COVID-19: What the numbers on the Telangana government’s website hide

As hospitals continue to be overwhelmed and doctors say that it is still too early to claim that Telangana is past the second wave of COVID, the numbers on the State government’s website do not reflect the true suffering of people on the ground.

A doctor checks the medical reports of a patient infected with mucormycosis after recovering from COVID-19, at a government hospital in Hyderabad on May 21.

The official COVID-19 figures put out by the Kalvakuntla Chandrashekhar Rao government in Telangana are persuasive, even convincing. The statements issued by the State’s top bureaucrat claiming that Telangana had slid past the second wave, are comforting. But the “heartening” numbers on the government’s website are not a true reflection of the situation on the ground.

As of May 26, Telangana’s official COVID statistics website (from the office of the director of Public Health and Family Welfare) reported 5,63,903 COVID-19 cases, 3,189 fatalities and (confirmed) cases per million (CPM) of 15,150.5, which means that 15,151 out of every million people in Telangana have tested positive for the virus. This number is substantially below the India national average of 20,532.6 CPM, and is dwarfed by the numbers in States that surround land-locked Telangana.

As of May 27, the Gandhi Medical College and Hospital in Hyderabad,Telangana’s largest COVID-19 facility that offers tertiary care with 1,400 beds did not have oxygen- or continuous positive airway pressure (CPAP) machine- and ventilator-equipped beds in the ICU. Nor were there beds to accommodate the countless black fungus patients who, in the words of a doctor, “are coming throughout the day and night, seeking beds at the hospital’s dedicated 150-bedded black fungus ward”.

Putting things in perspective, a senior doctor at the hospital told Frontline : “In pre-COVID-19 times, the hospital utilised, on an average, four to five tonnes of oxygen per day. During the first COVID-19 wave, there were just a handful of occasions like on June 29, when we needed 29 tonnes of oxygen. During this wave, our usage has not gone below 30 tonnes of oxygen per day, even on one occasion. We have 650 patients on ventilator/CPAP beds, another 600 on oxygen equipped beds, and now 150 mucormycosis or black fungus cases.” For doctors at the Gandhi Hospital, it has been a constant battle, juggling and adjusting beds in an attempt to treat the hundreds of patients who are still pouring in not only from all over Telangana but also from neighbouring States such as Karnataka and Maharashtra. Added a doctor: “If the government thinks cases are rapidly dipping, they should see the line of ambulances waiting with seriously infected COVID-19 patients who are looking for a bed. Yes, if earlier at the peak of the second wave in May, it was taking us half a day to find an oxygen or ICU bed, now it is taking us a few hours. On several occasions patients initially admit themselves to a private hospital, then as the cost of treatment climbs, they seek a bed here.”

While the Telangana government’s “live” COVID-19 hospital availability dashboard does indicate that 10,747 of the State’s total of 21,704 oxygen beds are available, and that 5,081 of the State’s 11,811 ICU beds are vacant, numerous patients have found that there were no bedsin most of the government general hospitals (GH) /district hospitals (DH),.

The World Health Organisation (WHO) guidelines recommend that COVID-19 patients be categorised as mild, moderate, severe and critical, with the first two categories being admitted in oxygen-equipped beds, and the latter two in ICU beds. But as Dr M.Raja Rao, the Superintendent of Gandhi Hospitals, said: “During this wave a vast majority of patients came directly to the ICU, and this is still happening.” But he denied any underreporting of cases or deaths, averring that all cases are reported to the Health Department. Doctors without exception expressed the view that “it is still too early to say that the State was past the second wave”.

The Telangana government’s tendency to test fewer people, a decision that has resulted in it being castigated several times by the Telangana High Court, has also resulted in lower COVID-19 numbers. The State has not tested with the vigour necessary to identify cases.

When asked why the Telangana government was underrepresenting the State’s pandemic, Dr Rakesh Mishra, the recently superannuated Director of the Hyderabad-based Centre for Cellular and Molecular Biology (CCMB), said: “There are both logistical and technical limitations in gathering this data. But it can be done. It is like people saying the new coronavirus variants are not being detected by the reverse transcription-polymerase chain reaction (RT-PCR) tests. They are not being missed; the tests are not being done properly. If it is a case of the RT-PCR tests not being able to detect the new variants, then that will be the case in all tests where the new variants are prevalent. But we know this is not the case.”

Mishra was at the helm of CCMB in January-February when a serosurvey was conducted by researchers from the National Institute of Nutrition (NIN) in 30 of the 150 wards of the Greater Hyderabad Municipal Corporation. The study found that on an average the seropositivity was 54 per cent. However, it also indicated that while 90 per cent of people who tested positive for COVID-19 had antibodies, 10 per cent did not, implying that there could be people who had been infected but exhibited no antibodies. Else the antibodies may have disappeared after six to eight months. Mishra and the researchers therefore extrapolated that the antibody seroprevalence in Hyderabad could be over 60 per cent. According to this serosurvey, 25,65,210 of Hyderabad’s total population of 42,75,351 could have been infected with COVID-19, but a percentage of them was probably not aware of it owing to their being asymptomatic.

A three-round national sero-surveillance study in December 2020 by the NIN, which works under the aegis of Indian Council of Medical Research, found that one in every four persons in Telangana has had COVID-19. The sero surveillance study was conducted in Jangaon, Nalgonda and Kammareddy districts of Telangana. The NIN noted that its “sero surveillance study had put the sero positivity rate, indicative of silent and prior exposure to COVID-19, at 24 per cent”. In numbers, that translates to 14,449,778 of the State’s 38,157,311 population. The Telangana government has declared 5,63,903 COVID-19 cases.

Mucormycosis cases

The State has also been facing serious issues sourcing both vaccine doses and medicines to treat mucormycosis. The system specified by the government to secure vials of Liposomal Amphotericin B, the drug recommended for the treatment, is not working. Doctors like Raja Rao even declared that alternative drugs such as Posaconazole and Isavuconazole are now being used to treat the virus. According to volunteers, the system of patients writing to the government appointed committee which will vet their application and then recommend or reject the request for Liposomal Amphotericin B is too lengthy and time-consuming. A COVID volunteer told Frontline that several patients had succumbed to the illness before their applications could be looked at by the committee.