COVID second wave: Number of worries for Tamil Nadu

The State is looking at tough times ahead as it grapples with rising cases of hospitalisation and oxygen scarcity.

Ambulances with COVID-19 patients waiting outside the Rajiv Gandhi Government General Hospital in Chennai on May 1. The number of hospitalisations is on the rise in Chennai.

COVID cases and deaths owing to complications arising out of the infection are rising with each passing day in Tamil Nadu, sending health professionals and administrators into a tizzy. In the second week of April, it appeared that the situation was under control, but in the last week, the number of cases grew to worrying levels. A Health Department official said: “At this rate, we don’t know what we will do if cases rise exponentially over the next few weeks.” For the first time after the second wave hit the State, the death toll crossed the 100-mark on a single day on April 29. The Health Department said in a press note that 107 people had died of COVID that day. On April 28, the number of deaths was 98. More than a fifth of all cases in Tamil Nadu, beginning with the first wave early last year (over 22 per cent), were reported in April.

The total number of cases in the State so far was just over 11 lakh. Of this, over 2.6 lakh people had tested positive in April alone. In all, the State recorded 13,933 deaths as on April 30. As many as 10.2 lakh infected people have recovered. The total positivity rate (TPR), which is the percentage of tests that turn positive, indicating COVID infection, in the State was 13.2 per cent on April 29—another worrying number. The Central government has recommended that State governments take additional steps, such as localised lockdowns in places where the TPR was above 10 per cent.

Also, every fifth person in Chennai was found to be positive, a hugely disquieting development for the health authorities because Chennai is the largest and most thickly populated city in the State. In just one week, ended April 24, Chennai recorded 30,706 new cases.

Oxygen and vaccines

The State is currently facing two perturbing problems: one, there are not enough beds fitted with oxygen delivery devices, and two, the pace of vaccination has slowed because the Central government did not provide enough doses. On April 28, the State government decided to place orders for the procurement of 1.5 crore doses. However, the vaccine producers have reportedly stated that their prior commitments will make it impossible to supply vaccines at an early date.

Dr J. Radhakrishnan, Health Secretary, has said that the required number of vaccines will not be available in the State to begin vaccinating people in the 18-44 years age group by May 1, the date set by the Central Government to expand the vaccination drive.

As on April 29, the total number of people vaccinated (who had received at least one jab) was over 57.6 lakh. Owing to the shortage of doses, the number of people vaccinated has fallen every day since April 26. Now, just over 1 lakh people are being vaccinated a day, and facilities across the State are reporting a vaccine shortage.

According to Health Department officials, the shortage of vaccines and the greater virulence of the second wave were of grave concern. An official said: “Earlier, we were doing house-to-house checks for people with signs of COVID. We have restarted this as the second wave hit us. But the problem with the second wave is that people sometimes develop complications a few days after being diagnosed for COVID. This is the unusual part. These people need oxygen and hospitalisation. That is the problem.” To tackle this problem, the government is increasing hospital capacity where it can and is enforcing some of the elements of the lockdown which it believes yielded results in the first wave.

Dr Radhakrishnan told mediapersons on April 29 that the hospitals in the State would add 9,000 beds by May 7 to deal with the rising number of people requiring hospitalisation. The State was also trying to source oxygen from wherever it could and ramping up the capacity of beds with oxygen support, he said.

The other issue of concern in the State related to the high demand for the remdesivir anti-viral drug. Dr Radhakrishnan said: “Every week, we get 59,000 vials of remdesivir. We have adequate stock. But people should understand that this is not a magic drug to cure COVID.” The Health Department has decided to take action against any private hospital that creates panic among patients and their relatives and demands that they procure remdesivir from elsewhere.

On April 30, the Health Department launched a unified command centre to tackle the COVID surge (its phone number is 104 and Twitter handle is @104GoTN). The centre’s mandate is to match bed demand with supply and it will monitor all hospitals in the State, private and government. A State government official said: “Where it is required, officials have forced private hospitals to comply. It was found that a large hospital was performing elective surgeries. One of our people went to the hospital and warned the management to fall in line or be ready for us to take over.”

In certain parts of the State, the administration is moving personnel from some peripheral health-related duties to critical health duties. In Coimbatore, for instance, the district administration moved personnel who were collecting data on how many people got COVID after getting the first dose to hospitalisation-related activities.

District administrations are bracing for the storm as they do not have adequate public health infrastructure. Most districts do not have enough oxygen-supported beds to cater to the current demand, and the newer districts only have rudimentary facilities. A District Collector said: “We are not really very concerned about the positivity rates. But what we are concerned about is the rate at which people are requiring hospitalisation.”

Many District Collectors have set up COVID care centres—which are basic facilities to isolate those who have tested positive—and have asked private hospitals to increase the number of beds allotted for COVID patients. In addition, in Chennai, the Corporation said that private hospitals too can start such centres without waiting for its approval. Districts are reporting two additional problems: people’s unwillingness to get tested for COVID and their reluctance to use COVID care centres. A Health Department official said: “The centres are just for isolation and monitoring. Last year there were some teething problems. People do not want to enter a facility where the care is not at the level of a hospital…. Testing is also becoming a problem because people feel that they will be isolated if they turn positive.”

However, these are not the critical issues, the official said, adding that oxygen was the key issue. If the State did not have enough oxygen-supported beds, the situation would be difficult by mid-May, the official added.

Oxygen troubles

According to Chief Minister Edappadi K. Palaniswami, Tamil Nadu would require up to 450 metric tonnes of oxygen shortly. But the National Medical Oxygen Allotment plan had allocated only 220 tonnes for the State. The Centre recently diverted 80 tonnes of oxygen produced in a plant in Sriperumbudur in Tamil Nadu to Andhra Pradesh. This created a huge uproar in Tamil Nadu, with political parties demanding that the flow to Andhra Pradesh, which had reported a much lower infection rate on paper, be stopped.

In a letter to Prime Minister Narendra Modi on April 25, Palaniswami said: “As compared to the maximum case number of around 58,000 during the previous surge in 2020, the active caseload has already increased to over a lakh today. This has increased the oxygen demand.”

Citing the Petroleum and Safety Organisation’s (PESO) data, the Chief Minister said that the consumption of oxygen in Tamil Nadu had already reached 310 tonnes compared with the “inadequate allotment” made by the Centre. (After the first wave, PESO was made one of the coordinating agencies for oxygen production and supply in the country.)

Sterlite issue

Since oxygen availability is now an issue, Vedanta Resources decided to use the opportunity to get its Sterlite Industries plant in Thoothukudi reopened. Hearing a petition by Sterlite Industries on April 23, the Supreme Court asked why the plant should not be reopened to produce oxygen. The Tamil Nadu government convened an all-party meeting on April 26 to consider the Supreme Court’s question. The meeting resolved to open Sterlite only for the production of oxygen.

News of a possible reopening of the plant led to protests in Thoothukudi, where the issue is controversial. Over 50 persons have been booked so far for protesting against the government’s move. Environmentalists and local residents had protested against the plant for long, and in May 2018, following many agitations, they went on a procession to press for their demand. The police claimed that this procession turned violent and fired at the unarmed crowd, killing 13 persons and injuring over 100.

Now, given the need for the oxygen, the government has appointed a committee to oversee the operation of the plant, but only for a period of four months. A government order issued on April 29 (G.O. (Ms).No.33, Environment and Forests (EC.3) department) stated that the seven-member monitoring committee, chaired by the District Collector, would oversee the running of the plant in compliance with the orders of the Supreme Court. Among other things, it would also conduct a safety audit before the commencement of operations.

The Madras High Court lambasted the authorities for the lack of adequate efforts to control the virus. On April 29, mincing no words, Chief Justice Sanjib Banerjee “wondered what the Centre had been doing for the past 12 to 14 months without anticipating the second wave”, according to a report in The Hindu . The Court said that there cannot be ad hocism in dealing with a pandemic, adding that the Centre should have acted in a planned and informed manner with expert advice, the report said. On April 26, the Madras High Court, in an oral observation, said that the Election Commission was “singularly responsible” for the second wave and that its officers should “probably be booked for murder”.

The biggest problem the State faced for over a month was the lack of a functional government. Voting for the Tamil Nadu Assembly election was completed on April 6. Although the main political parties, the All India Anna Dravida Munnetra Kazhagam (AIADMK) and the DMK, have no stake in the other States where polling was on, the Election Commission decided that all votes would be counted only on May 2.

Even with the infection rate rising to worrisome levels, governance mostly remained in the hands of a group of officials and a Governor, who were in charge of dealing with a complex situation needing critical decision-making and quick action.