COVID-19 Update: Andhra Pradesh

COVID-19: Andhra Pradesh fight against pandemic marked by community involvement

Print edition : June 18, 2021

The Government General Hospital in Vijayawada displays the number of beds available for COVID-19 patients, on May 26. Photo: Raju V.

Although the infection curve shows signs of flattening, the government ramps up measures to involve the people at every level in combating the pandemic.

A steep reduction in the number of calls being received at the State’s ‘104’ call centre helpline comes as an indication of a cessation of the exponential rise in the number of COVID-19 positive cases during the second wave of the pandemic.

From 18,000-19,000 calls a day during the past month, the number has plummeted to just over 6,000 in the past few days. For over a month, the call centre had become a veritable ‘one-stop solution centre’ for COVID-related queries, including action-oriented help in securing a hospital bed or testing facility.

The call centre, which had become the de facto lifesaver emergency helpline in Andhra Pradesh, is manned round the clock and is virtually connected to a team of nearly 3,000 doctors who lend their service when the calls are rerouted to them.

Also read: COVID-19 second wave fight in Andhra Pradesh

Stating that there has been a welcome slowing down of the number of fresh positive cases and a gradual decline of the nearly vertical trend line, Dr K.S. Jawahar Reddy, chairman of the State’s COVID Command Control Centre, told Frontline that the “numbers in Andhra Pradesh are still worrisome, but aren’t climbing alarmingly. Barring East Godavari and West Godavari, where the number of cases is still worrisome, in districts like Guntur, Krishna, Nellore, Kadapa, Vizianagaram and Visakhapatnam, the number of positive cases is actually showing a downward trend.”

Black fungus worry

Volunteers working on the ground also acknowledged a flattening of the curve, but cited the growing number of mucormycosis or black fungus infection as an extremely worrying phenomenon.

Confusion, fear and panic have gripped many COVID-19 patients. A doctor told Frontline that he had to try very hard to convince a woman patient who had just recovered from COVID-19 and had dark circles under her eyes that it was not black fungus but possibly just stress that had caused the discolouration.

At government hospitals, patients affected by black fungus are being treated under the State’s Aarogyasri scheme, but private hospitals and some government hospitals are asking patients themselves to procure vials of liposomal amphotericin B, the drug recommended for the treatment, or alternative drugs such as posaconazole and isavuconazole, which has created a black market.

Volunteers and non-governmental organisations (NGOs) also cited communication woes because patients who were unable to access social media platforms suffered the most. According to several volunteers, while the ‘104 call centre’ has provided help, the response time still left much to be desired.

A volunteer said: “Many officials at the call centre are not well-versed in handling a medical crisis or are technically equipped to take an emergency call. For example, even after tagging all the government officials concerned on an urgent requirement for either a hospital bed or an ambulance, there is often no response. Or the response comes hours after the patient passed away. On the contrary, social media platforms are much quicker to provide responses. But everyone doesn’t have access to social media.”

Also read: The deathly Black Fungus

The volunteer cited the example of a woman whose blood oxygen saturation levels dipped to 54 and was in dire need of an intensive care unit (ICU) bed, but the ambulance did not arrive even four hours after the call centre was alerted and government officials were tagged with appeals for help with the patient’s details. When the ambulance finally arrived, there were still no ICU beds available, and the patient was eventually taken to Hyderabad from Vijayawada. Sadly, she did not survive. Volunteers said that at least six to seven patients succumb every day because of delayed responses.

The State government has fixed numerous glitches in the hospitalisation dashboard, but the rising number of cases has meant an unimaginable pressure on the hospital system and an unending demand for oxygen and ICU beds. This has also traumatised patients.

Vijji Vinnakota, a volunteer who assisted patients scurrying for beds and oxygen, highlighted numerous cases of patients being forced to lie next to a bed where a patient had just died, as the overworked hospital staff were unable to come soon enough.

She broke down while recalling a 3 a.m. call from a 15-year-old girl who wanted help because her father had been traumatised after lying next to a dead patient and was trying to flee the hospital.

Cooperative tackling

Officials working on the ground in the State said that the biggest takeaway from handling the pandemic was the importance of equipping the community at large, and handling a crisis well, at the periphery itself.

In a bid to further strengthen the community at large, Andhra Pradesh has decided to establish a State-level and district-level nodal committees. These committees will consist of representatives of the government and NGOs and will help in coordinating medical and relief activities. The government has already identified two or three NGOs at the State level, while at the district-level around 40 NGOs will play a large part in taking the government’s schemes and relief measures to the people.

Also read: Missteps in India's vaccination policy

Dr Jawahar Reddy is of the view that NGOs will play a crucial role in linking the people and the government, given their strengths in community mobilisation. These committees will ensure that there is no duplication of relief work and will ensure that the health and administrative efforts are synergised. Dr Reddy said: “There is already a lot of coordinated work between the NGOs and the government, like for example, in providing assistance at burial grounds. These committees will formalise this mechanism.”

Creating awareness

The Andhra Pradesh government has also tied up with the United Nations Children’s Fund (Unicef) to create social awareness in the rural areas of the State. Termed the ‘social vaccine’, the joint campaign will include posters and other publicity material and involve personnel who will educate, monitor, and enforce COVID-appropriate behaviour.

Volunteers like Vijji Vinnakota have been demanding that the government pay more attention to educating the people on COVID, implement and undertake team building exercises, and heighten social awareness.

In an elaborate system that appears to be working, anyone in the State who has tested positive is put under surveillance and monitored closely at the village or ward level, with either a health worker, an ASHA (accredited social health activist) worker, or an ANM (auxiliary nurse midwife) visiting the household every day.

The infected person is provided with a medical kit and confined to his or her home. If that is not possible, the infected person is admitted at a community isolation centre, or a COVID Care Centre (CCC). Contact tracing is also undertaken. The person’s details are included in the State’s main database of infected persons. The health workers inform doctors at the primary healthcare centres (PHCs) or the area hospital.

Also read: How the poor live in a time of pandemic and lockdowns

At the CCCs, patients are kept under observation for around 10 days, and then discharged if their oxygen saturation levels do not fluctuate wildly. Districts like Krishna, Guntur and Prakasam have even set up dedicated triaging centres, in addition to the PHCs and area hospitals.

At the rural level, besides health workers, village sarpanchs (headmen) have also been roped in and asked to take charge. According to officials, the government has been able to establish a network of around 15 million people in this connection.

As on May 26, Andhra Pradesh had 192,104 active COVID-19 cases and a confirmed rate of 31,164 cases per million. It had recorded a total of 1,627,390 infections and 10,427 COVID-related fatalities.

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