Number of worries
The State is looking at tough times ahead as it grapples with rising cases of hospitalisation and oxygen scarcity.
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. m
THE situation in Delhi is nothing short of grim, with hospitals complaining of bed and oxygen shortages. The health care infrastructure has been thrown into a tailspin. Harrowing pictures of patients dying unable to get admission to hospitals have continued to flood newspapers and TV screens, and a conspicuous blame game has raged between the State government and the Centre.
On April 28, Delhi recorded 25,986 fresh COVID-19 cases, a gradual increase from the 20,201 and 24,149 infections recorded on April 26 and April 27 respectively. In the last 15 days alone, Delhi has added about 3,45,000 positive cases. The daily death count has been a matter of worry, with the highest ever daily death toll of 381 occurring on April 27. On April 28, the number was 368.
As hospitals report scarcity of oxygen, black marketeering and hoarding have been going on unchecked, earning brickbats for Chief Minister Arvind Kejriwal’s government from the Delhi High Court.
On April 27, the court pulled up the government saying that it had failed to monitor oxygen distribution to hospitals and prevent individuals and hoarders from stockpiling essential medicines. “Set your house in order. Enough is enough. If you can’t, we will ask the Central government officers to take over. We can’t let people die
Even as health care facilities are overwhelmed by the massive surge in infections and crematoriums are fast running out of space and firewood, the State government and the Centre are indulging in a blame game.
like this,” the court observed. However, the Kejriwal government accused neighbouring States of wilfully stalling oxygen supplies to it even as patients continued to gasp for breath. On April 29, Deputy Chief Minister Manish Sisodia said that the State Police of Uttar Pradesh and Haryana were trying to block the supply of oxygen to Delhi. “This jungle raj has been going on for three days. Some hospitals in Delhi have run out of oxygen completely. They don’t have any option available. I have been receiving calls, messages, emails. We have been making internal, makeshift arrangements, but this cannot continue for long,” he said. Sisodia appealed to the Central government to ensure a steady supply of oxygen even if that meant calling out the paramilitary forces.
The Delhi government also alleged that the Centre was discriminating against it by delivering far fewer oxygen concentrators to it compared with other States. The Delhi High Court added substance to these allegations when on April 29 it pulled up the Narendra Modi government over the limited oxygen supply to Delhi. The court asked the Centre to respond to the Delhi government’s submissions regarding the difference between the amount of oxygen demanded by and allocated to various States.
The submissions made before the court shed light on the fact that Delhi was not getting its allocated oxygen supply even as States such as Madhya Pradesh and Maharashtra were getting more than they had requested. The High Court said: “By no means are we interested in getting for Delhi more than what’s required at the cost of another State. However, if the submissions are to be accepted, the Centre needs to explain the chart.”
The State and the Centre have been at loggerheads ever since Chief Minister Kejriwal live-streamed an inhouse meeting of Chief Ministers chaired by the Prime Minister. Modi appeared to be agitated over the livestreaming and expressed his disapproval during the virtual meeting itself. The Delhi government later clarified that it had had no instructions from the Centre that the proceedings were to be kept confidential. In the live stream, Kejriwal is seen asking Modi whether the two crore people of Delhi should go without oxygen just because the State did not have an oxygen plant. When this footage went viral on social media, it showed the Centre in a bad light.
Kejriwal was, however, not without his share of faux pas. On April 28, his government came under severe criticism and scrutiny over discrepancies in the cumulative figures relating to COVID-19 cases, recoveries and deaths. While the cumulative number of deaths on April 27 was stated to be 15,009, the bulletin issued on April 28 observed that the number was 14,616. This when 368 deaths were registered on April 28. Getting a lot of flak for the discrepancy, the government corrected the figures on April 29 morning, noting that the number of deaths stood at 15,377. The number of total cases was also corrected.
CHAOS IN CREMATORIUMS
Delhi continued to appal people with chaotic scenes at crematoriums. With municipal-run crematoriums facing a shortage of wood for funeral pyres in the face of surging COVID-19 fatalities, North Delhi Mayor Jai Prakash on April 28 urged the Chief Minister to direct the Forest Department to ensure a smooth supply of firewood to these facilities. The Mayor also asked for at least 100 ambulances or hearse vans to be made available to municipal corporations to transport patients to health care facilities or take the dead to cremation grounds.
Several crematoriums in Delhi had to build makeshift funeral pyres as their existing capacity was clearly inadequate to accommodate the number of corpses they were getting. At the Sarai Kale Khan crematorium, at least 27 new pyres were reported to have been built and dozens more are being added in a nearby park. It is reported that the administration is also looking for additional space near the city’s Yamuna riverbed to cremate the dead. The Ghazipur crematorium in East Delhi added 20 more pyres in a parking lot.
The rising graph of fatalities has in some cases led to scuffles between attendants of patients and doctors. Talking about one such incident that took place at the Apollo Hospital in the Sarita Vihar locality, a hospital spokesperson said: “About seven to eight hospital staff, including doctors and security, have been injured after being attacked by relatives of a COVID-19 patient at our hospital in Sarita Vihar. The patient was brought to the hospital and needed ICU, but we didn’t have ICU beds and we informed them. We gave the patient oxygen and emergency care, but the patient passed away. The relatives then started attacking the staff.” The hospital staff sustained minor injuries.
Meanwhile, the Delhi government extended the lockdown by a week, to May 3, in a bid to arrest the alarming spread of COVID-19 in the capital. However, several organisations and groups are already demanding that the lockdown be extended to May 15. The Confederation of All India Traders, a traders’ body, too, supported the call.
From May 1, as vaccination opens for people in the 18-44 age bracket, officials in Delhi told the media that people with comorbidities would be given preference. The Delhi government has placed an order with manufacturers for over 1.3 crore doses. The vaccine is expected to be delivered in phases. m
The Kejriwal government accused neighbouring States of wilfully stalling oxygen supplies to it even as patients continued to gasp for breath.