‘Battle against Covid-19 is going to be a long one’
Since March, Tamil Nadu with its aggressive testing strategy, recorded the most number of Covid-19 cases after Maharashtra and Delhi. Confident of its health infrastructure, chief secretary K Shanmugam tells Julie Mariappan about the next phase of disease management and economic revival
How is Covid-19 situation in TN?
Multiple strategies including effective border checking, community vigilance and effective contact tracing and intensive fever clinics has helped bring the disease spread in Chennai under control. The daily count in the capital is reduced by 50%. Similar approach is being adopted in other districts. The present daily count of 4,500-4,900 cases is expected to come down in the coming days, if everything goes well. But the battle against Covid-19 is going to be a long one.
How do you react to the criticism that the state could not contain the spread?
The state operates within certain constraints. It is the culture, social behaviour, public responsibility that largely determine the spread of this disease more than government intervention. The state has done its best in creating awareness and restricting movement to break the disease cycle. The government has a clear strategy of aggressive testing, isolation and early treatment to save lives. Effective patient management system is in place with adequate testing infrastructure, sufficient medicines, upscaled health infrastructure in care centres, health centres and in terms of hospital beds. The clinical protocol is also being reviewed to create adequate oxygen beds, instead of relying on ventilators. Adequate pulse oximeters and high flow nasal cannula are also being procured for early intervention. All such measures have ensured the state has the lowest death rate in the country.
But there are allegations of under reporting of death.
As per ICMR protocol, all people tested positive for Covid-19 at the time of death are treated as Covid deaths. Sometimes patients with comorbidities have been admitted and they died before the Covid test result came, such cases might have been reported as death due to comorbidity. But this needs to be revised subsequently. Such discrepancy is assessed by a committee and the identified omission of cases will be added.
What is the state procedure on clinical intervention?
Tamil Nadu is one of the first states to constitute an expert committee and clinical group. The group reviews procedures regularly and updates the treatment protocol. The state also permitted use of siddha and ayurveda to boost immunity and complement therapeutic procedures under allopathy. The state is also conducting trials on plasma therapy and Indian system of medicines besides being part of the solidarity trail.
TN lockdown strategy is being intensely debated. What is your view?
Lockdown is a temporary measure that slows down disease spread, gives breathing time to understand the disease and gives authorities time to prepare for it by mobilising required resources, manpower and health infrastructure. In this process, we may face multiple peaks, but at low magnitude.
A mathematical model predicted the number of positive cases in Tamil Nadu to reach 9.3 lakh by July 14. Due to the lockdown, the figures reached 1.75 lakh as on July 20. Therefore, the lockdown has served its purpose to control disease spread. As continuous lockdown is impractical, relaxations are needed simultaneously to balance disease control efforts with the revival of economic activity to protect livelihood of people.
Experts said lockdown within a lockdown is a mistake because of panic buying. Your comment.
Such restrictions are essential to control disease spread like Covid-19, which spreads rapidly, if social distancing is not maintained and face masks are not used. As the government has the responsibility to resume economic activity, this kind of restriction and relaxation strategy is inevitable. Panic buying is an illogical crowd behaviour. Even if we give sufficient time, people still rush to buy things on the last day.
What lapses led to the Koyambedu market cluster?
Anticipating the spread and putting preventive measures in place were done from March 19 onwards. A meeting was held to restrict retail sales. Unfortunately, a large number of the public continues to gather in the market. The first case in Koyambedu complex was reported on April 24 and by that time the number of cases in the state reached 1,755. By April 29, few more tested positive, which led to the closure of the market. The government tried its best to identify and test all vendors and workers but some remained outside our testing ambit and many slipped to the districts, where the district administration could intercept and test most of them.
Will there be more lockdowns?
Lockdown is a framework that allows the government to restrict movement or ease it depending on the situation on the ground. Until all restrictions go, this framework will continue. But it will be localised to containment zones. The lockdown restriction shall get phased out over a period. But there is a need to prepare to deal with Covid in future. When movement is relaxed and economic activities are opened up, contact tracing will be practically impossible. Ultimately, the government and public should be fully prepared to fight Covid-19 unitedly.
How is TN’s health infrastructure coping with the pandemic?
We are well-equipped. We have 56,674 beds in government and private hospitals and health centres, of which 32% is occupied. There are 59,967 beds in care centres with occupancy of 19%. Adequate medicines and materials are available and Tamil Nadu Medical Services Corporation is in the process of procuring it continuously. As far as manpower is concerned the state has appointed additional doctors and paramedical staff.
There are complaints of private hospitals not rising to the occasion, fleecing public and turning them away.
By and large private hospitals are cooperating. There may be stray incidents which will be handled by the government if it is brought to our notice.
Virologists and epidemiologists say there is community spread. Isn’t it good for the state to acknowledge and strategise accordingly?
The term ‘social spread’ is being interpreted in different ways. If the disease attained a stage of social spread, then border control and contact tracing will be meaningless. The spread in TN is still localised and can be contained through multiple strategies even if the index cases in the form of ILI/SARI are not linked to travel history. But it may become social spread if the disease prevalence goes uncontrolled.
Revenue is under strain, what are government’s priorities now?
The budget estimate of revenue receipt for 2020-21 is ₹2,19,375 crore, which means in the first quarter ending July, we should have realised ₹54,843 crore under revenue receipts. But the state realised only ₹30,561 crore. This figure is yet to be reconciled. This is expected to widen further as the economy will not return to normal for another six months. The state revenue is strained badly. So also is household income, businesses and overall economy. It is necessary to revive economic activity as quickly as possible and restore it fully. Our priority continues to be controlling disease spread while focusing on economic revival
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SHARED RESPONSIBILITY: Public adherence to physical distancing and masking norms can only help break the disease cycle when restrictions are relaxed
K Shanmugam
