COVID second wave: Andhra Pradesh caught unawares

Overwhelmed by a sudden spate of infections, the government ramps up hospital facilities and augments tele-consultation in a bid to optimise bed usage, even as it struggles with a vaccine paucity.

People waiting outside a private COVID testing centre, in Vijayawada on May 1.

From hardly 575 active cases on February 23 to a staggering 1,22,980 cases on April 30, the second wave of COVID-19 in Andhra Pradesh has taken everyone by surprise with its suddenness and scale. And with nearly 20,000 new cases cropping up every day and the case fatality ratio climbing to 0.7 per cent, the Y.S. Jagan Mohan Reddy government is in a precarious situation as the State’s rudimentary health system is buckling under the sheer weight of infections. Oxygen and hospital bed shortages and non-availability of vaccine doses are the order of the day, and some desperate patients are even travelling to Chennai in search of a hospital bed and better treatment.

Dr K.S. Jawahar Reddy, who was recently reappointed as Chairperson of the State’s COVID Command and Control Centre, described this wave “as more severe and more devastating” than the first wave. . As the Special Chief Secretary (Health), he played a crucial role in controlling the first wave and was instrumental in strengthening the information network to check the rise in the number of cases then.

Speaking to Frontline, Dr Jawahar Reddy said that the State was constantly augmenting facilities at both hospitals and COVID care centres. The government had established 40,000 beds in over 500 COVID-designated government and private hospitals across the State’s 13 districts, he added. In addition, there were 30,000 beds exclusively for COVID patients at the COVID care centres.

Dr Jawahar Reddy said: “When the pandemic struck last year there were just 3,500 beds with oxygen facilities in the State. Today there are 26,500 such beds.” He also stated that the State’s oxygen position, which had dipped to dangerously low levels when the second wave began, had improved. He said: “In our estimate, the State will need around 520 tonnes of oxygen per day in the coming days as cases go up. We have been allocated 430 tonnes by the Centre. The shortfall is being met through our cryogenic tankers.”

In an effort to ensure that non–symptomatic people and patients experiencing mild symptoms were not occupying beds at COVID hospitals that could otherwise have been allocated to critically ill COVID patients, Andhra Pradesh on April 30 issued fresh guidelines under the ‘reclassification of patients and medical/general advisory’.

New guidelines

Speaking to Frontline, officers from the Health and Family Welfare Department said that even positive patients with a blood oxygen saturation of 96 per cent were rushing to COVID Centres and hospitals and occupying beds.

An official said: “These patients can isolate themselves at home. Deserving, critically ill patients can be allocated the beds. We are in the process of putting out guidelines for a ‘patient audit’ to be done so that some persons with less severe symptoms can be sent to the COVID care centres, or even to quarantine at home. Home isolation kits and follow up of all cases will be done to ensure treatment for them at home.”

The new guidelines are meant to allay the fears of the public at large and will be explained in videos by influential and well-known medical practitioners across the State. These videos will then be uploaded on social media sites. The State is also putting in place an ‘oxygen audit’, with every hospital monitored every day to increase efficiency.

As the number of cases rises sharply, Andhra Pradesh is banking heavily on the success of its revamped toll-free State-level ‘104’ call centre set up at HCL Technologies in the Gannavaram neighbourhood of Vijayawada in Krishna district. The call centre has been further strengthened, with 240 staffers, including 21 doctors, attending to calls in three separate shifts, in a bid to provide immediate advice on COVID treatment to patients and their kin and the need for hospitalisation. Further, 2,612 doctors have been linked to the call centre to provide tele-consultation to patients.

Officials at the call centre said they were handling over 15,000 calls each day, with all calls addressed in coordination with the district 104 command control and centres.

Chief Minister Jagan Mohan Reddy was one of the first to announce that Andhra Pradesh, starting May 1, would provide free vaccination to all those in the 18-44 years age group. Officials estimated the number of people in this bracket at 2,04,70,364, and the exercise is expected to cost the government Rs.1,600 crore. On April 24 the State placed orders to procure a total of 4.08 crore doses of Covaxin and Covishield.

Muddada Ravichandra, Principal Secretary (Covid Management and Vaccination), has written to Krishna Yella, Managing Director of Bharat Biotech, and Adar Poonawalla, Chief Executive Officer of Serum Institute of India, stating that the government is committed to vaccinating all people. (As on April 30 Andhra Pradesh had already administered 65.81 lakh vaccine doses.)

He wrote: “Extensive arrangements are made at the State Vaccine Stores (Gannavaram), regional, and district vaccine stores with state-of-the-art equipment for maintenance of vaccines and proper linkage of supply and monitoring. A mechanism to vaccinate over six lakh people per day is already in place in our State.”He also said in the letter: “The vaccine doses may be supplied, as early as possible, directly to the State government and payment shall be made as per the commercials, as per rules.”

However, the government may have to wait until August or even September before it can procure millions of doses from Bharat Biotech and SII, according to sources in the Health Department.

They told Frontline that Jagan Mohan Reddy had spoken to both Adar Poonawalla and Krishna Ella recently, but both of them had said they would not be able to immediately supply even a single dose to the State since they were committed to making deliveries to the Centre until June so that the section of the country’s population aged 45 and above could be vaccinated.

Jagan Mohan Reddy then decided to write to Prime Minister Narendra Modi stating that Andhra Pradesh would not vaccinate people in the 18-44 age group from May 1. The government has decided to first complete vaccinating people aged 45 and above owing to limited vaccine availability, he added.

The calculations are simple: a total of 9,91,700 Covishield doses and 3,43,930 Covaxin doses are available for purchase directly from the manufacturers. But these 13 lakh-plus doses will not be sufficient to take up a drive to vaccinate the 2.04 crore people in the 18-44 years age group. For that, Andhra Pradesh will need 4.08 crore doses (two doses per person). The State will continue to be allocated vaccines by the Centre for people aged 45 and above, which would at best amount to a few lakh doses a week.

In the 24-hour period ended at 7 p.m. on April 29, seven districts recorded more than 1,000 cases each. Chittoor led the chart with 1,831 new cases, followed by Srikakulam (1,829), Guntur (1,760), East Godavari (1,702), Anantapur (1,538), Visakhapatnam (1,129) and Nellore (1,002). The remaining six districts reported between 500 and 1,000 cases: Kurnool topped with 876 cases, followed by YSR Kadapa (669), Prakasam (639), Vizianagaram (624), Krishna (597), and West Godavari (596). The five districts of Chittoor, Srikakulam, East Godavari, Guntur and Nellore accounted for nearly 50 per cent of all active COVID-19 cases in the State.

The opposition lambasted the government’s decision to conduct board examinations for Class 10 and 12 students scheduled to start from June 15 and May 5, respectively, despite the raging pandemic. Several petitions have also been filed in the Andhra Pradesh High Court in this regard.

Pointing out that 30 lakh students and teaching staff were stakeholders in the exercise, the Court demanded to know how the State government intended to organise the examinations for COVID-affected students. Noting that several State boards, the CBSE and the ICSE had cancelled or postponed their examinations, the Court asked the government to reconsider its decision.