Progressive South’s weakened fight against Covid-19

* At 2,09,210, the states of Tamil Nadu, Karnataka, Andhra Pradesh, Telangana and Kerala account for more than a quarter of the 7,68,259 cases in India as on July 8

* In Kerala, wearing a mask and maintaining social distancing are compulsory till July 2021

* As the infection rate picks up in the TN districts, Chennai has been seeing a downward trend from July 3 (2,082 out of 4,329 new cases)

* Bengaluru is running out of hospital beds, going by the many complaints from patients struggling to be admitted

* In Telangana, of the 22,000 cases on record as of early July, 11,000 were reported in just 10 days

Five South Indian states, five approaches, one success story so far: This sums up the response to the coronavirus outbreak in Tamil Nadu, Kerala, Karnataka, Andhra Pradesh and Telangana. At 2,09,210, these states account for more than a quarter of the 7,68,259 cases in India as on July 8. Tamil Nadu accounts for over 50 per cent of infections — 1,14,978. The one success story so far is that of Kerala. It was first off the blocks in recognising and handling the novel coronavirus crisis, in January 2020. It recorded the first case and death in India, and adopted the test-trace-isolate-treat protocol to contain the spread.

The success in the containment efforts owes to the spirit of volunteerism (where individuals take their role in controlling the virus seriously); a single-point contact in health minister KK Shailaja, who doesn’t look over her shoulder before taking decisions; transparency as seen in the 78 press meets chief minister Pinarayi Vijayan had addressed till July 3 on the government’s handling of the pandemic; and a robust health infrastructure, which is supported by democratic institutions of governance from the village level upwards. The state president of the Indian Medical Association routinely shares updates on what stage the infection is in, and the likely consequences when the state is unable to contact trace a large number of infections.

Neither Vijayan, a former Kannur district secretary of the CPI(M) who understands grassroots politics more than the working of a virus, nor Shailaja Teacher — as the health minister, a schoolteacher and activist, is fondly called — are tech-savvy like their counterparts in the other southern states. Instead, they were upfront with the facts on the ground.

Kerala’s battle is far from over, though the number of active cases is among the lowest in India. As the total infected count crossed the 6,000 mark on July 8, the state acknowledged that local transmission was on, and said it was bracing for the worst.

The number of people under surveillance or quarantine had touched 1.85 lakh and 3,137 of them had Covid-19 symptoms.

Any spurt in the outbreak is responded with stringent measures: For a week from July 6, capital city Thiruvananthapuram has been under a ‘triple’ lockdown — apart from a citywide lockdown, there is a second lockdown on areas with reported cases and a third lockdown on individual homes with cases; and the pandemic-related restrictions and rules will be applicable for a whole year across Kerala.

Wearing a mask and maintaining social distancing are compulsory till July 2021. Marriages cannot have more than 50 guests, and funerals, 20 mourners.

Embattled in TN

In contrast, despite an exceedingly robust and functional health infrastructure beginning at the primary health centre level, and boasting some of the best tertiary care facilities in India, Tamil Nadu has been behind the curve in fighting the battle. A combination of poor policy decisions, indecisiveness at the top tier of the decision-making hierarchy and ineffective but politically connected people in critical positions of power created a state of denial, which guided the actions on the ground.

Chief minister Edappadi K Palaniswami’s apparent reluctance to be a forceful coordinator between the three ministers — health minister C Vijayabhaskar, local administration minister SP Velumani and deputy chief minister O Panneerselvam — who are critical to managing the pandemic, has meant that the infection numbers are soaring. In just the first three days of July, the death count surpassed the total for the entire month of May.

Palaniswami’s statements and actions did not help either: In mid-April, he said the virus would be under control in two or three days.

The virus did not listen to the chief minister.

He then announced a sudden four-day ‘intense’ lockdown of the Chennai region in end-April — which led to panic buying and huge crowds in shops. In June, he told presspersons that “God alone knows when the virus will go away”. In July, the state crossed many milestones — over one lakh infected, and the largest number of deaths in South India.

The other worrying statistic is that infections in districts other than Chennai are growing with each passing day.

Till end-June Chennai had the bulk of infections and deaths. By July 8, it accounted for 72,500 of the 1,22,347 cases reported statewide and 1,146 of the 1,700deaths, even as cases spiked in the neighbouring districts of Chengalpattu (7,215), Kancheepuram (2,970) and Tiruvallur (5,507). Madurai had 260 cases until May 31, before the count rose rapidly to 705 by June 21. By July 8, it had spiked to 5,057 cases.

As the infection rate picks up in the districts, Chennai has been seeing a downward trend from July 3 (2,082 out of 4,329 new cases). On July 8, it accounted for 1,262 of the 3,756 cases recorded in the state. With the daily new infection count crossing 4,000 statewide in the first few days of July, it appears that even the peak has not been reached.

Officials explain that the number of infections remains high because the government is testing more than any other state in India. Tamil Nadu had tested over 13 lakh samples (as on July 6), while Maharashtra, which accounts for the largest number of infections and deaths in India, conducted over 11 lakh tests, and Rajasthan over 9 lakh. “Wait and see. We will be better off in about six months from now,” an official said.

Neighbouring Karnataka has been testing about 15,000 samples a day on an average and medical education minister K Sudhakar told the media on July 7 that the state plans to test upto 40,000 samples each day “shortly”.

Test less, find less

Karnataka has a reasonably good public health system while in Telangana and Andhra Pradesh, the network is patchy and lags behind the rest of South India. Hyderabad is a pharmaceutical hub, which, according to one estimate, supplies close to 20 per cent of global medicines. But the city slacked in testing (2,361 samples per million population as on July 3, among the lowest in India). In fact, it stopped collecting samples on June 26, after thousands of samples had piled up, and eventually ramped up testing in early July. On July 5, it tested 5,356 samples in all — way below what Tamil Nadu was testing. The reason for low testing was the worry that a high number of cases might affect investor sentiment — a concern that Bengaluru also had embraced for the better part of June. But public health experts point out that there needs to be a functioning city for investments to be brought in, and hiding Covid cases was not the way.

On July 5, Telangana’s director of health services, G Srinivasa Rao, said that a majority of the people in the state would get infected. The long and short of his press interaction: Most won’t die but some will! He admitted that “it was not possible to contact trace every person”, effectively throwing up his hands. The spike in cases and the massive charges in private hospitals are forcing people to leave Hyderabad in large numbers — possibly carrying the infection to rural areas.

Next door, when Andhra Pradesh flagged off a fleet of 1,088 ambulances for Covid-19 care a few days ago, the Opposition promptly called it gimmickry. But it is handling the pandemic much better than Telangana — by July 4, it had crossed 10 lakh tests, with the total positive count at nearly 19,000. In contrast, Telangana had done a total of 1.15 lakh tests and had over 23,000 positive cases. Though the count in AP is lower, the problem is that in just over a month, the cases have gone up nearly four-fold. In Telangana, the greater worry is that of the 22,000 cases on record as of early July, 11,000 were reported in just 10 days. During this period, one in four samples tested positive.

On top :A mobile testing unit at Vijayawada railway station; Andhra Pradesh is testing more than Telangana

The story of Bengaluru echoes that of Hyderabad. From the beginning, chief minister BS Yeddyurappa was mindful of investor sentiment, insisting that there was no point in fighting the virus if people lost their livelihoods. “Karnataka got it right initially,” said a political analyst, who declined to be named. Pointing out that the state had declared a lockdown a week ahead of the all-India lockdown, he said many migrant workers returned to their home towns before the lockdown kicked in nationwide. “But once it reopened in early-June, everyone came back and threw caution to the wind. The danger with another long lockdown now is that people will carry the infection back to the villages,” he added.

Euphoria tinged with worry: Bengaluru police warmly greet a colleague who survived Covid-19, but the city is recently seeing a reversal from its early gains in the battle against the virus

Bengaluru is running out of hospital beds, going by the many complaints from patients struggling to be admitted.

Some of them vented on Twitter: “On the phone calling hospital after hospital. They don’t respond/switched off, if they do they say NO BEDS/with oxygen/ICU. Was finally able to accommodate a critical patient after a lot of requesting... Pathetic state of our healthcare,” wrote lawmaker Sowmya Reddy on July 4. She posted a screenshot of the numbers she had contacted.

“The chief minister is very clear he does not want to create panic and drive people away from Bangalore,” said an official who worked with the CM. “There is ample proof that even deaths are under-reported.” Karnataka is also not testing the dead — admitted to hospital for any reason — for Covid-19. Like Telangana, it has all but given up on contact tracing of Covid-19 patients.

It is clear that even the states with the best health indicators in India are struggling with their Covid-19 responses. But there is far worse to come: One, the front-line staff is fatigued across states. As India enters the fifth month of its battle against the pandemic, there is an urgent need to work on personnel deployment and management. But the Indian Council of Medical Research, which is meant to coordinate the effort, is widely seen as clueless. Second, states are running out of finances. In just over a month, Tamil Nadu will find it difficult to honour basic commitments such as salaries if the Reserve Bank of India does not increase borrowing limits. Other states, too, are in similar situations. The cash-strapped Centre is not stepping up, nor is it allowing the states to tap other sources.

It is increasingly clear that without a clear national plan, decentralised strategies at the state, district, taluk and villages levels, and the informed cooperation of the people, Covid-19 cannot be conquered. The sooner all stakeholders realise this, the easier it will be to battle this pandemic disease

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