Turning the COVID-19 tide in Chennai

With an exponential rise in infections, Chennai quickly became a COVID-19 hotspot during the second wave. Serena Josephine M. reports on how the situation was stabilised before it could spiral out of control

Updated - December 04, 2021 10:30 pm IST

Published - May 29, 2021 02:29 am IST

Ambulances carrying COVID-19 patients line up at the Government Stanley Medical College Hospital in Chennai.

Ambulances carrying COVID-19 patients line up at the Government Stanley Medical College Hospital in Chennai.

With the phones ringing off the hook and the queues of the sick becoming longer, S. Sangavi and S. Ramachandran knew better than to put their tired feet up. In their 12-hour shifts, the duo — an emergency medical technician and an ambulance pilot attached to the 108 ambulance network — took on multiple trips in Chennai, ferrying at least 10 patients diagnosed with COVID-19 to nearby government hospitals each day.

Though both Sangavi and Ramachandran, staff of the Vadapalani Depot ambulance, have been handling COVID-19 patients from the start of the pandemic, they soon realised that the unrelenting second wave of infections was unlike the first. With each passing day, they slowly got accustomed to the long queues of ambulances and longer waiting hours outside government hospitals, hoping fervently that the patient on board would get a bed. “It took us at least an hour or two to get a patient into the hospital ward. It became extremely difficult to get an oxygen-supported bed in the last two months,” Sangavi says. At times, their shift extended to as long as 15 hours. “There was no time to eat,” Ramachandran says.


As they set out to pick up a patient, either from home or from a screening centre, they would go beyond their defined roles. “Many fear the sight of an ambulance in front of their homes. So, we would call them earlier, tell them not to be afraid, and assure them that it is going to be fine,” Sangavi says.

Even as one patient was admitted, it would be time to pick up the next. “It was like working at the warfront,” says Mohamed Bilal, regional manager, GVK EMRI, which operates the 108 ambulances . “We (the Chennai team) have been on our toes since March. Each ambulance has had to cater to 20 cases a day, doing multiple trips day and night. From May 1 to 24, we handled 9,579 COVID-19 patients in Chennai alone.”

The task was far from easy. With many ambulances held up outside hospitals, the team had to ensure that the vehicles reached the patients on time. “Once a call is received, the average response time for a COVID-19 ambulance in Chennai is 10 minutes 25 seconds, while the average turnaround time is 1 to 1.5 hours,” he says.


Scramble for beds

Chennai turned into a COVID-19 hotspot in the blink of an eye. The second wave resulted in an exponential rise in the active case load. Since the beginning of the pandemic, 2.36 lakh cases had been reported in the city, as of March 5, 2021. When the State’s daily case count crossed 500 marking the beginning of the second wave, more than 2.50 lakh persons were infected in a span of just two and a half months in Chennai.

The rapid rise in cases and the fast deterioration of patients put great strain on major hospitals. Hospitals ran out of beds even as the demand for oxygen-supported and intensive care unit (ICU) beds surged. Chandru (name changed), a resident of Sithalapakkam, was one of the affected. “My father tested positive for COVID-19, and we managed to get a normal bed at a private hospital on May 14. But his oxygen saturation level dropped from 92 to 85, and nothing helped. He required ventilatory support, but no beds were available at the hospital. We had to shift him to another facility,” he says.

After frantic and unsuccessful attempts to get him a 108 ambulance, Chandru managed to take his father, 74, to the Rajiv Gandhi Government General Hospital (RGGGH) in an ambulance of the private hospital with oxygen support. “We waited in the ambulance. We managed to get an ICU bed only four hours later. The treatment could not save my father,” he says. While the wait and the death of his father was agonising, the number of deaths around him as they waited numbed him.


Over two months, the city saw hundreds of such cases. There were desperate hunts for beds, heartbreaking moments of watching loved ones gasp for breath while waiting in ambulances and private vehicles, and serpentine queues outside counters to pick up vials of Remdesivir. Meanwhile, hospital authorities spent sleepless nights waiting for oxygen trucks to arrive.

“The numbers were huge this time,” says E. Theranirajan, dean of RGGGH, one of the largest hospitals for COVID-19. Since mid-March, RGGGH has treated 12,000 patients with COVID-19. “The 72 beds in the zero-delay ward were just not enough. So, we increased the number to 238 to immediately attend to patients who were brought in ambulances and required oxygen support, as well as to ease the ambulance lines outside the hospital. We had a maximum of 250 ambulances bringing in patients in one day, 40% of which were from the private sector,” Dr Theranirajan says.

From April 24 to May 10, the hospital saw its per day oxygen requirement soaring to 40-45 metric tonnes a day. With beds in all seven floors of Tower-3 filled up, Dr. Theranirajan and his team started to open COVID-19 wards in other blocks. The number of beds quickly rose from 1,618 to 2,050, with the number of oxygen beds increasing from 817 to 1,522 from May 5 until now.

“In the first wave, the maximum number of in-patients we saw in a day was 1,083. This time, it was 1,658. We had over 1,600 in-patients for 15 continuous days. What made the second wave different from the first was the number of people requiring oxygen. We had 1,300 patients on oxygen therapy at a given point in time this year,” he says.


The hospitals faced several challenges: decongesting ambulances on campus, starting treatment on time, stabilising patients being wheeled in, and even adding space for the dead.

The doctors knew that they had to think differently. So, a team of three doctors along with technicians was deployed to triage patients waiting in ambulances and a respiratory care team was sent to assess every patient’s oxygen needs and provide appropriate dosage, he says.

The surge in cases

The first wave peaked on June 30, 2020 in Chennai, when 2,393 daily cases were reported. They gradually declined after that and were lower than 1,000 a day by mid-October. On February 19, 2021, Chennai saw just 136 cases .

By then, the State was preparing for the Assembly elections and all the COVID-19 control measures taken during the first wave in Chennai and other places were scaled down considerably.

The early signs of a resurgence in cases were noticed in the first week of March. Cases began to go up marginally. By the first week of April, when the State went to the polls, the number of daily reported cases had crossed 1,000. The number continued to rise sharply and on May 2, when the election results brought a change of government, the cases crossed the 6,000-mark .

More than crowding during elections or other factors, the sudden increase was primarily due to the mutant strains of SARS-CoV-2, says Alby John Varghese, Deputy Commissioner (Health), Greater Chennai Corporation (GCC).

P. Ganeshkumar, Scientist D, Indian Council of Medical Research-National Institute of Epidemiology, Chennai, says the new variants of the virus, poor adherence to COVID-19-appropriate behavior such as wearing masks and maintaining physical distancing, and not seeking early care for COVID-19-like symptoms were the major factors for the rise in cases. “New variants of the virus circulating in the population contributed to the higher transmissibility of the infection in the second wave. This led to higher case load compared to the first wave,” he says.


The seroprevalence study conducted during the first wave showed that 44.2% of the population in Tondiarpet and 34.4% in Royapuram, two of the worst-affected zones, had been exposed to the virus. “One would have thought that the second wave would not affect these zones much. But there was a large number of cases here as well, which is likely because of the new strains. We did not expect it to be this infectious with more people becoming sick and requiring hospitalisation,” Dr Varghese says. Analysis of zone-wise data showed that while the cases were comparatively lower in these two zones than the others during the second wave, the two nevertheless remained significantly affected.

The spread was more aggressive in the southern and central regions than the northern regions this time. While the northern zone accounted for 34% of all cases in the first wave, it accounted for only 28% in the second wave.

By the time the new government was sworn in on May 7, it was becoming impossible for many patients to get oxygen-supported or ICU beds in hospitals. Social media was flooded with requests for beds or oxygen. It appeared as if the city was heading towards the crisis faced earlier in Delhi and Bengaluru.

“We had two main challenges in the city,” says J. Radhakrishnan, Health Secretary. “People threw the Standard Operating Procedures (SOPs) to the wind. When cases surged, the situation put the oxygen and ICU bed capacity to test. Despite having the best hospitals in both the government and private sector, this was a big challenge,” he says.

Healthcare workers check the oxygen saturation levels of residents during a door-to-door survey for COVID-19 in Chennai’s Mogappair West area.

Healthcare workers check the oxygen saturation levels of residents during a door-to-door survey for COVID-19 in Chennai’s Mogappair West area.


Rise in fatalities

The deaths due to COVID-19 kept rising in the city. A government doctor, on condition of anonymity, said it was agonising to see young persons succumb to the infection, primarily due to respiratory failure. “Some were brought dead to hospitals,” he says.

The crisis began to take a huge toll on healthcare workers. “It was very stressful. Some of my friends from other departments who were posted on COVID-19 duty had to take sedatives to sleep as they had never seen so many people dying around them,” says a PG student.

On May 12, when Chennai recorded 7,564 daily COVID-19 cases , the highest since the start of the pandemic, Dilli Rajan, the caretaker of Velangadu crematorium, stood beside a hearse, directing his seven assistants to work late into the night to cremate the bodies. Several hearses had lined up at the crematorium. Prior to COVID-19, cremations were held only till 6 p.m. “During the first wave, the number of cremations decreased from eight to two a day at our crematorium. During the second wave, the number increased to 32 a day,” says Dilli Rajan, who lost his aunt during the pandemic. The situation was similar in most of the 41 crematoriums in Chennai. GCC data show an increase from 150 death registrations a day to more than 350 a day during the second wave.


Since the last week of March, the city has reported more than 3,300 deaths, almost close to the total deaths reported during the first wave till October 2020. However, the case fatality rate has remained low compared to the first wave. While it was around 1.8% during the first wave, it is currently 1.4%.

“Under-reporting of deaths continues. Very sick patients are not subjected to RT-PCR testing. They succumb to the infection and those deaths are not counted as COVID-19 deaths. This is also true of patients with suspected symptoms of COVID-19,” an official says.

Non-COVID-19 deaths have also increased by 300% in many crematoriums, which is a major cause of concern for public health officials. One of the reasons for the rise in the number of deaths during the second wave in Chennai has been the crowding of tertiary care government hospitals by patients who do not require higher-level medical care. With limited number of beds in government and private tertiary care hospitals, many patients who required emergency care were unable to get admitted to hospitals.

The turnaround

The situation, however, was controlled and stabilised through multi-pronged community-level strategies before it spiralled out of control. The State government imposed a complete lockdown on May 10 . While this was aimed at curbing the rapid spread of infection, it also gave the much-needed breather for hospitals and time to scale up the infrastructure.

Door-to-door fever surveillance to proactively identify cases at an early stage was ramped up and so were screening centres for triaging, and telecounselling centres. While these measures existed during the first wave, new ones were added to tackle the second surge. Two hundred and fifty-one car ambulances with oxygen support were introduced to address the shortage of ambulances and ensure zero-delay transfers to hospitals.


Another key initiative was field triaging. With the 13 screening centres located in different parts of the city proving inadequate to handle the surge, field triaging was introduced. Two hundred and fifty-one teams, each comprising a doctor and two nurses, were formed.

“The field triaging team visits every person who tests positive at their doorstep. If further examination or hospitalisation is needed, the person is taken to a nearby facility. Else, they are asked to isolate at home. Further follow-ups are done through the telecounselling centres,” Dr Varghese says. Every patient in home isolation is called at least once a day by the telecounselling centres, where final year MBBS students along with doctors are deployed.

More than 12,000 fever survey workers have been deployed to visit every household to identify people with COVID-19 symptoms. This is in addition to around 400 fever survey camps across the city, mainly focusing on hotspot areas. A group of volunteers called ‘Friends of COVID Citizen Under Surveillance’ was deployed to assist those under home isolation. The members provided groceries and monitored adherence to rules.

Apart from these measures, the Medical and Family Welfare Department worked on increasing the bed capacity and set up a Unified Command Centre (UCC) for bed allocation and oxygen monitoring, which was later converted to the State’s war room for COVID-19.

From the day it was set up as a UCC on April 30 till May 25, more than 60,000 calls were received requesting beds and oxygen support. An official working at the UCC says that while the UCC was able to fulfil only 30% of the requests in the initial days, it has been able to fulfil more than 60% of the requests in the past one week.


Dr. Varghese also says technology was used both for administrative purposes (for efficient monitoring and deployment of resources) and for the public. An example is the GCC VidMed application. Given the difficulties for many to visit a doctor or a hospital, the app was launched to enable patients to consult doctors online.

“While we deployed technology, we were also conscious about technology not becoming a barrier for those from underprivileged backgrounds to seek help. So, we had helpline numbers, proactively called those under home quarantine and also ensured visits by field staff,” he says.

By now, a ‘Chennai Model’ had emerged. Prime Minister Narendra Modi mentioned that he wanted other cities to emulate some features of this model. GCC Commissioner Gagandeep Singh Bedi says the Chennai Model of COVID-19 prevention and case management has become more effective because it is “community driven”.

“We have 200 mobile teams, 10 mobile units, 42 static centres, and 140 urban primary health centres carrying out doorstep COVID-19 testing with a turnaround time of 24 hours,” he says.


All laboratories have to report results to residents through the single-window system adopted by the GCC, for better coordination. The civic body has “established oxygen centres, promoted a symptomatic case management system irrespective of the test results, accelerated vaccination services for the elderly, disabled and non-ambulatory elderly, and hired FOCUS volunteers for helping residents who are in home isolation,” Bedi adds.

GCC’s Deputy Commissioner (Works) Meghanath Reddy says the second wave was managed through several micro-targeted interventions. “We constituted 30 zonal enforcement teams to enforce lockdown SOPs. We launched 100 mask kiosks to distribute seven lakh reusable masks,” he says.

Ramping up facilities

Amid the raging pandemic, government hospitals continued to ramp up infrastructure . They needed more beds, oxygen points, oxygen supply and manpower to handle the rising number of patients. “There are 6,500 oxygen-supported beds in institutions under the Directorate of Medical Education in the city. We have oxygen centres with 2,500 beds. There are 20 COVID-19 Health Centres with 3,085 beds and 24 COVID-19 Care Centres in 24 places with 16,000 beds,” says R. Narayana Babu, Director of Medical Education.

In the meantime, vaccination has started to pick up in Chennai. While Tamil Nadu’s overall performance on vaccination leaves much to be desired , Chennai has done significantly well compared to most other cities with around 70% of the elderly receiving at least one dose of the vaccine.

GCC plans to vaccinate at least 50,000 persons a day from the present 23,000 once the vaccine supply improves. Till date, the city has achieved a coverage of approximately 19 lakh (two doses).


Cases fall in city, rise in districts

Cases have begun to show a declining trend in Chennai, dropping from a peak of 7,772 cases on May 12 to 2,762 cases on May 28 . The burden of cases in Tamil Nadu is shifting to the rural areas.

Chennai accounted for 25% of the 30,355 cases reported in the State on May 12, while on May 26, it accounted for 10% of the 33,764 cases reported.


“Chennai has started showing a declining trend. The fall in cases with 30,000-odd tests a day is a welcome sign. But this is the time we need to be extremely careful,” Radhakrishnan says.

There is a gradual decline in the weekly percentage change in incidence and daily test positivity observed from the reported data in Chennai. Dr. Ganeshkumar says, “This may indicate to us that the spread is limited. When this current trend continues, Chennai will further limit the spread of infection.”

Cases have started to rise in a number of districts. As the Health Secretary points out, “Cases are increasing in 19 districts. This included the western districts, Theni, Madurai and Tiruchi. This is definitely a cause for concern as we need to ensure that the spread does not reach rural areas. Containment and public health measures will continue with no let-up.”

With inputs from Pon Vasanth B. A. and Aloysius Xavier Lopez

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