Why COVID-19 cases are rising steeply in Chennai

The city of Chennai is facing one of its biggest challenges in the last decade. And this is saying something, considering that Tamil Nadu's capital has been forced to deal with massive floods, a devastating cyclone and a crippling drought in the last 10 years. This time, the battle is being fought against an invisible enemy - the novel coronavirus and unfortunately, the fight is not going as well as expected.

Chennai is currently Tamil Nadu’s biggest hotspot contributing directly to 2,008 cases out of a total 4,058 while indirectly contributing to hundreds of cases across the state, with several migrants leaving the city to their respective districts. Two-hundred-and-seventy-nine of the new cases reported on Tuesday are from Chennai, and district authorities have reported more cases, their areas pushed into the red zone, after workers from the city went back to their homes.

What began as a single case on March 9 has snowballed into a growing crisis that has left the city's health department and residents scrambling for cover. And according to those overseeing the management of this pandemic, the blame for this falls on both the authorities calling the shots and residents of the city.

Failure in planning?

The Koyambedu market is one of the city's fast emerging and most worrying clusters. According to The Hindu, as of Monday, it accounted for more than 600 cases of infections, spreading across almost half the state. And unlike in the case of the Tablighi Jamaat cluster, contact tracing has proven to be very challenging for health officials.

The failure to split the market and move it to different areas has come back to haunt the city and neighbouring districts. But the biggest flaw in the planning, says a health official who is monitoring Koyambedu, is allowing workers from other districts to leave the market without testing them. After a surge of infections, the market was temporarily shut on Monday night. 

"We should not have allowed them to leave before the market was closed," says the official, on the condition of anonymity. "We should have quarantined, tested and then decided who can leave the city. This way, the infection could have been contained," he adds.

The health official points out that the market should have been closed at least a week ago and necessary precautions be taken to avoid  spread of infection.

"They should have reduced the number of entries and exits to the market and checked anyone coming in for symptoms," says a fruit vendor, who has now shut shop. 

Several warning signs regarding the market were already clear and presented by the media through visuals of uncontrolled crowds and lack of social distancing. But what worsened the situation was the 'complete lockdown' from April 26 to April 29.

On April 25, a day before the 'complete lockdown', crowds gathered across the city to gather supplies. And when retail stores ran out, they headed to the Koyambedu market, increasing chances of infection.

"It is quite possible that this is the reason the numbers have exploded," explains former bureaucrat S Devasahayam. "Ahead of the second lockdown, there were immense crowds across the city. They offered no proper logic or reasoning for this. It was totally unnecessary and may have made things worse," he adds.

And not just residents, even frontline workers have allegedly been victims to poor planning and lack of coordination.

 Frontline workers not protected?

Over the period of the lockdown, both doctors and sanitary workers who spoke to TNM have alleged that protective gear has been in short supply. A senior doctor from Stanley Hospital in Chennai had told TNM that while staff in the COVID-19 ward received personal protective equipment (PPE), those in other departments and in the out-patient department were forced to make do with their own equipment or had to work without them.

In fact, in the Rajiv Gandhi Government General hospital alone, 7 doctors and three nurses were tested positive for the coronavirus. Speaking to TNM, a senior doctor in Stanley Hospital had pointed out that doctors and nurses outside the COVID-19 ward continue to treat patients without knowing whether they are infected or not.

"At the cardiology unit or even the neurology department, doctors continue to see emergency cases and only later come to know that a patient was actually positive for the virus," says the doctor. "By then, medical professionals around them are already susceptible to the virus," he adds.

 Doctors explain that as part of their profession they come across several patients with compromised immune systems on a daily basis and the lack of protective gear could lead to further spread of the virus amongst those who visit hospitals.

 But while tests for the virus have been accessible for doctors, police officials began being tested only in late April.

 At least 26 police officials have been tested positive for the virus so far. And amongst them a sub-inspector, according to health officials, is suspected to have passed on the virus to his son who is the first patient in the media cluster in the city. Over 30 persons from a news channel that the 26-year-old worked in have tested positive for the virus.

 “The failure to initially test police and volunteers who were managing the streets and delivering food could also be considered a reason for Chennai’s growing numbers,” says Devasahayam. “While the testing numbers have increased now, they were abysmally low in the beginning,” he adds.

 In fact in Teynampet, the Corporation suspects that two volunteers distributing food items could have transmitted the virus to over 40 persons on VR Pillai Street alone.

And while rates of testing have increased now, with the state recording over 11,000 samples tested on Tuesday, initially they refrained from testing residents unless they had travel history or showed irrefutable symptoms.

'People lack discipline'

A majority of health officials, however, allege that irresponsibility on the part of residents and failure to take the disease seriously is amongst the chief reasons for Chennai's increasing numbers.

Currently there are 357 areas in the city that are under containment. This means that entry and exit points are sealed on the street, police personnel appointed for supervision, vehicles not allowed in and out and people leaving the street to buy groceries supervised.

"The necessary precautions have been put in place but people are failing to follow them," says a senior health official, on the condition of anonymity. "At least 25% of residents in containment zones are not wearing masks. And if they do, they either keep touching it or lowering it to talk to other people. People's attitude is problematic because they believe that they won't get the virus," he adds.

Speaking to TNM, a health official from Thiru-Vi-Ka Nagar, which has recorded over 200 cases, states that residents were refusing to comply with rules in the containment zone. 

"The people here are mostly daily wage workers and they felt compelled to go for work to earn money. But now, with the government arranging for rations, they are more willing to listen," says the official.  She further adds that the increasing number is also due to more testing. 

"The numbers of people being tested is steadily increasing. So we are able to identify more people and immediately quarantine them,"she points out. 

The Health officer who is handling one of the most challenging zones also states that sheer density of population is a factor that affects the spread of the virus.

“The houses here are really close together and there is not much social distancing that can be achieved,” she points out. Thiru Vi Ka Nagar alone has a population of 60,000 and the whole of Chennai over 70 lakh. 

Even Chief Minister Edappadi Palaniswami had admitted on Tuesday, that the dense population was amongst the reasons for the spread of the virus. But the most challenging aspect in educating the masses, according to a state government official, has been that at least 90% of those affected are asymptomatic.

"The disease itself is puzzling," admits the official. "When people exhibiting no symptoms turn out to be infected, those around think that there is no need to fear it. They ask why they should take precaution when there are repercussions even when infected," he adds.

However, health experts maintain that even if the disease does not affect the carrier it could be fatal to those with pre-existing conditions- heart problems and diabetes, as well as the elderly. In fact, the lockdown, when announced, was with the motive to protect the vulnerable.

"We need to look out for the elderly and those with comorbidities," says Dr K Kolandasamy, former Director of Public Health.

"Even if younger people get it, they will survive. But it is not so for the former group. The need of the hour will be to isolate and protect them."