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Covid-19: Primary health pays

| Updated on April 19, 2020 Published on April 17, 2020

Three cheers: Three patients (from left) are discharged after testing negative for Covid-19 amid cheers from the staff at a Chennai hospital   -  B JOTHI RAMALINGAM

Tamil Nadu leans on its efficient public health system as it battles the novel coronavirus

Ilayaraja is in his mid-40s but walks with millennial vigour. It’s early morning and he is at the Ceebros Heritage Apartments in Chennai’s Velachery. He climbs the stairs briskly and snappily presses a doorbell. An elderly man comes out and smiles at him. “All good, sir?” Ilayaraja asks. The man answers in the affirmative and Ilayaraja ticks a few columns on the writing pad he carries. No fever, no other diseases, he murmurs behind the bright white mask he’s wearing, and smiles before moving to the next flat. The mask may well hide his smile, but not the gleam of enthusiasm in his eyes.

Ilayaraja is one among hundreds of ad-hoc inspectors deployed by the Greater Chennai Corporation to visit houses in areas marked susceptible to the Covid-19 infection. Together, they cover nearly 19 lakh households each day.

More than 3,000 people have reported Covid-19 symptoms in the 15 zones of Chennai. Such inspections are on across the state, in places such as Coimbatore, Erode and others, director of public health K Kolandasamy tells BLink. He says Tamil Nadu — where the overall tally of Covid-19 cases stood at 1,267 on April 16 — is prepared to meet any eventuality, thanks mainly to its strong and well-oiled public health infrastructure.

Tamil Nadu’s healthcare apparatus covers the eight-crore-plus population extensively, says Kolandasamy. “This helps us track cases easily and bring them better care.” The state has around 8,000 health sub-centres. Health secretary Beela Rajesh says the government is focusing on aggressive testing and coordinating with private hospitals too.

“We have been asked to be prepared to work two weeks at a stretch with just a two-hour break in a day, and we are prepared,” says a doctor working with Chennai’s Sri Ramachandra Medical College. “But so far we haven’t seen such a spike, thanks to the lockdown and active measures taken by the state government.”

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The Covid-19 action plan set in motion includes thermal or clinical screening of passengers travelling to or from affected countries to prevent or delay the entry of the virus into the state, and isolating and home-quarantining them for 28 days (which is twice the infection period). The next steps include hospital isolation of persons with symptoms. Of the 1,205 confirmed cases so far, only eight have foreign travel history.

To maintain respiratory hygiene, the government is encouraging people with cough, sneezing and fever to remain inside homes and follow basic precautions, including frequent hand-washing.

The third part of the Covid-19 strategy — hospital and community preparedness — includes protocol training for doctors and nurses. The government has stocked up personal protective equipment and disinfectants while preparing isolation rooms in hospitals, according to Rajesh. The aim is to contain the infection at Stage 2 — local transmission through persons with travel history or direct contact with infected persons — and avert community spread.

“We are better placed compared to others [geographies], considering the size and strength of the state,” says Kolandasamy. Healthcare authorities say that barring the infections from a single source — the Tablighi Jamaat conference held in Delhi in March, which accounts for over 1,000 cases in Tamil Nadu — the numbers are low and manageable.

The Greater Chennai Corporation has launched a ‘Corona Monitoring’ app, which allows residents to capture and upload a photo of their door or a selfie if they develop fever, dry cough and breathlessness, and obtain instant assistance and guidance. The state’s recently launched ₹2,800-crore Health System Reform Programme — which aims at improving the quality of care, strengthening the management of non-communicable diseases and injuries, and reducing the inequities in reproductive and child health services — is expected to strengthen its hands for the longer battle against Covid-19.

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In the near term, samples are being collected in large numbers for testing. In Chennai alone, a Covid-19 hotspot, efforts are on to collect at least 1,000 samples a day.

Additionally, care is taken to “make sure the bottom of the ladder does not suffer because of the preventive measures, including the lockdown,” says Kolandasamy. He cites Tamil Nadu’s well-known welfare history, which includes free rations for below-poverty sections, free education, access to medical care and easy access to credit. This is believed to have minimised casualties and collateral damages to a great extent. “Still, this is an event that has caught everyone unawares across the globe, so we must be vigilant until the last patient is cured,” he says.

Ilayaraja echoes this sentiment: “I’ll see you tomorrow; will keep coming until this thing is banished,” he says, smiling at the gatekeeper as he speeds down the stairs to get to the next housing cluster.

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Published on April 17, 2020
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