As cases drop in cities, TN shifts Covid fight focus to hinterlands

As the Covid-19 tally in Chennai, which was witnessing the highest number of daily cases in Tamil Nadu, remained static for a week, all concerns have now shifted to the number of infections and disproportionate death rates in smaller cities and hinterland with less healthcare facilities

As the Covid-19 tally in Chennai, which was witnessing the highest number of daily cases in Tamil Nadu, remained static for a week, all concerns have now shifted to the number of infections and disproportionate death rates in smaller cities and hinterland with less healthcare facilities.

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On May 20, a two-tier city like Coimbatore reported 3,335 new cases and 20 deaths while a small district like Dindigul reported 389 new cases and 19 deaths. While Thiruvallur reported 1,791 cases and 20 fatalities, Vellore registered 567 cases and 36 deaths on the same day.

While intensive care units (ICUs) and oxygen beds were available in Dindigul’s single Covid hospital, three government hospitals in Coimbatore had none of them available.

“This is an indication of not just the state of the health infrastructure but also delay in detecting cases and timely-transportation of patients to hospitals. Our test-trace-isolate strategy has to be strengthened in rural areas and small towns,” Dr Prabhdeep Kaur, deputy director, National Institute of Epidemiology, said.

“We did a lot in Chennai, everyone knows where to go for tests. There is so much awareness that the moment a person develops a symptom, they think maybe it is Covid. They get tested or if there is reluctance, they consult a doctor immediately. But that doesn’t happen in small towns and rural areas.”

In Trichy district, for instance, fresh cases reported in its rural blocks have surpassed the urban areas in the past one week. From an average of 300 new cases, the figures jumped to 800 cases per day.

“As the virus shifts from the major cities to smaller districts, I feel we are not prepared enough as the resources are less compared to Chennai to scale up. We need to assess the capacity, man power, oxygen beds, ICUs, testing capacity in smaller districts,” Kaur said, adding that the government could consider introducing rapid antigen tests in areas with limited laboratories to conduct RT-PCR testing.

State health secretary J Radhakrishnan also said that though the Covid tally is static in Chennai and adjoining districts, the government is concerned of rising cases in major cities and towns like Coimbatore, Tiruppur, Erode, Thoothukudi, Madurai and Trichy as well as smaller towns like Ariyalur.

“We are currently increasing oxygen-supported beds in the districts and we are planning to bring in a district-level containment plan,” Radhakrishnan said. The state has also decentralised its Covid-19 war room, presently functioning in Chennai, and has opened a Unified Command Centre in each of the remaining 36 districts. The helpline will triage patients and find oxygen and ICU beds for them.

Tamil Nadu has been witnessing a rapid rise in cases among India’s 20 most populous regions even as the curve is on a downward trend in Maharashtra, Karnataka and Kerala. In the past one week, the state has reported the fourth highest number of daily cases in the country in absolute numbers – only Maharashtra, Karnataka and Kerala are reporting more infections on a daily basis right now.

On Tuesday, with 33,059 infections in 24 hours, Tamil Nadu reported the highest number of infections in terms of daily count across the country.

No ICU beds but a few oxygen-supported ones were available across Chennai’s government and private hospitals as of 7 pm on Friday.

On Sunday, the state reported 35,483 cases and 422 deaths, taking the overall tally to 1,842,344 and 20,468, respectively. Chennai alone reported 5,169 cases and 81 fatalities.

“We are decentralising oxygen centres across the city where patients can be supported with oxygen until a hospital bed is vacant. At least 3,000 such beds are being planned,” Greater Chennai Corporation commissioner Gagan Singh Bedi said.

Civic officials attributed the drop in cases in Chennai to surveillance and a change in strategy in triaging. For those below 60 years of age and no comorbidities, the corporation’s health team triaged the patients at home to prevent them from coming to screening centres and therefore, reduce the risk of further spread and exposure.

“The state has a pragmatic triaging protocol that empowers the primary healthcare system to take care of mild, moderate patients,” Kaur said.

“They initiate treatment even for severe cases while they are being transported which means the delays get reduced. This should help especially in the rural areas and smaller districts so one doesn’t have to wait till they reach the hospital to start treatment. This should help in reducing deaths.”