K’taka needs to invest more towards healthcare: State deputy CM

Karnataka is one of the most Covid-19 impacted regions in the country has seen nearly 26000 people succumb to the virus in the second wave

Karnataka is one of the most Covid-19 impacted regions in the country has seen nearly 26000 people succumb to the virus in the second wave. Though the state had initially fared well in containing the spread in the first half of 2020, the pandemic got the better of Karnataka, which has been, among other things, attributed to the indecisiveness of the BS Yediyurappa government. Dr CN Ashwath Narayan, deputy chief minister and chairperson of Karnataka’s Covid-19 task force in a interview with Sharan Poovanna , speaks about the past mistakes, learnings and the way forward in dealing with the pandemic and much more. Edited excerpts.

HT Image

How has Covid management been in Karnataka?

Covid management has to be done at the primary level, but the focus goes on tertiary. In infectious diseases, management goes on basic levels, and we have to ensure it does not escalate or pressure starts to build on oxygen supply, medicine and other things. When this happens, basic level emphasis becomes tough. Unless we understand this, it would be difficult to work.

Was this learning missing in the first wave?

In the first wave, people only spoke if they were positive or negative. Once someone is infected, there is an incubation period and then there is just dead virus in the body. But if the immune process does not respond, then it continues to escalate and becomes a problem. We should understand this and work. But there is a lag in people reporting after getting the symptoms. The sixth-eighth day is very important and if the date of symptoms is recorded, it (disease) can be managed efficiently.

What are the challenges in Covid-19 management during the second wave?

There should be more emphasis on the basic levels, detection, creating awareness among people, etc. The best way is to presume that any symptom could be Covid-19 and they should immediately get a test done. That urgency should be from both the government and people. If this kind of connection is there, 90% of our job is done. This makes it easier to triage and then take appropriate action, whether to keep them in a Covid care centre (CCC) or in home isolation. In rural areas, it is better to keep people in CCC to control the spread and monitor them. To make it gold standard, inflammatory tests should be done.

Were logistics like medication, ramping up beds and other requirements a big challenge?

These medications do not cost much. All put together it will not cost more than ₹200-250 per person. Even if you give a pulse meter, it won’t be more than ₹700. The entire rush for hospital beds, oxygen and other things can be avoided if handled properly initially. That situation should not be allowed to arise. Majority of it has been handled. Compared to other countries, we are far superior in our care. But these situations shouldn’t come up.

We saw the healthcare system in Bengaluru almost collapse.

The demand was more. Our triaging system was not strong. Those people who do not require hospital, were also admitted. The numbers also increased drastically and there was no time to correct themselves. In the first wave, if there was a mistake, there was about a week to rectify it. This time there was less than one hour as the virus was spreading very fast. The incubation period in the first wave was 15 days and now it is 2-3 days. But damage could have been less. We predicted that the second wave will be more, but disease impact will be less. But both were more this time. Normally, it was believed that there would be less virility. When a virus mutates, incubation comes down and so does virility. But surprisingly, virility did not come down.

By this estimate, the third wave should be more dangerous.

Ideally, it shouldn’t be. But the second wave itself behaved so differently and it is difficult for us to tell.

How are we preparing for the third wave and what are the challenges?

We can’t predict this; but will need to scale up our health infrastructure. We are not at any loss if we prepare more. If you look at our health infrastructure, it was not that great. It needs to be scaled up even for our day-to-day needs. It should definitely be improved, and we need to spend a lot. There should be more towards healthcare investments. If we do not do it now, it will be a crime.

Was there a clear lack of vision and decision making?

Preparations had been done. Hospital beds have been scaled up to 25,000 oxygenated beds when compared to earlier. 3000 ventilators were also added but that was not enough. Demand for hospitalisation surged and duration of stay was very long. Some people refused to leave the hospital even after being cured. Several private players also failed. We needed proper manpower, systems but this did not happen.

Had the government not predicted the scale of the second wave?

No one knew the scale of the pandemic and how serious it would be. There was a belief that the second wave too would go the same way as the first one. There was no time to repair and set the process right.

The technical advisory committee had warned the state government in November. Why was no action taken?

The projections, mathematical models and other predictions were there. But many people didn’t take it seriously. They knew it would come, there was preparation and a system, but no one predicted the scale.

Has the Centre’s decision to take control over vaccine, oxygen and medicine supply become a problem?

Without the Centre’s intervention and managing the system, it would have been difficult. How can we negotiate since there is nothing that we manufacture? So, the support system was good, allocation, medicine procurement, if not for them who would ask pharma companies for Remdesivir. There was exemptions for raw materials. They (Centre) facilitated and worked hard to help ramp up services.

Karnataka has floated a global tender. Can the likes of Pfizer and others also participate?

Anyone can participate. There are some approvals and coordination that are required and there are certain criteria and conditions, but it can be done. We needed 65 million vaccines and we have placed orders for 30 million. But they (SII and Bharat Biotech) were taking time to supply and by this time there was a huge demand. We are trying hard to the best of our capability. We have done this for Remdesivir as well.

You had said that everyone in the state can be vaccinated by the end of this year. Is this a realistic target?

This is definitely possible. By August, we should have completed giving at least the single dose to 25-30 million people. We can reach over 20 million by August and by December we can provide everyone at least the single dose.

Why was healthcare taken away from the BBMP?

There was no expertise, infrastructure, manpower and capability. How much can BBMP spend? At the government level it is good and in BBMP, that priority is missing. We can replicate what we did at Zilla Panchayat level and make it accountable to BBMP. Bengaluru is the bread earner for the entire state, if there is a problem here then from where will the revenue generate for the state?

The chief minister said that there will be no lockdown, but he did go back on his words.

When the numbers increased, we couldn’t have managed without a lockdown. When numbers started to surge, people as well the opposition started demanding for a lockdown.