On Friday, the Tamil Nadu government informed the Madras High Court that it had no intention to impose a complete lockdown in Chennai and its neighbouring districts in the near future. This statement was made even as the capital saw another single day record increase in coronavirus cases, with 1477 patients testing positive, taking the city's total to 28,294 cases.
And while experts have welcomed the state government's decision to avoid another lockdown, doctors on ground and heads of government hospitals are dismayed by the state's decision.
Speaking to TNM, the Dean of a government hospital and college in Chennai, on the condition of anonymity, says, "This is the right time to impose a complete lockdown in the state. We are reporting over 1,000 cases everyday in Chennai alone. Doctors are bearing the brunt of COVID-19, working long hours and treating a huge influx of patients. A lockdown will reduce the stress on the healthcare system and help ensure physical distancing."
A senior doctor who works in the COVID-19 ward of Stanley Medical College and Hospital explains that lack of infrastructure, shortage of staff, increasing number of patients and ill-conceived strategies by the government are amongst the reasons that medical professionals are requesting for a lockdown.
"A 30-day lockdown will really help this situation, where cases are not coming down. The purpose of the first four lockdowns was to improve medical infrastructure and increase the number of medical staff, but neither was done successfully. Only now have they added 1500 doctors, 200 nurses and 50 mobile units to the fray," he says. "The government completely underestimated the number of cases that would erupt and did not increase the number of beds within hospitals," he alleges.
Controlling influx of patients
The senior doctor points out that while the Chief Minister had claimed on April 17 that cases will be brought to zero in three days, the Health Minister had informed a woman on Twitter that she could travel for a wedding without worry, in the same month.
"Even now, I am not sure if the government understands the extent of the problem we are facing," he says. "People who are elderly and have comorbidities are really suffering. They are in absolute torment till they recover and several cases just don't recover and die. If we go into a properly executed lockdown, we can control the influx of patients and give medical staff the time to give each patient more attention," he adds.
Public health experts, while sympathising with the plight of the doctors, do not agree that a lockdown can be a solution to the current crisis.
"While I will give high priority to doctors' request, I don't know if a lockdown will make a difference at all at this point of time," says epidemiologist and Chairman of the Scientific Advisory Committee of the National Institute of Epidemiology, Jayaprakash Muliyil. "Chennai is already under a partial lockdown and it has proven to be ineffective. The basic requirement is to have enough beds, oxygen supply and to prioritise cases right now. Only some cases become serious, most cases will become fine with oxygen supply and medicine. But instead mild cases are occupying beds in hospitals, when they can be home quarantined. If you remove asymptomatic and mildly symptomatic people from hospitals, you will have enough beds, " he argues.
The senior doctor in Stanley Medical College and Hospital, however, argues that the cases on ground are not that simplistic.
"The problem with home quarantining patients with mild symptoms is that when they take a turn for the worse, it becomes too late to treat them," he says. "They arrive at the hospital very sick and sometimes too late. As for arranging beds, it is not that easy. There are enough beds for patients but when they require constant oxygen supply and advanced care, it becomes very difficult," he adds.
Several experts have pointed out that the epidemicâ€™s peak in India can come between July and August.
A source in the Chennai Corporation, however, points out that even imposing a lockdown, could not have the results that doctors expect.
"Even if we impose a lockdown, there is no guarantee that people will listen.When we close offices and other institutions, people are still mingling within their areas - be it in apartments or slums," says the IAS officer. "If we give one day and impose lockdown, then people will throng public areas and this will lead to another cluster like Koyambedu and if we impose it without warning, there will be hardships for a large section of society. The major problem is enforcing the lockdown because it is difficult to predict how people will act," he adds.
The senior doctor at Stanley Medical College and Hospital, however, dismisses this argument. He points out that the government's inability to manage a lockdown cannot be a reason to oust the idea.
"How can a government say that they will not be able to implement a lockdown?As doctors, on the ground we are clearly saying that it is required to manage the epidemic. It is their duty to ensure that residents follow rules," he says. "Shifting the blame on people is not a way out," he adds.
The Dean of one of the medical colleges and hospitals handling the pandemic points out that the lockdown period will be particularly useful in helping underprivileged sections.
"In slum tenements and highly populated areas of Chennai, residents could have been shifted to care centres so that there are not more than two people in a house. This would significantly help the situation. Then with more physical distancing, we can break the chain of infection," says the Dean.
â€˜Behavioural change from public neededâ€™
But virologist Jacob John says that only individual discipline can help tide over this crisis.
"Only 100% mask wearing can control cases here on. More and more evidence is coming from the west that 100% mask wearing will protect people. A lockdown can lead to physical distancing but is not a permanent solution. Moreover, even small particles in the air could lead to infection, " he says. "Tamil Nadu has to instead focus on educating the public about why they should change their behaviour and make them understand the importance of wearing a mask," he adds.
He points out that essential services must be defined and protected by the government and steps taken to prevent further transmission as well.
"The government can also start conducting antibody tests to confirm who will be immune to the virus. An Indian style lockdown will not work," he adds.
But doctors remain resolute in their views. Speaking to TNM, a doctor from Rajiv Gandhi Government General Hospital says that the medical system cannot handle this onslaught of cases for much longer.
"Over 80 postgraduates have already tested positive here. Even after wearing personal protective equipment, they are still getting infected," says the doctor. "In such a scenario, they are out of commission for at least 21 days. A lockdown will give doctors space to breathe and recover themselves, so they can treat patients effectively."