Telangana Govt’s Fight Against COVID: Retrieving Lost Ground

Former Union Health Secretary, K Sujatha Rao, explains what exactly went wrong in Telangana’s COVID management.

In coping with the COVID-19 pandemic, the Telangana government’s response has undergone three distinct phases:

• denial
• reluctant acceptance
• resignation

These are in keeping with the evolution of the pandemic from Phase I to III –– from low to localised to community transmission, over a four-month period. In Phase I, when Telangana had very low transmission –– the little that was present was fuelled largely by people returning from abroad –– the chief minister led the effort from the front. Though Chief Minister K Chandrashekar Rao enthusiastically called for stringent lockdowns, there was also a simplification and a denial of the seriousness of the disease spread, treating it as a variant of influenza, and declaring that the state would be ‘COVID free’ by 7 April.

With numbers within tolerable limits due to the lockdown, a sense of complacency steeped in, estopping action towards an appropriate testing policy.

Ramping Up COVID Testing

The second phase –– of reluctant acceptance –– started in mid May 2020, after the lockdown was lifted, thereby resulting in a surge of cases. An unusually aggressive High Court threatening contempt, three visits of the Central teams, Opposition parties calling out for public action and a vigilant media, compelled the government to ramp up its abysmal level of testing.

Two lakh testing kits were procured from South Korea, and test rates per day increased from an average of 104 per million to 334 per million as of 15 July.

In addition to the Gandhi Medical College, other government hospitals were also notified for treating COVID cases, and laboratories expanded to include TrueNAT, Rapid Tests and private laboratories, without however, necessarily addressing the price at which such tests and treatment were to be provided. Overall, the tests per million were at about 10 percent, and the number of laboratories notified were less than half, as compared to neighbouring Andhra Pradesh.

• With cases galloping, community spread set in, implying that anyone could be a carrier of the infection, and anyone could get the infection.
• In reality, this is the phase when government intervention is needed the most.
• Telangana has fallen short on several of the components of the comprehensive strategy required for mitigating the dangers of COVID-19.
  
• Trust needs to be restored without delay, as the unintended fallout has been fear, anxiety and apprehensions among the people.
  
• In a country where government departments are understaffed and overworked, piling them with additional targets could have adverse outcomes.
  
• Telangana has done well in bringing a new team in the health department. It needs to be buttressed by deploying more IAS officers to severely-affected hotspots.

Managing the Crisis

With cases galloping, community spread set in, implying that anyone could be a carrier of the infection, and anyone could get the infection. In reality, this is the phase when government intervention is needed the most, as the scale of implementation, resources and imagination has to be much more focused and ambitious, demanding forceful execution on ground, in tandem with a set of three distinct policy packages:

1. On the supply side: Doubling and intensifying efforts with regard to testing, isolating, and treatment. Since caseloads will increase, coopting private hospitals at reasonable rates of compensation, and decentralisation of the efforts in order to expand ease of access will be inevitable.
2. On the demand side: Massive public health education campaigns to educate and remind people to adopt preventive behaviour. Behavioural change does not happen due to government directives or police action, but with repetition and persistent reminders in easy-to-understand language. Maintaining physical distance, using masks, avoiding crowded areas and washing hands are simple messages, but tough to enforce and obey. Given their high value in reducing infection rates, some countries have made such behaviour mandatory, to the extent of imposing heavy fines in the event of non-compliance. But such punitive measures must follow only after a large-scale mass education effort.
3. Mobilising: The active participation of people through engagement of civil society organisations and NGOs for community-based activities such as behaviour change communication, management of isolation, and quarantine centres in rural areas and urban slums, helping patients navigate the health system for treatment and having systems for grievance redressal, helping bereaved families navigate the process of disposing their dead, and so on.

Trust In Telangana Govt Needs To Be Restored Without Delay

Telangana has fallen short on several of the components of the comprehensive strategy required for mitigating the dangers of COVID-19. The media has been relentless in exposing the chaotic conditions that persist in accessing testing and treatment facilities. The poor functioning of government hospitals, the latest being the knee-deep flooding of wards in Osmania Hospital, the non-transparency of data, the inability of government to rein-in the private sector, the stubborn unwillingness to engage and partner with community organisations, the harassment and fear that people face at every stage interfacing with the health system, has adversely affected credibility, and deepened an already-fractured trust.

Trust needs to be restored without delay, as the unintended fallout has been fear, anxiety and apprehensions among the people.

Infectious diseases have to be managed with proactive public health action in order to save lives and avert human suffering. There are models that Telangana can learn from. Kerala has a clear strategy for implementing public health action with comprehensive policies for testing, treatment, migrant welfare, isolation, contact tracing, decentralisation to village panchayats. So does Mumbai, that resulted in achieving the impossible –– zero transmission in Dharavi.

Tamil Nadu has handed over the entire responsibility of transportation and organising the decent burial of deceased COVID patients to NGOs. Nearby Andhra Pradesh started well, but has since rapidly lost control, with a daily caseload of over 8000, which is indicative of ineffective implementation of interventions. In fact, the recent news of Guntur General Hospital mortuaries full of undisposed of corpses and over 350 deaths of patients on dialysis, is alarming.

Of importance is for Telangana to immediately address the growing public perception that the government has resigned and ‘given up’, waiting for ‘herd immunity’ to help contain the pandemic. As a journalist recently said, ‘waiting for herd immunity cannot be a proxy for justifying inaction’.

These perceptions are growing with the news of tired field teams and increasing diversion of senior management to non-COVID routine activities in several states, such as, implementing policies to fulfil electoral promises, restructuring departments, demolishing buildings, organising temple functions, creating political instability, etc –– when COVID management needs undivided policy attention.

In a country where government departments are understaffed and overworked, piling them with additional targets could have adverse outcomes.

With the pandemic spreading into the rural hinterland, mitigation efforts need to become more complex. Rural areas have weak health infrastructure, resources are few, and people’s resilience to such infections is low.

Telangana has done well in bringing a new team in the health department. It needs to be buttressed by deploying more IAS officers to severely-affected hotspots.

The state has the capacity, and vast institutional resources. Telangana, at this moment, needs political leadership to facilitate and enable effective implementation of public health strategies. Neglect can only entail much suffering that may not be easily forgotten.

(K Sujatha Rao is Former Union Health Secretary, Govt of India. She tweets at @sujakrao. This is an opinion piece, and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for them.)