VIJAYAWADA: The number of coronavirus cases is bound to increase as people move about. But rather than focusing on the inevitable, the government is working to reduce the mortality rate, Special Chief Secretary (Health and Family Welfare) Jawahar Reddy told TNIE in an exclusive interview on the government’s pandemic-management strategy.
Early testing is essential to bring down the mortality rate, he asserted, adding that it would give doctors more time to treat those whose lives are at risk. "Besides this, it is important to test people from different categories. We are now testing people at random in industries as people have arrived from outside and transportation has resumed," he explained.
Those who test positive and have mild symptoms might be able to recover in home isolation, but experts say that within the next two months, 40,000 people in the state will need to be hospitalised. To prepare for this, the government is planning to add 40,000 hospital beds to supplement the 30,000 it has. It is also trying to get 15,000 beds at COVID care centres, Jawahar Reddy revealed.
Asked whether he sees signs of community transmission in the state, the official responded, "We have not been able to link a few cases epidemiologically, perhaps because we have not been able to get the contacts due to lack of in-depth research... If at all it is there now, it is only at a beginning stage. With so much movement happening, we have to be prepared for such kind of a situation as well."
State preparing for 40,000 hospitalisations in next 2 months
In an exclusive interaction with Ritika Arun Vaishali, Special Chief Secretary (Health and Family Welfare) Jawahar Reddy spoke about the government’s strategy to contain the spread of COVID-19 amid the increased movement of people both within and across the State’s borders.
Excerpts from the interview:
With more people outdoors these days, what is the government’s strategy to restrict the spread of coronavirus?
Generally, the strategy for an infection of this magnitude is to implement community surveillance. The Central and State governments did this. Whenever a case was reported, we ensured cluster containment, contact tracing and testing, besides isolating those who were infected and treating them as per their risk profile. Now that the lockdown norms are being eased, the number of cases is bound to rise. We observed this in other States, and are now observing it in Andhra Pradesh as well. The focus is now on reducing the mortality rate and saving lives rather than being concerned over the rising number of cases.
For this, testing must be focused on places where positive cases are detected, and high-risk people, including those above the age of 60 years and those who have comorbidities, should be tested immediately.
We are working to ensure the time between detection and death is more than six-seven days, so doctors have enough time to treat patients. Despite our efforts, cases are reported late and sometimes doctors only get a day to treat patients. In such cases, the mortality rate is high. Hence, apart from community surveillance, we are focusing on testing people in the high-risk category, and all of them, if possible, should be admitted to critical care hospitals. Those who have mild symptoms can be admitted to other hospitals, and if possible, we can have these people isolated in their respective houses.
Besides this, it is important to test people from different categories. We are now testing people at random in industries as people have arrived from outside and transportation has resumed. Tests are being done in markets, temples and malls, especially among vendors, as they could be super-spreaders. This is being done to avoid developing a big cluster which could go unnoticed. So, for surveillance, we are testing these people, and to prevent deaths, we are testing people in the high-risk category.
What is the current situation with regard to testing in the State?
At present, the testing capacity is in the range of 15,000-17,000 per day, both TrueNat and RT-PCR put together. Recently, even TrueNat was made a confirmatory test. We would like to increase the testing capacity to about 20,000 samples per day, and if we witness a sudden surge in cases, we should be able to test as many samples as possible.
Several people have been hired on an outsourcing basis. When the pandemic began we only had one testing laboratory, but now have 13 labs in all districts. This apart, four more private labs recently got permission from the Indian Council of Medical Research (ICMR) to conduct tests. We are also using the pool sample testing method rigourously. We conduct close to 9,500 tests per million, which is the highest among States, so our testing process is robust. Samples are also being collected faster, and all staff at PHCs have been trained in collecting samples.
Some district collectors have hired Intelligent Monitoring Quarantine Analysis Service buses, which can collect 10 samples at a time. Vehicles have also been deployed to collect samples at people’s doorstep. Results are given the day after samples are collected. A few days ago we started sending messages to all people who were tested, irrespective of their results.
We are also trying to maintain the supply of testing kits, RNA extraction, Viral Transport Media, despite the expenses. Each test costs around `1,000. We have a proper system for monitoring demand and supply, and the State is quite comfortable with its supplies. We are also aggressively procuring the material required. The fact that we conduct 10,000-12,000 tests per day shows we do not have a conservative approach to testing.
How many private hospitals and/or doctors have volunteered to treat COVID-19 patients?
We are working in close coordination with private hospitals, and have already taken all private medical colleges as our district COVID hospitals. They have been quite forthcoming. A few hospitals in each district are helping us in the COVID campaign. Currently, we only have the support of private hospitals that are registered under Aarogyasri, as COVID procedures are covered under Aarogyasri. There are about 15-20 such hospitals. But not many of them are actually treating Covid-19 patients.
We are seeking tie-ups with private hospitals and are working on framing standard operating procedures (SOP) for them. Hospitals that are willing to follow the existing protocols of demarcating the wards (COVID special and general treatment) can start treating COVID-19 patients after getting the government’s approval. We have also provided testing kits to several private hospitals as they were getting symptomatic patients. They collect the samples and send them to our labs. We will soon bring an SOP for private hospitals to treat COVID-19 patients.
What is the status of beds and ICUs?
The State has 20,000 normal hospital beds, 10,000 oxygen beds, and over 1,000 ventilators. Considering experts’ predictions, we are trying to procure 40,000 more beds, including 15,000 oxygen beds. Of these 15,000, we will have 5,000 ICU beds. Besides this, we are trying to get 15,000 beds at COVID care centres. The State is also trying to get permissions from the ICMR to procure 50 more TrueNat devices and 20 more RT-PCR machines.
What is your assessment of the increase in the number of cases in the next two months? Do you see any signs of community transmission?
Experts suggested that the State prepare for 40,000 hospitalisations. In such situations, it is always better to be over-prepared rather than under-prepared. There might be a phased increase in the number of cases, which will help the government take better measures. We expect Kurnool, Guntur and Krishna districts to have their peak first, followed by Nellore, Chittoor and Anantapur.
If the peak wave passes through one group of districts onto another, we can chip in resources from other districts. With regard to community transmission, as of now, we try to link all new positive cases to a known one, which is known as epidemiological linking.
We have not been able to link a few cases epidemologically perhaps because we have not been able to get the contacts due to lack of in-depth research. We may get it if we invest more time. If at all it is there now, it is only at a beginning stage. With so much movement happening, we have to be prepared for such kind of a situation as well.