In an interview to TNM, Health Secretary J Radhakrishnan speaks about the state’s effort to bring down COVID-19 cases, evolving a vaccine strategy and more.

Tamil Nadu Health Secretary J Radhakrishnan wearing a white shirt and speaking into a mic
news COVID-19 Tuesday, October 20, 2020 - 18:21

Tamil Nadu continues to see a steady decline of COVID-19 cases over the last month with the number of new infections dipping below 4000 this week - the first time in 99 days. TNM caught up with Health Secretary J Radhakrishnan who has been observing patterns, devising strategies and fighting the virus on ground. But even as the number of cases drop, the bureaucrat says the state machinery cannot consider this a victory yet. In fact he adds that if at all there is a time to worry, it is now.

Cases in Tamil Nadu have dipped to below 4000, what was the breakthrough that brought down numbers?

When we first began tracking cases, we looked at the numbers ward-wise and zone-wise. Our first breakthrough was devising a plan for streetwise micro containment. We did a thorough analysis to see which zones and wards had the maximum cases. From here we broke it down further into streets because we realised that if say, Teynampet had a huge number of cases, this didn't reflect on the whole area. Only a VR Pillai street was contributing to most cases, so our strategy had to be more microscopic. We studied the situation and found that of the 39,000 streets in a city like Chennai only 11,000 were affected. Within these streets we then identified clusters and grouped them based on the number of cases in a cluster. Micro containment was the first step in our strategy.

How did your strategy evolve based on the increasing number of cases?

We began multiple concurrent efforts to update our strategy. The house-to-house survey involved 11,000 workers visiting residents and checking for any symptoms. Fever camps were set up and we went on to link the swab collection centres to get direct admissions. Through this we identified people with symptoms and directed them to camps immediately. We further began identifying teams for different portions of the work. For instance, health workers were specifically tasked with following up with testing centres and fever camps, some workers are assigned to identify positive cases and bring them to fever camps and other groups to serve persons in home quarantine. This prevented confusion as roles were clearly defined. We are also simultaneously ramping up COVID care centres and increasing oxygen beds.

In urban areas, self-help groups and local bodies helped us carry out all these functions. In rural areas we also roped in non-governmental organisations. The fundamental core of our strategy was that minimum 10 times the average positives per day in a week has to be tested. We ensured that aggressive testing was the base of our work. Earlier there was more testing in Chennai, but we soon ramped up testing in districts across the state.

Tamil Nadu is one of the few states that has insisted upon the RT-PCR test. Has this worked for the state?

Yes, Tamil Nadu did not compromise on RT-PCR tests even when other states decided on antigen tests which have lower sensitivity. Chief Minister Edappadi Palaniswami was very particular that we test aggressively and use RT-PCR. Today we can conduct upto 1.20 lakh RT-PCR tests per day. We currently conduct 85,000 tests on an average. RT-PCR tests ensure that there are lesser false negatives and more asymptomatic patients are recognised. In addition to this Tamil Nadu also did X-rays, chest CT scans and COVID blood profiles. We did focussed testing in containment areas and a detailed analysis on the cases that were coming. This helped redraw borders for containment areas.

Was there any hesitation to ramp up testing or worry that increased numbers will draw criticism?

Earlier there were second thoughts on testing and only 10,500 tests were being conducted in the whole state at one point, 3000 of which were in Chennai. But upon the insistence of the Chief Minister who took the advice of public health experts, we began testing aggressively. The CM said, 'Don't bother about numbers, I will manage that'. He told us to be bold in our efforts.

At one point we were testing so aggressively that if samples were less on one day, it actually disturbed us. We would enquire and ask what happened or if any testing centres didn't submit numbers. But the increase in numbers was not easy to handle. Whenever we controlled a street, city or district another would suddenly emerge. There are times when you just feel gripless in the night and wonder what went wrong. In Chennai alone, from 2000 streets the cases spread to 10,000. We were concerned but at the end of the day, this was just 25% of the city. So we kept our micro level management in place and eventually things fell into place. We knew we could stop things from going haywire.

The state has opened up most establishments and workplaces and restrictions have been lifted. How have infections not seen a larger spike?

This is a million dollar question. We need to do a deeper study on the matter. Personally, I believed that even the huge migrant crisis could have tipped India, not just Tamil Nadu, into a very difficult position. But compliance to non-medical methods seem to have kept scales balanced. When atleast 50% of residents follow masking and handwashing practices it could make a huge difference in the speed at which the virus spreads. But this has to be validated through research. Another factor which matters, I think is the duration of contact. Usually in a residence, if one person is infected, the entire family will soon contract the virus. The same happened in my house as well.

This having been said, we cannot rest easy now. We saw a state like Kerala which had a reduction in cases, witnessing a second wave. Our focus now is on virgin areas such as panchayats and hamlets which are yet to see infections. We cannot give a confident interview even now. In fact we are hoping that in the coming months our hard work doesn't go down the drain.

What has caused this concern?

The festival times will pose a huge challenge to the civic bodies and health department. When you say crowding your mind goes to a Koymabedu market. But ahead of Diwali, Christmas or New Year a Ranganathan street, Thana street or Purasawalkam can be worse in terms of the crowds it attracts. We have been working with shopkeepers and advised them to ensure masking and physical distancing. We have also told them to not announce any sudden sales and create crowds in flash. We are ready to create focussed containment areas in case of fresh clusters. Any place with over 20 people will be seen as a risk of crowding.

Now is the time for people to stay concerned and be more worried. Even a single person can create a cluster at their workplace or residence because the duration of contact has increased. We are not letting down the official guard by reducing testing or fever camps. At this stage, we also need to be on alert for dengue.

On ground, individual compliance to COVID-19 guidelines seems absent. What are your thoughts?

Based on awareness given, there has been behavioural change in half the population. As for the other half, we are still working on it. We are addressing the matter with local bodies, local influencers and leaders and requesting that the importance of COVID appropriate behaviour be impressed on residents.

Was there a different approach to containing numbers in the district?

Districts like Madurai have also seen a sharp reduction in the number of cases. But this is because we have just applied the same template that was designed in Chennai to other districts. It was all about micro containment.

For months now, frontline workers have been complaining of fatigue and exhaustion. Can this be remedied?

This is a tough question to answer. Any frontline worker, including myself, who says there is no fatigue, is lying. We are experiencing anxiety from constantly having to be alert and on the edge. Health workers are working day in and day out. From workers of the Tamil Nadu Medical services corporation to microbiologists, health workers are slogging for 18-20 hours  sometimes. All frontline workers, including those who visit quarantined homes are grassroot heroes and their contribution is unparalleled. What we as bureaucrats are doing is working on the ground with them and running along with them. Currently the case load is coming down. But no matter what the number is, we remain encouraging. Even when deaths rose, there was no reviewing of doctors. There was only encouragement and the constant reminder that we were there to support them in their efforts. 

Has Tamil Nadu begun devising a vaccine strategy?

We have already written to the health units of all districts, asking them to send a plan. We are working closely with the government of India. Vaccine trials are going on in RGGGH, Ramachandra hospital and SRM. Assuming the vaccine comes out, initially the frontline workers and health workers will be the people who first get it. But it is a work in progress.

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