way of other cities such as Chennai, Mumbai, Delhi and Ahmedabad, which are struggling to contain the spread of the virus.