Chennai under control, but these districts are pushing TN’s COVID-19 tally higher by the day

Senior health officials in Tamil Nadu are now hoping to replicate the Chennai strategy — testing, containment and surveillance — to southern districts where cases have been steadily rising.
No lockdown, porous borders: How TN's southern districts upped state's COVID-19 tally
No lockdown, porous borders: How TN's southern districts upped state's COVID-19 tally

Over the last two weeks, Tamil Nadu's capital has been gaining an edge in its battle against the COVID-19 pandemic. From over 2,000 positive cases everyday at the end of June, Chennai’s numbers have plateaued to close to 1,200 cases a day. Despite Chennai managing to keep a lid on further clusters of infection, however, the total number of cases in the state is steadily climbing.

The state has added 1,09,565 patients between July 5 and July 27. This is after the lockdown was relaxed across several districts. During this period, Chennai has contributed 27,603 cases or 25% of the cases. Overall, the city has contributed to 43.43% of the total cases in the state since the outbreak.

Districts surrounding Chennai — Kancheepuram, Tiruvallur and Chengalpattu with 32,564 cases so far, constitute 14% of the overall cases. Along with the state capital, these districts in north Tamil Nadu have seen a huge rise in infections over the last few weeks. Similarly, another upward trend was observed in south Tamil Nadu including in Madurai, Theni, Dindigul, Sivagangai, Virudhunagar, Tirunelveli, Ramanathapuram, Thoothukudi and Kanyakumari. Overall, these districts contribute to 18.9% of the total cases.

TNM plotted the rise in cases from seven districts in the state over a period of eight weeks between June 5 and July 24. While Chennai went into a full lockdown from June 19 to July 5, parts of Chengalpattu, Kancheepuram and Thiruvallur also saw restrictions imposed at the same time.

Chengalpattu

Chengalpattu witnessed a 596% increase in cases from June  5 to July 24, going from 1,624 coronavirus cases to 11,308 cases within a span of eight weeks. Between June 12 and June 19, Chengalpattu had recorded an average of 123 positive cases a day. For the next 17 days, parts of Chengalpattu went into a lockdown. Chengalpattu saw an average of 174 cases daily between June 19 and June 26, increasing by 22% the next week to 212.57 cases a day. The effects of the lockdown appeared to slow infections over the next two weeks.

However, cases went back up and between July 17 and July 24, Chengalpattu saw 324 cases a day — a rise of 62% from the previous week.

As of July 27, Chengalpattu has 3,304 patients being treated for COVID-19, while the total number of coronavirus cases in the district stands at 12,717. The district has recorded 233 deaths due to COVID-19, with a case fatality rate of 1.83%.

Kancheepuram

Kancheepuram recorded a whopping 1,216% jump in COVID-19 cases in a span of eight weeks. The district went from a total of 483 cases on June 5 to 6,361 COVID-19 patients on July 24.

Kancheepuram reported an average of 50 cases a day between June 12 and June 19, the week before the partial lockdown. However, despite restrictions, COVID-19 cases continued to increase. Kancheepuram went from an average of 82.71 cases per day between June 19 and June 26 to 98.85 cases a day the following week. 

Between July 10 and July 17, Kancheepuram averaged 189 cases per day — a nearly 60% rise from the previous week’s number of COVID-19 patients. Since then, the average number of cases per day has increased to 277 for the week between July 17 and July 24.

Kancheepuram has 2,891 active patients as of July 27, with the district recording a total of 7,527 cases. A total of 94 persons have died due to COVID-19, with Kancheepuram’s case fatality rate at 1.24%.

Tiruvallur

In a span of eight weeks, Tiruvallur went from a total of 1,191 coronavirus cases on June 5 to 11,008 COVID-19 patients on July 24. That was a jump of 824%.

Like Chengalpattu and Kancheepuram, Tiruvallur’s average number of cases have also steadily increased over the past few weeks despite the partial lockdown. The average number of cases per day was 77 for the week between June 12 and June 19. However, Tiruvallur has averaged 382 cases per day between July 17 and July 24.

As of July 27, Tiruvallur has a total of 12,320 cases, with 3,998 patients receiving treatment presently. The case fatality rate stands at 1.73% with 214 deaths reported in the district.

Cases in southern districts

The rise in cases in this region was particularly noticeable in Madurai, Theni, Thoothukudi and Virudhunagar. These four districts alone have seen 26,308 COVID-19 cases in the last four months and contribute to 11.91% of the overall cases. Between July 5 and July 27 alone, these districts constituted 17.4% of the total cases reported in the state. 

Madurai

The district saw a 3,196% jump in cases between June 5 and July 24.

Between June 19 and June 26, the district saw an average number of 132.42 cases per day. And on June 24, a complete lockdown was imposed in Madurai; but it had no immediate effect. Between June 26 and July 3, the number of cases doubled from the previous week to 278 per day and the week after that, between July 3 to July 10, it increased to 294 cases per day.

Between July 10 to July 17, the district saw an average of 339.42 cases per week. While the lockdown was lifted on July 15, its effects began to show soon after, with cases plummeting to an average of 206.28 between July 17 and July 24.

A total of 216 people have died in the district so far and the case fatality rate is 0.097%. As of July 27, Madurai has recorded a total of 10,057 cases, with 2,032 patients being treated presently.

Theni

The district saw a 2,744% jump in cases between June 5 to July 24. 

From an average of just 41.74 cases per day between June 19 and June 26, the average number of cases grew to 156 between July 17 and July 24. Despite a lockdown similar to neighbouring Madurai, cases rose in Theni after July 17.

Theni has reported a total of 4,053 positive cases so far, with 1,962 patients being treated presently. A total of 49 people have died in the district so far and the case fatality rate is 0.02%

Thoothukudi

The district saw a 1624.5 % jump in cases between June 5 to July 24. 

What started off as an average of 37.14 cases per day between June 19 to June 26 increased to 263.14 cases per day between July 17 to July 24. The biggest spike came after July 3. Between June 26 and July 3, the average number of cases per day was 38. But between July 3 to July 10, this number rose to 127.7 cases per day. This is a 236% increase in cases per day.

There was no lockdown in the district either and cases have been steadily rising over the last six weeks.

A total of 29 people have died in the district so far and the case fatality rate is 0.01%. Thoothukudi has recorded a total of 5,896 COVID-19 patients. Out of this, 2,439 are active cases.

Virudhunagar

The district saw a 3,657% jump in cases between June 5 to July 24.

Similar to Thoothukudi, Virudhunagar also saw a huge spike in cases over the last six weeks. What started off as just 19 cases on average per day between June 19 and June 26, rose to an average of 320 cases per day between July 17 and July 27.

From July 17 to July 24, there was an 85.5% increase in cases.

A total of 63 people have died in the district so far and the case fatality rate is 0.9%. Virudhunagar has reported a total of 6,302 cases, with 2,321 patients at present. 

What is leading to this rise?

Public health experts and government officials both tell TNM that the rise in cases in districts surrounding Chennai and in southern Tamil Nadu was expected.

“The way the Directorate of Public Health envisioned this is that Phase 1 of the pandemic would be the two clusters: the Tablighi Jamaat and Koyambedu. Phase 2 was supposed to be Chennai. Phase 3 was the districts surrounding Chennai,” explains former Director of Public Health K Kolandasamy.

“The fourth phase was then expected to be Madurai and Coimbatore because these are pretty much Tamil Nadu’s second headquarters. Other southern districts were expected to face the brunt of the pandemic in Phase 5,” he explains. 

Sources in the DPH, however, point out that Phase 5 came sooner than expected. In  Thoothukudi and Virudhunagar, in fact, the government didn’t see the need to impose a lockdown between June 24 and July 14, when Madurai and Theni were made to follow major restrictions in movement. 

“This is definitely our major concern right now. We are focussing on Madurai and other southern districts,” a nodal officer monitoring the crisis tells TNM. “The movement of people to these districts before the last lockdown in Chennai has been one reason for increase in cases. And in general, there is a lot of movement here. We have stepped up efforts to control cases there currently. We have intensified border checking, increased number of samples tested and improved health infrastructure,” he adds.

Experts say that rise in cases in districts like Virudhunagar and Thoothukudi went unnoticed because they were not considered centres for business or heavy movement. 

“But in an arid district like Virudhunagar, there is a large movement of individuals who depend on other districts for work,” points out Kolandasamy. “Virudhunagar is also a geographically big district and the effect of the virus was not expected to be this intense. More restrictions may have helped keep the number of cases down,” he adds. 

In Theni, he further adds, there are two points of entry from Kerala — Munnar and Thekkady, which has led to an increase in cases.

“Theni is also full of small towns. It has six municipalities and 20 town panchayats,” he explains. “Density of population is a factor in the spread of the virus,” he says.

In districts surrounding Chennai meanwhile, a delayed response could be responsible for the quick rise in cases. 

According to a senior health official in the state who spoke on the condition of anonymity, while aggressive testing, house-to-house screening and focus on fever camps was the strategy for Chennai, relatively lower cases in other districts meant that initially, the need for testing was not felt.

“In Kancheepuram for instance, the lockdown was very localised. It wasn’t the entire district under lockdown. It was basically GCC (Greater Chennai corporation) limits under lockdown plus select areas of Kancheepuram,” he says.

How will the government tackle this rise?

Speaking to TNM, Dr TS Selvavinayagam, Director of Public Health, says that across the world, the rate and pattern of infection has been very different within any kind of geographical boundaries.

“In different districts, the rate of infection is in a different phase. This is seen globally as well. But irrespective of the stage at which the pandemic is, testing, containment and fever surveillance will be the strategy to control it,” he explains.  

A senior health official points out that a strategy similar to Chennai’s will be carried out in districts surrounding it and in southern Tamil Nadu.

“In Kancheepuram, Thiruvallur and Chengalpattu, aggressive testing will help in identifying cases. We will be able to isolate and treat these people and automatically the spread will start coming down. It’s like an upside down umbrella hook - it will go like a ‘U’ and then come down. We are keeping our fingers crossed for the next week or so. The government is hoping that aggressive testing will help us in isolating positive cases. My feeling is that aggressive testing along with effective containment and perimeter control will definitely help in bringing it down sooner rather than later,” he adds. 

Health experts predict that in another month, the neighbouring districts will have their cases under control. It will then take an equal amount of time for cases to reduce in Madurai and other southern districts. Madurai, for instance, is seeing early signs of stabilization.

“But even as these districts manage to reduce cases, numbers will rise in others. Puducherry, Vellore, Ranipet, Hosur, Salem, Tiruppur, Coimbatore and Dindigul are likely to see the next spate of rising infections,” says Dr Kolandasamy, adding, “Cases in Chennai may seem to be coming down now. But this only means that we can’t afford to let our guard down. Carelessness could break the momentum.”

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