Telangana: Late lessons

After initial hesitation, Telangana begins testing on a large scale by involving the private sector as the disease, earlier confined to Hyderabad, spreads to rural areas.

Rainwater and sewage in the inpatient ward of Osmania General Hospital in Hyderabad on July 15.

With the fever refusing to subside even after three days and the visit to a local hakim proving to be of little help, Zakhira, 43, a single mother of three, who works as a domestic help in an apartment complex located in the vicinity of Hyderabad’s Seven Tombs Road, was on the verge of a mental and physical breakdown. She was told to get herself admitted to Osmania General Hospital (OGH), Hyderabad’s oldest hospital. She did so on July 10. Doctors there duly recommended that she be tested for COVID-19. While the test results were awaited, she was placed in isolation and assigned a bed in the outpatient building of the dilapidated OGH. On July 13, her test results confirmed that she had been infected. Even as she was informed that she needed to get herself admitted to Gandhi Hospital, a designated COVID-19 facility, rainwater and sewage flooded most parts of the OGH, throwing her final consultation and time-consuming discharge protocol into disarray.

Zakhira’s is not an isolated case. Many other patients have suffered a similar fate.

The Telangana government headed by Kalvakuntla Chandrashekar Rao (KCR) has appeared clueless in its fight to contain the pandemic. As on July 20, the State had 46,274 positive cases, more than 32,000 of which were reported from the Greater Hyderabad Municipal Corporation, a COVID hotspot. By July, other districts started recording large numbers of positive cases. About 422 people have succumbed to the virus in the State.

A recent report titled “A vulnerability index for the management of and response to the COVID-19 epidemic in India: An ecological study”, published in The Lancet , which assessed the vulnerabilities of Indian States to the coronavirus infection, ranked Telangana as the third most vulnerable State to the effects of the pandemic. Measured on a scale of zero to one across five domains—socio-economic, demographic, housing and hygiene, epidemiological, and health—the study defines “vulnerability” as the risk and consequences of infection, including its spread, morbidity, mortality, and social and economic effects. Telangana scores 0.943 in “overall vulnerability”, with only Bihar (0.971) and Madhya Pradesh (1.000) being more vulnerable. (With a score of zero, Sikkim was assessed as the least vulnerable.)

Statistics on the ground seek to reinforce the findings of the study. Telangana, which until the middle of June refused to acknowledge that testing was the key to tracing, treating and isolating COVID-19 positive patients, is faced with major challenges, which include enforcement of physical distancing norms, especially in the densely populated urban areaswhere a large percentage of the population lives below the poverty line; a huge number of people with comorbidities; and the return of a large number of migrant workers from other States.

However, Telangana has reversed its policy on testing. It roped in the private sector to ramp up the testing process from June 16. While the number of tests done between March and June was a mere 53,757, as many as 211,462 tests were done between June 21 and July 20. The Telangana High Court had intervened in the matter and upbraided the government for not conducting enough tests. Commenting on the State’s changed outlook towards testing, Minister for Medical, Health and Family Welfare Etela Rajender placed the blame on the Centre for Cellular and Molecular Biology (CCMB) and the Indian Council of Medical Research (ICMR). He said: “Earlier both these organisations had issued guidelines that did not call for a rigorous testing schedule. They later changed their norms and guidelines, increasing the severity of the virus. Thereafter, we tailored our response and started testing on a large scale.”

Several pathologists working in private laboratories, contacted by Frontline ,welcomed the government’s decision to involve them in the testing process, but maintained that there were several constraints in scaling up testing. Said a senior doctor: “There are huge issues in capacity building, procuring the reagents, getting the right technicians. Only virologists and serologists can undertake these tests. And many front-line technicians are not reporting to work, fearing they might contract the disease. The government must initiate more confidence-building measures among front-line staff and hospitals treating COVID-19 patients. The virus has played havoc with the financial models of hospitals. Today, hospitals are able to generate only 20 per cent of the budgeted revenue.”

As per the ICMR protocol, test results are uploaded to the Telangana government, the ICMR and the jurisdictional deputy health officer. The current test rate stands at 7,421 per million population. With single-day spikes happening frequently, Telangana’s confirmed per million (CPM) stands at 1,243.26 (the all-India average being 866.47 CPM), which means 1,243 out of every one million people in Telangana have tested positive for the virus.

Although the unlocking of the State’s borders, the return of migrantsand the opening up of most of the sectors were seen as the reasons for the sudden jump in the number of cases, officials told Frontline that the virus had begun to spread within the community. “Effective contact tracing requires us to investigate and trace at least 20 primary and secondary contacts of the patient. But given the rapid spread and the fact that test results take at least 48 hours to come, this has become almost impossible.” Telangana claims a mortality rate of 0.91 per cent – in other words for every 100 confirmed cases, one individual has died from the virus. But there are allegations that several COVID-related mortalities have gone unreported.

Speaking to Frontline, Rajender readily agreed that the virus, which hitherto was confined to urban and semi-urban areas, had begun to spread among the rural masses. He said: “The government had initially planned to confine the coronavirus to urban pockets. But with migrants coming back to their rural homes this has not been possible.” Underlining the seriousness of the situation, he said instilling confidence among the people was one of the biggest challenges faced by the government. “Despite there being adequate testing facilities, including for the rapid antibody-based blood test, and a well-established protocol for home or institutional isolation if a person tests positive, people are panicking. There is the fear of stigmatisation. Patients are rushing to private hospitals. People should not be afraid. Also, the chances of mortality are very low. The government has established a system to take care of those who test positive.”

According to Rajender, Telangana has planned to “test every single patient who exhibits COVID-19 symptoms within a 24-hour window”. The government has decided to “decentralise treatment protocols” and in this respect, it is in the process of authorising 22 medical college hospitals in various parts of the State to treat COVID patients.