When the image of Chief Minister M.K. Stalin donning a PPE kit to go into the COVID-19 wards in the western region hit social media, it expectedly spiralled into viral status. His act of walking into the COVID-19 high-dependence units and ICUs where the sicker patients are receiving treatment, despite the advice to the contrary from doctors, brought him praise across the political spectrum, but it was likely planned as more of a confidence-building strategy.
With the western districts piping Chennai to the post heading the number of daily cases, Mr. Stalin’s act had a lot of tactical significance too — it would tell the people of the district that the Chief Minister was with them at this very crucial juncture; it would also tell the people and the doctors that he summons the weight of the health machinery to their assistance.
Even in the first wave, the trend of the western region falling into the Chennai pattern after a couple of weeks was quite obvious. A similar trend has come to play in the second wave too, except this time the total numbers have shot past the Chennai figures, once the number in the metro began to fall. According to the Union Ministry of Health’s figures, the test positivity rate (the percentage of positive cases among all the tests conducted) for the last one week is the highest in the western region, at 28.6 %, while in the rest of Tamil Nadu it was 17.67%. While the western region accounted for 18% of the daily cases on May 1, it accounted for 35.9% on May 30. While Tamil Nadu’s own figures might point out a more keen difference, the trend is along predictable lines.
Lockdown buys time
But working with the spare time that the two-week lockdown provided, and based on the projections of the epidemiological curve, health officials took up a targeted approach in these regions. While efforts were made to nearly double the infrastructure, a localised strategy was employed, with the rural and urban divides and the special requirements of tribal and remote areas and forests factored in.
Health Secretary J. Radhakrishnan said the focus is on these regions showing higher daily test rates — and disease containment. Non- compliance with the protocols and low testing rates were noticed in these areas, and “we decided to reset these things.” “While Coimbatore was testing high numbers, we had to ramp it up in the other areas. We are also working with the local governments to ensure that people come in early for testing and treatment, and possible migration within the western region as carrying infections across was also on our radar.”
The two-week lockdown has served its purpose of reducing the burden on the healthcare system, says a senior health official. Meanwhile, efforts are on, using the epidemiological projection models to expand and strategise as per the local requirements, he adds. Health officials are hoping to use the next week to put in place a field surveillance, of which goal is to have one person from within the community visit every house in the State every day for a status check.
This has been the cornerstone of the Tamil Nadu strategy, while the inspiration was derived from the Chennai model of the focus volunteer and syndromic surveillance, dropping the importance of RT-PCR tests or CT scans. The focus shifted to treating people for their symptoms. Simultaneously, the test-and-treat strategy was also used, with the goal of bringing in people with mild symptoms early for treatment and reducing the dependence on intensive care units, and conservative use of steroids.
The strategies have to be different. What works in urban areas will not necessarily work in rural areas; even the messaging needs to be constructed differently. “We are attempting a kind of ring-fencing attack in rural areas, to implement a lockdown there is not very easy. We need to have the populations understand that closing down for a while is for their own benefit,” the official explains. In the west of Tamil Nadu, a variegated landscape will have to be catered to – there’s urban Coimbatore and Tiruppur, agrarian areas in Coimbatore, Namakkal and Salem, hilly and forest regions in the Nilgiris, hardcore rural pockets in Krishnagiri and Dharmapuri.
Apart from this, there was surge capacity planning from the Unified Command Centre in Chennai, depending on where each district is on the epidemiological curve. The implementation is done by the local body or the district administration, with monitoring assigned to the UCC.
The advantages of the lockdown must not be frittered away. Whatever time the State bought with the total lockdown, it must it use effectively. A lockdown cannot last forever, the economic and social impact of it would be prohibitive. Even as the State mulls a slow lifting of restrictions after June 7, it will have to work doubly hard during this week to ensure that whatever gains achieved so far are not surrendered to the subsequent waves of the infection.
