How Andhra Pradesh Has Been Fighting Against Coronavirus And Is The State Prepared For The Upcoming Peak

New Delhi: Andhra Pradesh, the tenth most populous state in the country (Census 2011) with a population of 8.46 crores (84,580,777), is the second healthiest state in India after Kerala, reveals the NITI Aayog’s 2019 Health Index report ‘Healthy States, Progressive India’. At a time when the world is battling a coronavirus pandemic, Andhra Pradesh is giving a tough fight to the SARS-CoV-2 causing COVID-19. As on June 25, 11,489 positive cases have been identified in the state. Of this, while 6,147 cases are still active, 5,196 patients have recovered and have been discharged and 146 casualties have been recorded.

Despite having a large population, how did the state manage to contain the spread of the virus when compared to other populous states like Gujarat, Tamil Nadu, Uttar Pradesh, Maharashtra, Delhi, and others?

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Early Detection Of Coronavirus Positive Cases And Meticulous Contact Tracing

On March 9, Andhra Pradesh reported the first positive case of Novel Coronavirus but the screening of people returning to the state from outside, followed by isolation and quarantine had started from February 22. Recalling the steps taken at the early stage, PV Ramesh, Additional Chief Secretary to the Chief Minister said,

Because of the nature of the Coronavirus pandemic in the other parts of the world, my sense was this is an exogenous disease which has come from overseas which means it has to be physically brought by someone; materials cannot carry it for so long. With this, we started screening and testing people returning to Andhra Pradesh from overseas.

Parallely, the state government requested the bureau of immigration to share the list of individuals who have passports with the residential address of Andhra Pradesh or whose destination was anywhere in the state. This helped the state in the tracking of possible COVID-19 positive people and their contacts. With coordination between various departments including the health department, district administration, local police, the state was able to track 28,000 foreign returnees to Andhra Pradesh and their primary and secondary contacts going up to about 83,000 people. Together 1.11 lakh people were put in home quarantine and they were asked to report their symptoms, as and when these arose.

On March 30, a new set of cases started reporting in hospitals. We got to know about a group who attended a religious meeting in Delhi. We tracked each one of those who returned by whatever means and there were 1,164 returnees and their contacts were another 5,600 or so. We tested all of them, said Mr Ramesh.

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A Microscopic View Of Active Coronavirus Cases In Andhra Pradesh

As on June 25, the state has 6,147 active cases of Coronavirus. While 5,186 cases are from within the state, 961 patients are those who have returned from other states like Maharashtra, Odisha, Gujarat, Karnataka, Rajasthan and countries.

If we look at the bifurcation of the total cases, we see that there are more male patients than females. Of 6,147, while 3,798 COVID-19 patients are male, 2,349 are female. The coronavirus being more prevalent among men of Andhra Pradesh is not related to male to female ratio in the state, as Andhra has an almost equal number of male and female, (4.24 crore males, there are 4.21 crore females) as per Census of 2011.

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If we further try to understand the data of active cases, we see that maximum patients belong to the age group of 16 and 45 years old. A total of 3,950 patients are between age 16-45 and of this, while 2,441 are male, 1,509 are female. People belonging to the age group of 46-60 also have 999 active cases and in this age group also, more men are infected with COVID-19. Currently, 615 males and 384 females in the age bracket 46-60 years have coronavirus.

GVS Murthy, Director, IIPH (Indian Institutes of Public Health), Hyderabad believes that the number of COVID-19 cases in Andhra Pradesh is less because of the proactive testing and contact tracing done by the state government.

According to Mr Murthy, so far Andhra Pradesh has faced three COVID-19 waves. Elaborating on the same, he said,

The first wave came when people returned to the country. For a very long time, COVID-19 was limited to people coming from other countries therefore the transmission was low. The second wave came when people came back from Chennai. In areas like, Tirupati, Chittoor, Nellore people were involved in trading and travelling to wholesale market in Chennai. They came back with COVID-19 and the transmission started within the districts. The third wave came when migrants started returning from states like Mumbai, Delhi and others. In all three waves, the numbers have been much smaller than most other states in India and this can be attributed to testing and tracing.

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Mr Murthy also informed that the state government has a strong activity control room where health secretary, chief secretary and other officials have been actively seeking professional help.

Earlier in May, less than 100 new cases would come up in a day but now 100-200 and sometimes even more new COVID-19 cases are recorded every day. Mr Murthy believes the reason behind this is the relaxations and movement that has been allowed. But, what’s important is that though the cases are increasing, deaths are still low.

From No COVID-19 Testing Lab To Conducting Over 1 Lakh Coronavirus Tests In A Month

The first sample was tested and diagnosed at the National Institute of Virology (NIV) in Pune because Andhra Pradesh didn’t have any lab to carry out the COVID-19 test. Later few samples were sent to Gandhi Medical College in Hyderabad until the state got its first lab ready in Tirupati, followed by Vijayawada and other districts.

We now have a testing capacity in all 13 districts. We have started using TrueNAT testing machines which were earlier procured for Tuberculosis. We have also got one lakh rapid antibody testing kits from South Korea, said Mr Ramesh.

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The state has 70 government labs, six private labs, and 4 non-governmental organisations (NGOs authorised by the ICMR for COVID-19 testing). According to the official data, in March only 948 samples were tested. Whereas, in the month of April, the number of samples tested shot up to over one lakh (1,01,550), in May, it was 2.8 lakh (2,80,817) and as on June 25, over 4 lakh samples have been tested.

Talking about how the testing capacity was increased and the current status of COVID-19 testing in the state, Jawahar Reddy, Special Chief Secretary Health, Andhra Pradesh said,

Once you start testing 2,000-3,000 samples, you need a lab. You can’t continue sending it to Hyderabad or other places. Even after starting five to six labs in different districts, we found it difficult to send samples from one district to another. It’s then we realised we should have testing labs in every district. In 11 districts we had government medical colleges but in the remaining two we identified private medical colleges for testing. From conducting mere 100 tests per day to now over 15,000 tests a day, testing has increased manifolds.

State’s Health Infrastructure In Numbers

On one hand, the state was testing, tracing and tracking people and on the other hand, it was preparing healthcare facilities to face any upcoming challenge posed by a possibility of an exponential rise in the future. Existing medical colleges having more than one campus were used to set up COVID hospitals. Elaborating on the same, Mr Ramesh said,

From five hospitals we moved general patients to other healthcare facilities and created five state-level COVID hospitals exclusively equipped with critical care facility.

Along with this, the state identified 126 district level COVID hospitals which will be operational in six phases, depending on the patient load. As a precautionary measure, the state government planned to increase the number of district COVID hospitals. Currently, five state-level hospitals, 17 district-level hospitals are functional.

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Sharing her experience of staying in one of these hospitals as a COVID-19 patient, 16-year-old Sheema from Andhra Pradesh’s Guntur said,

My father was diagnosed with Coronavirus and through him I also got infected. I was in the hospital for 22 days and I didn’t face any kind of problem in terms of hygiene or the food. All the doctors and nurses were always available to address our problems and we were given nutritious diet consisting of legumes, vegetables, fruits. I didn’t feel I was suffering from a contagious disease like COVID-19.

Talking about the state’s health infrastructure and its preparedness against COVID-19, Mr Murthy said,

Andhra Pradesh was one of the earliest states to take over most of the private hospital beds right across the state. They have prepared but fortunately, they have not had caseload which they were initially anticipating and had developed infrastructure for. Therefore, they have been in a safer zone compared to other states like Delhi, Maharashtra, and Gujarat. The government data shows that it is prepared to tide over casualties.

The COVID hospitals are incomplete without isolation beds, and critical care infrastructure which includes ICU beds, ventilator, protective gears – personal protective equipment (PPE) kits, masks, and other things. Also, the healthcare staff to run these COVID hospitals and ensure everyone’s well-being, is also required. Here is how prepared Andhra Pradesh is, as on May 31, 2020:

Infrastructure: The state has dedicated 37,869 isolation beds to COVID-19 patients. 5,365 ICU beds are available for COVID-19 patients. Along with this, 1,399 ventilators are currently available in the COVID hospitals and the state is procuring another 2,000 ventilators.

Healthcare Staff: As on June 25, 5,943 medical officers including Anaesthetists, Pulmonologists, and other specialists were available. Of this, while 732 are on COVID duty in 22 state and district hospitals, 942 are in quarantine and 4,271 have not been assigned any duty. In addition to this, 3,784 post graduates and 3,545 house surgeons are available. These figures have changed significantly; two months ago, on April 30, a total 3,879 medical officers were available. Of which, 638 were on COVID duty, 962 in quarantine and 2,279 were not assigned any duty.

To assist the doctors, 7,858 nurses are available. The state has a policy as part of which doctors and paramedics work for a week and stay in quarantine for two weeks.

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Protective Gears: Personal Protective Equipment (PPE) is essential to keep healthcare professionals safe while treating coronavirus positive patients. On April 8, Dr K Sudhakar of the Area Hospital in Narsipatnam, Visakhapatnam had accused the state of not providing N95 face masks to medical staff treating COVID-19 patients and had alleged doctors and nurses use the same mask for 15 days at a stretch. However, the stock position (as on June 25) shared by the state health department tells a different story. At headquarter warehouse, 0.69 lakh PPEs, 7.70 lakh N95 masks, 6.76 lakh triple-layered masks and 3.5 lakh pair of gloves are available.

Collectively, the 13 districts have over 11 lakh (11,11,596) PPE kits, over 45 lakh (46,86,892) surgical masks, more than 5 lakh (5,43,607) N-95 masks and over 26 lakh (26,85,456) pair of gloves.

Talking about what these numbers mean and whether the state is prepared to address the caseload, Dr Priyanka from Guntur District, said,

In the last few months, the manpower has increased tremendously. Currently, we have over 5,500 doctors and even hospitals are geared up to face the peak. What has worked for us so far is the team work; from municipality taking charge of sanitary measure, to police department ensuring strict implementation of lockdown, everyone has worked together and this is the reason we have been able to contain the spread to some extent.

Conclusion

When asked about the challenges Andhra Pradesh has faced in over two months in fighting COVID-19, Mr Ramesh said that there have been some or the other challenge at every stage. But because of the clear leadership, quick decision making, resources or money to procure what is needed was never a problem.

This is the reason we were able to set-up beds and arrange for nutritious food. We also mobilised staff and recruited a large number of doctors and nurses and have been organising training programmes for them with the help of UNICEF, said Mr Ramesh.

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According to the experts, coronavirus peak is yet to come and the coming months are going to be challenging. Talking about how well is Andhra Pradesh prepared for the upcoming spike in the month of June and July, Mr Ramesh said,

The coming days are going to be more challenging because the onset of monsoon brings in a host of other diseases like malaria, typhoid, and water borne diseases. But in the last two months, we have tried to prepare ourselves for this only. I think what is essential is destigmatisation, early reporting of symptoms, early testing, isolation and treatment of high-risk people. I hope we are able to sustain the level of intensity with which we have been working so far.

Mr Ramesh also noted that till date Andhra Pradesh has been able to perform because of the support from various departments including police officials, village volunteers, railways, Auxiliary Nurse Midwife (ANM), doctors and others and hoped to continue with the best efforts to contain the virus.

While signing off, Mr Murthy gave a word of advice for not just Andhra Pradesh but other states as well to effectively handle such outbreaks in the future and said,

This is one particular outbreak but this is not the last of the outbreaks. The only way we can fight this challenge is to have a dedicated public health cadre who has the skills to screen, to do surveillance, to do infection control, give policies, so that next whatever disease comes, the state is well prepared and can immediately fight. The benefit Kerala had was because of the Nipah outbreak two years ago which geared the state to act to set up a public health system. The states which are suffering today are those who don’t have that.

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