COVID-19 Update: Tamil Nadu

COVID-19: Chennai’s success story

Print edition : July 02, 2021

Chief Minister M.K. Stalin inspects a 100-bed COVID-19 centre set up at Bharati Arts and Science College in Chennai on May 27. Photo: Jothi Ramalingam B.

Gagandeep Singh Bedi, Greater Chennai Corporation Commissioner, at a vaccination camp in Chennai on May 26. Photo: Srinivasan K.V.

The city Corporation’s new strategy of expanding emergency care infrastructure, conducting door-to-door surveys and follow-ups and encouraging public participation proves to be highly effective in containing the infection rate, but the authorities, being aware of a long battle ahead, are not complacent.

By adopting a technology-aided and community-driven strategy that ensures optimum integration of multiple verticals and an inclusive engagement with residents, the Greater Chennai Corporation (GCC) is battling against the raging second wave of COVID-19 infection in Chennai. And it has achieved a breakthrough in containing the virus’ surge that had threatened to spin out of control.

The scenario was grim and disturbing when the new Dravida Munnetra Kazhagam (DMK) government took over the mantle on May 7. On May 8, the State had registered 27,397 cases; on May 14, the number crossed 30,000. On the same day, Chennai recorded 6,846 positive cases; the next day the number surpassed the 7,000-mark. The daily death toll rose alarmingly, hovering around 400 across the State, with Chennai recording over 100.

A cursory comparison of the total number of positive cases between the first and second waves paints an agonising picture of the havoc wrought by the pandemic in the State.

The number of fresh cases in the State on May 16, 2020, stood at 384 as against 33,181 fresh cases on May 16, 2021. On the same day, in 2020 Chennai recorded 332 cases, compared with 6,247 a year later. As on May 29, 2021, the State had logged an overall total of 20,68,580 cases, with 23,754 deaths and 17,39,280 recoveries. Chennai recorded a total of over 5 lakh cases and more than 5,000 deaths. The pandemic placed enormous strain on the State’s public health system, with hospitals stretched to the limit and intensive care units (ICUs) and oxygen beds becoming scarce.

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Chief Minister M.K. Stalin launched COVID control measures on a war footing and roped in the senior bureaucrat Gagandeep Singh Bedi, a 1993 batch Indian Administrative Service officer from the Department of Agriculture, to tackle the pandemic in Chennai. Gagandeep Singh Bedi was posted as Principal Secretary and Commissioner for the GCC.

The Chief Minister’s trust in Gagandeep Singh Bedi, who has significant experience in disaster management, gave him the much-needed space to create an innovative, inclusive and integrated data management platform, with the help of massive manpower resources at his disposal.

War room model

Aware of the huge challenge ahead of them, Gagandeep Singh Bedi and his core team evolved an integrated ‘war room’ model, with ‘centralised command control’. The digitalised COVID War Room is equipped with hi-tech networks, computers, giant monitors, cameras, mobile phones and landline phones, and is manned round the clock by a team of officers and technical and paramedical personnel.

Speaking to Frontline, Gagandeep Singh Bedi said: “This nerve centre coordinates with all verticals in perfect sync with the field-based personnel for an effective enhanced surveillance system against the scourge.” A major hurdle before the team was the city’s huge population spread over 426 square kilometres. According to the United Nations’ World Population Prospects, Chennai’s population in 2021 is an estimated 1.12 crore. It is the fifth largest urban agglomeration in India and the 30th largest in the world. The city’s population density is 26,903 per sq km.

Humane approach

The strategy of direct engagement with residents has not only removed the fear and stigma among people about the infection but added a humane touch to the exercise, leading to an increase in surveillance and testing in the core neighbourhoods. Gagandeep Singh Bedi said: “The residents now volunteer for testing, which has registered a sharp increase. That was a major impediment during the first wave. We are now identifying the symptomatic individuals, the first step in the entire response exercise, without any hassle.”

The fieldworkers are the foot soldiers in the war against the disease. A total of 12,000 fever survey workers (FSWs) undertake door-to-door visits across the city and identify symptomatic individuals with thermal scanners and oximeters. They then take individuals with fever to camps nearby for swab collection.

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Gagandeep Singh Bedi said: “They play a crucial role in our entire strategy since they identify the symptomatic patients early. They have been asked to be polite and friendly to the people. We are receiving very positive responses.” Monitoring and follow-up of the cases are vital to reduce the spread and mortality. Hence, the corporation has introduced another interactive concept called FOCUS, or Friends of COVID Positive Cases Under Surveillance.

Each FOCUS volunteer is allotted three to five streets on the basis of the number of cases. They visit the homes of patients twice a day and ensure their isolation and quarantine. They also help the households in daily chores such as buying groceries and vegetables.

These volunteers also lend a helping hand if patients need to be shifted to hospitals. Gagandeep Singh Bedi said: “As an extension to it, we have, for the first time in the country, started lending oximeters to patients who cannot afford to buy them and are quarantined in their homes. After recovering from the infection they can return the oximeters. The Corporation has around 10,000 oximeters, all donated by good samaritans.”

Field triage and tackling

One of the major problems the system is facing is the anxiety that is widely prevalent among those suffering from Influenza Like Illnesses (ILIs), who, despite minimal or no serious issues, end up occupying beds in emergency wards in hospitals, depriving those in need of intensive care of hospital care.

To prevent this, the Corporation has implemented a new strategy of ‘field triage and tackling’ to ensure early identification of severe cases. Under this, a team consisting of a medical officer and paramedics would visit the household of people below 45 who have tested positive to find out if they have co-morbidities.

Dr Alby John, Deputy Commissioner (Health), said: “Based on their investigation and recommendation, a patient would be quarantined or referred to a screening centre or hospital. After the introduction of the field triage, the utilisation of private health services has decreased from 37 per cent to 9 per cent.” Tele-counselling centres have been established in the ‘war rooms’ of respective zones to follow up all cases under home isolation daily for 10 days. Dr Alby John said: “Medical trainees who are deployed in these centres identify the red flag signs such as breathlessness, persistent cough and drop in oxygen saturation and refer them to the triage centre/hospital under the guidance of the zonal war room personnel.”

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From May 13 to June 1, these centres responded to 7,04,810 calls, with Division 13 recording a maximum of 87,230 calls (the city is divided into 15 zones comprising 200 divisions). A Chennai resident said: “I called 104 first. After that, every few hours, volunteers called me to check on the patient status and updated me about every vacant bed I could go to.”

The Corporation has also established a “passive surveillance” system, which has brought all health care facilities—government and private, laboratories, CT scan centres, etc—together for effective surveillance. They have to report all ILI cases to the Corporation through email every day for follow-up.

Further, it has deployed 200 mobile swab collection teams, 10 mobile swab collection units and 42 static sample collection centres at all its health facilities. The mobile swab collection units collect samples from markets, industries, and workplaces. They serve as walk-in testing centres for residents. Daily medical camps are also being organised across Chennai.

In a new endeavour, the Corporation has established 21 screening centres in strategic locations across the city. These centres are equipped with thermal scanners, pulse oximeters, blood pressure checking apparatus, and x-ray units.

A medical team from the Corporation and the Directorate of Medical Education (DME), along with technicians, run these centres. Those above 45 years and with co-morbidities are first brought here and the authorities then decide on the further course of action.

‘Oxygen centres’ have been established at various points in the city to provide oxygen supply to those who urgently need it, until hospital beds are allotted to them. Gagandeep Singh Bedi said: “These decentralised oxygen centres have been developed as temporary holding centres until a hospital bed is made available for the patient. Recuperating patients with a minimum oxygen requirement would also be transferred here to prevent hospital bed shortage.”

The city administration has ramped up the bed strength in all major government facilities and set up oxygen storage and manufacturing facilities. It has also established a massive 800-bed hospital with oxygen facility in the premises of Chennai Trade Centre. Dr Alby John said: “It has a 11-kilolitre oxygen tank. A total of 280 patients are now being treated here now.” The Chief Minister has also announced that a 500-bed full-fledged hospital would be built on the Guindy King Institute campus, where a temporary COVID facility is already functioning.

Besides, the Corporation has introduced a special ‘car ambulance’ scheme with oxygen support, a new concept in the country, to minimise the waiting time for hospitalisation. Dr Alby John said: “This system has been introduced to improve the patient transport system. A total of 251 car ambulances have been deployed in addition to 99 ambulances under the 108 service. The vehicles transport individuals to screening centres, health centres and hospitals. The Zonal War Rooms coordinate the car ambulances on request from the field team. Between May 13 and June 2, these ambulances ferried 22,633 patients to various care centres and hospitals.”

Community vaccination

As part of a massive vaccination drive, the government has launched vaccination programmes in Corporation and private health care facilities, and set up temporary vaccination centres in residential areas, workplaces, industrial areas and apartments and gated communities, apart from launching “a doorstep vaccination” programme for the bedridden and the differently-abled.

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Gagandeep Singh Bedi said that around 55 per cent of those above 45 in the city had been vaccinated, which was “the highest percentage of population that any metropolitan city has vaccinated in this age group”. The Corporation is aiming for a daily vaccination target of 30,000, depending on availability of vaccines. On May 17 alone, the Corporation vaccinated 35,000 persons. As on June 8, a total of 21,38,586 persons had been vaccinated in Chennai.

Declining trend

The Corporation statistics point out that these efforts have started yielding results. Since May 18 this year, the positivity rate has started declining in the city. There were 47,060 positive cases between May 4 and 10 (22.5 per cent positivity rate). They rose to 47,596 between May 11 and 17 (22.7 per cent) and came down to 21,113 for a 10.1 per cent rate between May 25 and May 31. The epidemiological curve shows a healthy 70 per cent reduction in total positive cases in the 20 days from 7,564 on May 12 to 2,217 on June 2. On June 4, after two months, the city recorded a below-2,000 count.

The total number of cases in Chennai fell from 49,055 on May 23 to 19,184 on June 7 and the daily number of fresh cases also declined from 5,169 on May 23 to 1,530 on June 7.

The decline has eased the pressure on hospitals. By June 2 the number of vacant COVID beds in Chennai hospitals showed a sharp 20 per cent increase compared to the previous week, registering lower arrival of serious patients. However, the government is continuing with its efforts to upgrade the health infrastructure to meet any emergency in the city and across the State.

Gagandeep Singh Bedi wrote a letter to the civic body’s doctors and health personnel on May 25, expressing his gratitude and appreciation for their selfless work. He said: “The message is clear: we still have a long and bitter battle ahead. If we don’t act together to stop the spread of the virus we will be undoing the sacrifices and works that have been rendered so far and may face a great risk once again.”

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