Worst of times in Andhra Pradesh

In Andhra Pradesh, hospitals are running out of beds and medical oxygen supplies, health workers are under tremendous pressure, and vaccines are extremely hard to come by.

Patients waiting for admission to the Government General Hospital in Anantapur on May 10.

“My relative phoned me and between gasps for breath he kept pleading with me to help him get an oxygen cylinder. Even as I was expressing my helplessness, he died. We as a people have lost our humanity.” Sake Sailajanath, Andhra Pradesh Congress Committee president, breaks down while narrating the incident, adding that both he and his wife and their 27-year-old son had tested positive for COVID-19. Incidentally, all three are doctors.

Andhra Pradesh is going through some of its worst moments, recording 90 to 100 COVID-related deaths every day. As on May 14, the State had reported over 2,00,000 active COVID cases, with an average of 20,000 new cases every day and a positivity rate of 23.5. There have been 9,000 deaths since the State documented its first COVID death on April 3 last year. Despite the numbers, officials seemed to be relieved that the pandemic has not exploded exponentially in the State.

However, the fact is that health workers are under tremendous pressure, hospitals are overwhelmed and running out of beds and medical oxygen supplies, and vaccines are extremely hard to come by. Cremating a bodyat times comes with a price—a bribe of Rs.10,000.

Low vaccination rate

As of May 12, the State had administered the mandated two doses of vaccine to just 2,057,750 persons or 3.90 per centof its population of 52,669,000. It has temporarily suspended administering of the vaccine to people under 45. Chief Minister Jagan Mohan Reddy stated that if the State got one crore doses a month, the entire population could be vaccinated in six months. But the State gets only 19 lakh doses on an average a month.

On May 13, Andhra Pradesh issued a global tender for procurement of vaccines that will cover a population of 10 million. Officials told Frontline that with some global pharmaceutical companies/manufacturers offering a single-dose vaccine, they felt that rather than specify the ‘number’ of doses in the tender, it was better to specify the coverage that was needed. The State has also placed orders for 20 million doses each from the Indian manufacturers Serum Institute of India and Bharat Biotech. Neither of them has responded to the State’s requests.

A senior official from the Andhra Pradesh COVID Command Control Centre said that the State nevertheless was not slacking in its testing regime. He said: “We are testing around 100,000 people using the reverse transcription polymerase chain reaction [RT-PCR] test every day. Anyone who is tested positive is put under surveillance and monitored closely at the village or ward level. Our health workers, ASHA [accredited social health activist] and ANM [auxiliary nurse midwife],— one for every 50 houses, both at the ward and village level—visit every household every day, identifying and getting tested anyone showing signs of COVID. Contact tracing is also undertaken. The details of those tested positive are included in the State’s main database. The health workers in turn inform doctors at the PHC [primary healthcare centres] or the area hospital. A doctor visits patients every two days. They are provided with a medical kit if they are in home quarantine. We have earmarked one oxygen bed for every ten infected persons.”

Triaging of patients is done after home visits to decide whether a patient needs to be hospitalised, sent to COVID Care Centres (CCC) or kept in home isolation. The doctor suggests a CCC if the patient is unable to isolate himself or herself properly at home. These CCCs provide food and basic medical facilities. Patients are kept under observation for 10 days, and then discharged if their oxygen saturation levels are stable. Some districts such as Krishna, Guntur and Prakasam have, apart from the regular PHCs and area hospitals, set up triaging centres.

Said Dr K.S. Jawahar Reddy, Chairman of the State’s COVID Command Control Centre: “Our focus is on getting symptomatic cases treated and reducing fatalities. Andhra Pradesh has nearly 48,000 hospital beds earmarked for COVID patients. We increased the number of oxygen beds from 3,500 at the start of this second wave to 27,000. We can increase it further, but one must understand that even 100,000 beds will not be enough in this pandemic.”

The Andhra Pradesh Health, Medical and Family Welfare Department’s COVID-19 dashboard offers real-time data of bed availability across the State’s 13 districts and and gives space for airing grievances. The State has 108 government hospitals, 345 corporate empanelled hospitals, 47 corporate temporarily empanelled hospitals and 94 private hospitals providing COVID treatment. Rates for these hospitals have also been specified. While treatment is free in hospitals empanelled by the government and its healthcare programme called Aarogyasri, private hospitals offering non-critical COVID treatment without oxygen can charge up to Rs.4,000 a day, and Rs.6,500 for beds with oxygen support. Critical COVID treatment in an ICU and with invasive ventilator support will cost Rs.12,000 and Rs.16,000 a day, respectively.

As of May 13, only 384 of the 6,256 ICU beds, 1,499 of the 22,378 oxygen-equipped beds and 690 of the 2,597 ventilator beds were vacant. According to Jawahar Reddy, the clamour for beds is primarily because patients were going straight from home quarantining to hospital rather than to CCCs, which have 30,800 beds in total. “This puts pressure on hospital beds. This is because, unlike in the first COVID wave, the drop in oxygen levels of a patient is happening, not gradually, but suddenly,” he said.

Augmenting oxygen supply

The State’s multipronged strategy includes vaccination and securing oxygen. The demand for liquid medical oxygen in the State is 1,000 tonnes a day. However, with the Centre allocating only 500 tonnes a day, the State has sanctioned Rs.309.87 crore to enhance oxygen generation, storage, and transportation facilities in the State. Said Dr Arja Srikanth, the State’s COVID Nodal Officer: “We are securing oxygen in three to four ways. Besides the traditional means, we are importing empty cryogenic tankers, oxygen from Singapore, and by reviving dysfunctional oxygen-generating plants we hope to generate around 40 to 60 tonnes of oxygen. A temporary hospital with 1,000 oxygen-equipped beds is being established next to the Rashtriya Ispat Nigam Ltd [Vizag Steel plant]. Others will follow at Hindapur, Srikalahasti and Tadipatri.”

The opposition has accused the government of lacking in intent to help people suffering from COVID. Sailajanath’s calls for the government to utilise the services of public health experts, including those in preventive medicine, finds favour with several bureaucrats. Said Sailajanath: “Why can’t Jagan Mohan Reddy call for an all-party meeting to elicit the opposition’s suggestions on helping people? Karnataka has done it. In this State, if a bureaucrat meets an opposition figure, the Chief Minister will initiate action.”

The opposition has also accussed the government of not honouring contractors’ bills. This, it says, was causing food contractors to stop providing food or supply substandard food to COVID patients.