Preparing for a crisis
and Udupi (8,663). The swift rise in the number of cases in June and July can be understood when one looks at the timeline of the pandemic in Karnataka. The State took four and a half months to report one lakh cases, the tally it reached on July 27. And then it took only 17 days to report another one lakh cases on August 13.
The increase in the number of cases is directly linked to the increase in testing. Testing was ramped up in the State in August with close to 50,000 tests done every day in 101 laboratories across the State using both RT-PCR and rapid antigen methods. A total of 21,34,174 samples have been tested in the State. The Bruhat Bengaluru Mahanagara Palike (BBMP) introduced free testing in the city but there were complaints that many designated fever clinics had run out of testing kits. There were also complaints of delay in getting the test results, which took anywhere between three and eight days. According to information from the Health Department, the State has ordered 10 lakh rapid antigen kits to address the shortage. Officials said the delay in testing was because of the backlog accumulated since early July.
Even as the number of cases continued to rise, a decline in the positivity rate was noticed in Bengaluru along with a slight decline in the daily number of active cases. The BBMP uses a moving average rate of seven days and 30 days to ascertain the spread of the virus.
According to the data shared by the BBMP COVID-19 war room, the test positivity rate (positive samples among total samples tested) has been falling consistently since it peaked in mid-july. The data revealed that the positivity rate in Bengaluru was down to 18 per cent in August from 24 per cent in July. (The State’s positivity rate is 15.3 per cent.) The death rate has also dropped in the city. N. Manjunatha Prasad, the BBMP Commissioner, attributed this to “increased testing which is helping us to detect cases early and provide treatment in the early stages itself.” Dr Giridhar Babu, epidemiologist and member of the State’s COVID-19 Task Force, said, “Bengaluru has seen the highest fall in the death rate whereas other districts have also seen a slight fall in the death rate.” Two other developments that are seen as positive in Bengaluru are the decline in the demand for hospital beds and admissions to COVID care centres (CCC). According to the BBMP’S live status of hospital beds available for COVID-19 patients across government and private hospitals, almost 50 per cent of the 5,802 hospital beds are available but intensive care units (ICUS) are still reporting an occupancy of more than 90 per cent.
A statement by the Private Hospitals and Nursing Homes Association in the city has requested the government to free up the beds which are currently reserved for COVID-19 patients so that they can be used for other patients. With clarity emerging in home isolation protocols, more and more asymptomatic patients were opting to remain at home. As a result, five of the 11 CCCS in Bengaluru, including the 10,000-bed one at the Bangalore International Exhibition, are likely to be wound up. Complaints about the lack of facilities at the CCCS is said to be one of the factors responsible for people opting for home isolation.
Dr Srinivas Kakkilaya, a Mangaluru-based general physician who recently published a book on COVID-19 in Kannada, said he expected the number of cases to start falling in Bengaluru “in another month”. He said in other parts of the State it could take some more time depending on the extent of the spread of the virus in the community. The COVID-19 Task Force has recommended that a sero-survey be done to ascertain the extent of community transmission. This is a viable option, according to sources in the Health Department.
STRANGE as it may seem, COVID-19 and news updates on it are gradually being relegated to the inside pages of newspapers in Kerala just when experts are warning that infections in the State will peak in the next two months.
On August 16, as the State crossed 200 days since the first positive case in the country was reported there, Chief Minister Pinarayi Vijayan said in a message on Twitter: “We are into the 200th day of the COVID19 crisis. Looking back, we can say with pride that this has not been just a period of despair & loss. It has also been a time of courage, compassion, resilience and survival. People of Kerala responded to the crisis with an unflinching spirit.”
The Chief Minister and several of his Cabinet colleagues are in self-isolation since August 14 following a scare about possible infection after their visit to the Kozhikode air crash site. The Chief Minister’s daily COVID press conference, a key element in the government’s strategy to keep the pandemic at bay and build public awareness about the infection, has been suspended since he went into self-quarantine. The Congress-led
opposition, obsessed as it is with the government’s good record in handling the COVID-19 crisis until now and the effect it would have in the coming local body elections, has been raising a series of allegations with regard to the gold smuggling case in order to divert attention, instead of offering constructive support to the government at a time of crisis. In mid-august, Health Minister K.K. Shailaja, quoting experts, warned that from September the State might see an increase of 10,000 to 20,000 cases every day. The death rate, too, was likely to go up if the spread of the virus went beyond the carrying capacity of health care facilities, she said.
A sharp increase in positive cases was noticed by the end of June, and from then on local transmission became the dominant cause of infection, unlike in the first five months when the infection was caused mostly by those who had arrived in Kerala from Covid-affected countries or other States.
On July 31, the State had a total of 23,613 confirmed cases, of which 19,171 were reported that month. But in the first 19 days of August, there were 26,618 new cases. From August 1 to 18, more than 1,100 cases were reported every day. On August 19, the State witnessed the highest single-day spike of 2,333 cases, taking the total number of confirmed cases to 50,231 (17,382 of them being active cases).
The Health Minister said efforts were on to mobilise resources to manage the possible increase in the number of cases. She said health care personnel were appointed, more than 800 first-line treatment centres had been set up, and basic facilities upgraded in COVID hospitals. A COVID Brigade has been formed, with doctors, nurses, paramedical staff and volunteers to run the first-line treatment centres (FLTCS).
While announcing the launch of the COVID Brigade, the Chief Minister said: “We need more people to volunteer, in view of the rising number of cases.”
Kerala is entering another phase in its COVID containment efforts. These include ramping up testing, identifying asymptomatic patients early on and providing treatment, using the police and their resources to trace contacts and manage containment zones, and revising treatment and containment protocols regularly.
The State has followed a centralised and uniform treatment pattern in all dedicated COVID hospitals, which has been an important element of its management strategy. As private sector involvement is expected soon in a big way, the Health Department said it would amend treatment guidelines in order to “streamline the treatment of SARS-COV 2 infection based on the available evidence from across the world and also based on data from Kerala”. The guidelines would be updated from time to time on the basis of “evolving evidence”.
Meanwhile, in a controversial move in early August, even as it eased lockdown restrictions and limited containment zones to the immediate surroundings of a hotspot as a measure to liberate the economy, the government entrusted the police with the primary responsibility of enforcing quarantine measures and contact tracing. Many organisations, including the Indian Medical Association, raised concerns about assigning the job of health care workers to the police.
Leader of the opposition Ramesh Chennithala approached the High Court to appeal against the move to allow the police to gather call data records of COVID-19 patients, saying it was an infringement on the right to privacy of an individual as laid down in the Supreme Court’s judgment in the K.S. Puttaswamy case. The opposition said the move was meant to convert Kerala into a “police state”.
The Chief Minister, however, justified the decision as the most effective way to trace contacts, given the increasing number of cases, and said that the State had been using this method for a few months now. He said “the information collected thus will not be passed on to anyone else or used for any other purpose.”
The police, in an explanatory note on August 15, said they were only using technology for effective contact tracing “in a legal manner”. They collected details of tower locations and did not gather contents of calls, they said.
The High Court had not given its verdict on the opposition’s appeal at the time of filing this report.
With the number of cases continuing to rise, the government announced that it would make testing more widespread, as demanded by health experts, “for early detection and management of the disease and for keeping mortality down”. The State spent Rs.1.7 crore every day to conduct tests alone. There were nearly 200 private hospitals or laboratories in the State with facilities for COVID-19 testing using various diagnostic methods. The government has relaxed the norms allowing people to undergo tests in private facilities as well.
Apart from the spread of clusters in coastal areas of the State, urban clusters in slum colonies and an increasing number of institutional clusters, for example, in prisons, are posing a challenge for the managers of the crisis. There is growing concern about NON-COVID care in
government tertiary care hospitals getting affected, with more health care workers contracting the infection.
The State has recorded a total of 182 deaths. Some people have argued that the figure is higher and that the procedure followed for the classification (coding) of deaths relating to COVID-19 is wrong. A discussion paper published by the Health Department recently denied this claim. It said the cause of death was ascertained on the basis of “international guidelines for certification and classification (coding) of COVID-19 as cause of death”. It said that of the 62 deaths in July, for which audit had been completed, seven were classified as “death not due to COVID infection” because the underlying cause was not COVID infection. The Health Minister is on record as saying: “Only those fatalities in which COVID-19 is the root cause of death can be determined as COVID-19 deaths as per the international guidelines.”
About 10,000 tests were conducted in the State on July 21 and the number of positive cases was 1,078 with 10.78 per cent test positivity. Over the next three weeks, tests were increased to nearly 50,000. However, the number of new cases was 2,496 on August 14, and the positivity rate had come down to around 5.2 per cent. The number of positive cases per 10,000 tests had come down to around 500, and this reduction was drastic and achieved quickly, according to the senior officials.
In the second week of August, the State increased tests from around 20,000 to almost 50,000 within just five days in spite of logistical problems in the supply of test kits. Odisha’s fatality rate, at 0.58 per cent, continues to be among the lowest in the country; dedicated hospitals, care centres and homes established across the State have made this possible. The State is giving priority to plasma therapy to save lives.
As many as six plasma banks have been set up in major cities across the State and many patients have recovered completely after plasma therapy. Each plasma donor can donate up to three times and save up to six lives.
COVID-19 treatment is being provided free of cost through partnerships with reputed private hospitals. The State has set up 48 COVID hospitals and 178 COVID care centres, apart from the 17,647 temporary medical centres for quarantining migrant workers at the gram panchayat level. The government has also set up its own COVID hospitals in districts where partnership with private hospitals is not feasible.
On August 2, the government responded to the steep rise in the caseload by allowing private hospitals, nursing homes and laboratories to conduct COVID-19 tests through rapid antigen and RT-PCR methods as per ICMR norms. The government instructed private health establishments to share test results with the administration before releasing the report to the person from whom the sample was collected. Private institutions could charge a maximum of Rs.450 for rapid antigen tests and Rs.2,200 for RT-PCR tests.
It was observed that NON-COVID patients undergoing treatment in private hospitals became Covid-infected during the process of treatment. So on August 7, the government allowed private hospitals with 30 or more beds to treat COVID-19 patients. The hospitals were cautioned not to collect exorbitant fees and warned of strict action in case of any violation.
Meanwhile, the administration is paying special attention to worst-affected districts such as Ganjam and Khordha. Though several front-line workers have died of the disease, the high recovery rate has kept up the morale of the people.
As of August 17, Odisha had conducted 10,09,454 tests and a total of 64,533 people had been found positive. As many as 43,780 of them have recovered, while 20,338 are under treatment. A total of 415 people have died—362 owing to COVID-19 and the remaining 53 owing to other ailments.
Economic activities are slowly reviving in the State as
lockdown restrictions get lifted in phases. Of the lakhs of migrant workers who had returned home from distant towns in other States after the nationwide lockdown was announced in March, some have started returning to their places of work but the majority of them have engaged themselves in agricultural activities in their villages. After the initial few weeks of the lockdown, the agriculture sector has displayed resilience. There has not been any report of farmers’ suicide in the State in recent months. Migrant workers face some uncertainty, but farmers in general are happy with the government’s welfare measures, in particular the Balaram scheme launched in July. Under this new scheme, the government will provide agriculture credit worth Rs.1,040 crore to seven lakh farmers in groups in the next two years.
THE Trinamool Congress government has announced a number of steps to bring the raging pandemic under control but has been found wanting in terms of its response on the ground. The 3,000 odd new cases every day, and the average daily COVID mortality rate of well over 50 are enough for allegations that the government is struggling to handle the situation.
An important step the government has taken is to establish a COVID Patient Management System (CPMS) for hospitals. This system is aimed at facilitating admission of patients, providing information on facilities available, and updating family members of the patient’s condition. Announcing the establishment of this new system on August 17 at a press conference, Chief Secretary Rajiva Sinha said: “Our COVID-19 health-care system is good and this new mechanism is unique. It is one of the biggest steps of the government.” The facility can be accessed through the State government health portal—www.wbhealth.gov.in.
The CPMS comes in the backdrop of allegations that hospitals were turning patients away and that once they were admitted, family members were not able to find out how they were doing. According to Rajiva Sinha, the new system would also “help ensure transparency”. As of August 18, the CPMS was in place with respect to three COVID hospitals in Kolkata. It was announced that by the fourth week of August, 84 more hospitals would be brought under its purview. The State government also announced that oxygen support would be available in all the 11,775 COVID beds in the State.
Talking about some of the steps taken by the government, Chief Minister Mamata Banerjee said at a press conference on August 17: “We have set up a plasma bank, a monitoring cell, and we have joined hands with Calcutta University for the purpose of medical counselling.