The serpentine queues of customers before liquor stores in Anantapur and the unending line of those seeking alms outside the Kanaka Durga temple in Vijayawada, hardly anyone in them wearing a mask or appearing to be concerned about physical distancing norms, describe the nature of public response in Andhra Pradesh as the State battles COVID-19. It is no surprise that a number of hotspots have cropped up in Andhra Pradesh, belying predictions that COVID-19 cases in the State will peak during the second week of August. With 53,724 cases and 696 deaths recorded until July 20 and single-day figures being surpassed regularly, officials believe the peaking has started at least two weeks early. Districts like East and West Godavari and Chittoor, which exhibit urban features in a rural landscape, have been the worst hit.K urnool, Guntur and Anantapur are other districts with a large number of positive cases.
‘A free run’
M.T. Krishna Babu, COVID-19 Task Force Committee Chairman, described the spread as “exponentially increasing”. He and other officials attribute this, among other things, to increased testing, the relaxation of the lockdown from July 8, the don’t-care attitude of the general populace, and the influx of people post lockdown. Estimates are that 15,000 people have been entering Andhra Pradesh every day, and with isolation protocols no longer in place for domestic travellers, the virus, say officials, “has a free run”. With Chief Minister Y.S. Jaganmohan Reddy not keen on further lockdown, officials aver that they have a challenging situation on hand.
Andhra Pradesh follows the proven mantra of testing, more testing, and then tracing and isolating, and it had clocked a total of 1,350,000 tests as on July 20. Officials on the ground undertake surveillance testing and have tried to contact-trace at least 20 primary and secondary contacts of anyone who tested positive for the virus. Teams have moved in to contain the situation and break the chain of transmission as soon as possible, thereby avoiding the formation of hotspots.
Testing has been ramped up to around 30,000 a day, with the State also deploying the quicker rapid antigen test in order to test many more people, in addition to the gold standard, the Reverse Transcription-Polymerase Chain Reaction (RT-PCR) test. According to Krishna Babu, Andhra Pradesh will soon be conducting 3,000 rapid antigen tests in each of its 13 districts, ramping up the number to 5,000 in districts where the virus is rampant.
The number of cases confirmed per million (CPM) in Andhra Pradesh stands at 1,028.78; in other words 1,029 out of every one million people have tested positive (the all-India CPM is 867.34), while the mortality rate is 1.3 per cent. For every one million people in Andhra Pradesh, 25,835 people have been tested, in stark contrast with neighbouring Telangana where there have been only 7,421 tests per million population. But a worrying statistic is the spurt in the number of cases, a figure which climbed to around 9 per cent in July from around 3 per cent.
Spelling out Andhra Pradesh’s strategy, K.S. Jawahar Reddy, Special Chief Secretary, Health, Medical and Family Welfare, told this correspondent that the main challenge was to prevent deaths. Said Jawahar Reddy: “To achieve this we have to increase, prolong as much as possible the window (number of days) that is available for doctors to treat patients who have tested positive for the virus. We would like a window of at least six days. What is hindering us is the fact that people report to the hospital very late, giving the doctors very little time to treat infected patients effectively. This is where we are losing lives. We are trying to overcome this by employing the rapid antigen tests, results for which are available in 15 to 20 minutes. Using rapid antigen tests also lowers the burden on the number of RT-PCR tests that are needed.”
With studies showing that oxygen saturation levels in the blood are a good indication of the patients’ condition, field staff have been provided with 18,000 pulse oximeters. Field staff have also been trained to evaluate a COVID-19 symptom by carrying out simple sub-maximal exercises or tests like the six-minute walk test (a test developed by the American Thoracic Society in 2002 and used to assess aerobic capacity and endurance). A person with a blood saturation level below 94 post the test, especially those above 60 or those in the 48-60 age bracket who have high blood pressure and/or high blood sugar, will be immediately tested and sent to hospital or a COVID containment centre. As a follow-up, the patient will undergo chest X-rays and CT scans if necessary.
Officials like Jawahar Reddy say that the ideal situation is one in which the time from the onset of symptoms to detection (by a test) is as short as possible, 24 to 36 hours, while the time from detection to stabilisation of the patient is as long as possible. Officials hope to bring the mortality rate below 1 per cent from the present 1.3 per cent.
Specialist warriors
Besides increased testing, the State has planned to strengthen the infrastructure and human resources. Keeping this in mind, besides the 84 COVID-19 designated hospitals (with a total of 35,000 beds), the State has established COVID Care Centres in all the 13 districts. While patients with severe symptoms will be taken to designated hospitals, those with less severe or moderate symptoms will be admitted to these centres, which, too, have a total bed strength of around 35,000. The idea behind these centres is to ease the pressure on hospitals.
On the human resources front, in addition to the 10,000 posts of doctors/paramedics that have been sanctioned, the government, with the help of the Indian Medical Association (IMA), has formed a pool of 17,000 specialists (mainly doctors) drawn from various parts of the State in order to be prepared for any eventuality. These specialist COVID warriors will be recruited on a temporary basis and paid Rs.1,50,000 a month.
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