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On 23 July 2020, Tamil Nadu recorded an all-time high of 6,472 coronavirus cases, making it the highest single day spike so far. This sounds striking, but here's another bit of information. While the state has recorded the second highest number of coronavirus cases in the country, next to Maharashtra, but is also testing more than 50,000 persons everyday.
It took 60 days for positive cases to cross the 5,000 mark in the state, and it took a mere eight days to cross the 10,000 mark and another eight days to cross the 15,000 mark.
Despite the high numbers, Tamil Nadu, with a population of over 8 crore, has been commended for the way it has handled the pandemic.
The Quint spoke to experts and medical professionals to find out the five lessons the rest of India can learn from the state.
‘Testing, masks, early treatment’ is the (only) winning mantra, cited by all experts.
1. Early Detection
We are literally chasing coronavirus to catch it at the earliest, was what Dr J Radhakrishnan, the state health secretary said in June to explain the way the state was working on early detection of cases.
Every person traveling to Tamil Nadu by road, rail, air and sea is checked for their temperature and only if they doesn’t exhibit any symptoms, is sent home and advised strict home isolation for 14 days. Anyone showing symptoms of COVID-19 is transferred to a COVID care centre, and if these symptoms get severe, they are admitted in a hospital immediately. Dr Paranthaman, the head of the department of the medicine ward at Kilpauk Medical College said that extensive screening and confinement of zones has helped in controlling the spread.
“Government is doing a wonderful job and COVID care centres, over 50-60, have been started only in Chennai. Every week we discuss advancement in the medical field, in terms of treatment and scientific advancement. We keep changing protocols, treatment and diagnostic strategies, so we are able to implement the effective measures to tackle the disease,” he said.
During the 14 days of isolation, if one is tested to be positive and is asymptomatic, he is advised to seek treatment at home and is continuously monitored by medical health professionals. The Chennai Corporation has deputed workers in every area who come door-to-door every 3-7 days to check on all family members for their temperature, blood pressure and thyroid levels.
“We need to approach this scientifically and not be affected by increase in positive cases and hospitalisation of patients. Because the more you find out, you can isolate, contact trace and quarantine those who are likely to get affected. And then you can manage them better because you can get them hospital help. We've seen that so far most deaths happen because they don't come to the hospital on time,” said Dr Ramasubramanian, part of the state medical expert team advising the government.
The state was under a strict lockdown till 6 July and even after that there are strict restrictions on the movement of people across district and state borders. Public transport has not been allowed and auto rickshaws and cabs can ply with only two passengers other than the driver. In order to enter the state or move to another district, you will need to get permission for travel, by applying for a travel e pass. Any movement to and from a containment zone is strictly prohibited.
2. Aggressive Testing
During the initial period of the pandemic, the state was criticised for the low number of testing done. In the first week of April, the state tested around 2,700 samples, and by the end of April, the number of persons tested was 9,643. By 15 May, the number of persons tested everyday rose to 10,883, 18,403 on 15 June, 39,715 on 15 July and by 22 July, the number has crossed 50,000 everyday.
As on 23 July, Tamil Nadu is number 1 is testing having tested nearly 21 lakh persons, ahead of Maharashtra, Delhi, Karnataka, Andhra Pradesh.
Many experts said that media has been irresponsible by spreading panic with the rise in number of cases as ‘more we test, more (and sooner) we find out'.
“Despite Trump not helping out, see how the US has done over 45 million tests for a population which is one fourth the size of India. And we've done only 10 million tests so far. But Tamil Nadu has done a stellar job despite the media hype. They kept testing which is a very wise thing to do which has helped contain things better, making sure the mortality rate is low,” said Dr Ramasubramanian.
As on 24 July, there are a total of 114 -- 58 government and 56 private -- COVID -19 testing facilities in the state. 53,132 persons are undergoing treatment at home.
3. How the Sudden Spike in Other Districts is Being Managed
Of 1,75,678 cases in the state, 87,235 are from Chennai. However, what needs to be observed is that in contrast to 2,000-2,500 cases recorded everyday in June in Chennai, the number has significantly dropped to 1,200-1,500 cases daily by July.
The doubling time of COVID-19 in Chennai is now at 47 days, compared to the national average of 21 days.
Greater Chennai Corporation Commissioner G Prakash said that they are working to bring down the positivity rate in the city from 10-12% to 8-10%. Rapid testing, strict lockdown and isolating containment zones is what helped handle the surge in the city, experts cited.
While May to June saw many districts record single-digit number of cases and some days even zero, July saw many districts climb the ladder.
There has been a lot of criticism that the testing has been concentrated in Chennai. But experts stated that the state capital had recorded a majority of cases due to its population and influx of people by road, rail, air and sea. However, once the lockdown was lifted, other districts, like Chengalpattu (9,658), Thiruvallur (9,110), Madurai (8,251), Kancheepuram (4,739), Vellore (3,948), Thiruvannamalai (3,916), Thoothukudi (3,441) and Virudhunagar (3,393) began recording a spike.
“This is inevitable,” said Dr Ramasubramanian. “Chennai, Mumbai, Delhi and Ahmedabad were ahead of the curve with cases concentrated here predominantly. But we are at a stage where it is plateauing. Now it is Hyderabad, Bengaluru, Trichy and Madurai which are going ahead now. This is not unexpected," he said.
“And in a few months when Tamil Nadu is at 0 other states will still be at a peak and will take time to come down. There is a possibility that we will hit another spike in 3-4 months, so we have to be prepared.”Dr Ramasubramanian
The health secretary has assured that they have increased testing in these districts now and all measures that were imposed in Chennai have been applied here as well. They have mapped all streets by allocating one officer to monitor 300 persons, movement has been strictly curbed in and out of containment zones and daily check of the residents living in these areas is going on. Dr J Radhakrishnan said that 25-30% of people in these districts are not wearing masks and so the district administrations are using novel methods to inform people.
4. Masks and Physical Distancing
The state has strictly instructed that those found not wearing a mask and violating social distancing will be strictly penalised. Everyone is advised to shop only in a two kilometre radius, work from home and avoid any travel that is not essential.
Customers will not be allowed to shop for groceries, essentials, clothing, anything for that matter without a mask. Women dressed as goddesses, men dressed like the God of death, even an ambulance with a fake COVID patient to scare those who are not wearing masks -the state is trying many innovative methods to impose the rule.
As on 22 July, 8,07,214 persons have violated the rule of moving freely without a valid reason and over 6,46,689 vehicles have been seized.
Dr Jacob T John had proposed that the solution to handling this pandemic that is equal to the lockdown, but also helps in maintaining economic stability, is ‘100% mask wearing.’
5. Just a Lockdown Cannot Stop COVID
While the lockdown has definitely helped in curbing the spread of the virus, experts say that it is not a rationale decision to impose a lockdown every now and then. The initial lockdown in Tamil Nadu was till 30 June, and despite the state medical expert team recommending that an extension is not warranted the state government imposed a complete lockdown till 6 July.
Dr Ramasubramanian told The Quint that the reason could be “because they were not able to handle it. Ideally, what would be good is focal containment in areas with increasing number of cases rather than putting the whole of Tamil Nadu in quarantine. But they had issues with staffing and implementation of such a focal quarantine.”
Criticising West Bengal government’s order to impose a complete lockdown for two days every week, Dr Ramasubramanian told The Quint, “I don’t understand the rationale behind this. We need to have a comprehensive scientific team advising the bureaucrats. You need a public health person, a clinician, someone from WHO which is what happened in Chennai. An advisory team is very important and discussing it with the team and being transparent is very important. And a good communication between the various agencies like the police, corporation and the public health department.”
Tamil Nadu boasts of one of the best healthcare systems in the country and doctors said that this established system has been extremely useful during this pandemic. Video conference meetings are held every week when heads of all hospitals, the medical expert team, health department officials and other functionaries discuss the course of action, making sure to stay up-to-date with the latest trends and developments in the field. Doctors also said that following a lot of criticism that hospitals were understaffed, the state has extended a lot of facilities to hospitals, medical staff and even looked into appointment of more staff to handle the influx of cases.
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