Telangana’s COVID trials and tribulations

Crowded hospitals, lack of transparency of data, and inadequate testing are some of the problems that mark the State's response to the virus. K. Shiva Shanker and Abhinay Deshpande report on how Telangana seemed to be in control of the situation, but is now fumbling

Ambulances parked in front of Gandhi Hospital, Hyderabad.

Around 8 a.m. on June 27, a distressed health volunteer sat next to his sick younger brother outside the Government General and Chest Hospital in Hyderabad. The brother, a software engineer, had had nine days of fever and shortness of breath. Suspecting COVID-19 , the family rushed him to hospital. Two hours had passed since they reached the hospital, which had 308 beds, including 105 designated for those suspected of having COVID-19. But there was no information on whether he could be admitted. “He desperately needed oxygen support, but no one from the hospital told us how much time it would take to admit him,” the health volunteer said. The family spent several hours in agony. Finally, the 34-year-old techie was admitted a little after 10 p.m. Many other patients and attendants who wanted to get admitted at other government hospitals in the capital reported similar complaints.

The beginning

COVID-19 didn’t seem much of a threat to the Telangana government even when the first patient suspected of having the disease was detected in the last week of January. A 34-year-old postdoctoral research scholar in chemistry, who was studying at a laboratory in Wuhan, China, returned to Hyderabad on January 20. He was admitted at the Sir Ronald Ross Institute of Tropical and Communicable Diseases. The State health department officials sent his samples for testing to the National Institute of Virology, Pune. At the same time, they chalked out plans on where COVID-19 patients could be admitted. Everyone breathed a sigh of relief when the research scholar tested negative. As days passed, more people suspected of having the disease were detected and more samples were sent to the institute for tests. All of them tested negative.

More than a month later, on the afternoon of March 2, the Ministry of Health and Family Welfare announced that a techie from Telangana with a travel history to Dubai had tested positive for COVID-19. That was the first case in the State. The 24-year-old from Hyderabad, who was working in Bengaluru, had developed symptoms a few days after returning from Dubai. He was admitted in State-run Gandhi Hospital and was diagnosed with pneumonia. The State government got down to tracing the techie’s contacts. Gandhi Hospital, where he was admitted, was later turned into the largest isolation centre in the State. It has been designated as a ‘Centre of Excellence for COVID Care’, but several issues, such as of COVID-19 patients on oxygen support waiting for hours for their soiled diapers to be changed, are hampering its reputation .

Chief Minister K. Chandrasekhar Rao spoke of the techie in the State Assembly on March 7 and tried to allay fears. Quoting some doctors, he said a paracetamol tablet was sufficient to fight COVID-19. He called the techie a “ sannasi daridrudu (unfortunate nincompoop)”. He also claimed that the virus cannot survive in temperatures above 22 ° C, despite the fact that there is no scientific basis for this claim.

 

Coming under flak for his comments, Rao later said on record in the Assembly that it was a scientist who had told him that paracetamol would cure fever induced by COVID-19. He added that the statement had been blown out of proportion.

Police high-handedness

Soon after appealing to the people to remain calm, Rao announced a complete lockdown in the State from March 23 to March 31. Telangana was among the first States to announce a lockdown. The number of cases in the State then stood at 21. The government closed the inter-State borders during the period. No vehicles, except goods vehicles carrying essentials like medicines, were allowed into the State. The State government also suggested to the Union Health Ministry that all international passengers be stopped from entering as a majority of those who had tested positive until then had returned from abroad.

The decision to impose a lockdown was largely welcomed by everyone, but questions remained. During the initial days of the lockdown, a string of press conferences were held where some of these questions were raised. A reporter asked if the lockdown would resemble a curfew. Rao asserted that a lockdown was not a curfew, even as the Director General of Police issued new orders for a curfew-like bandobast. As day gave way to night, people began complaining about police excesses, especially in the three urban police commissionerates — Hyderabad, Cyberabad and Rachakonda — of the State capital. Over the next few days, videos and photographs of police personnel chasing people on the roads and beating them mercilessly emerged on social media. In Wanaparthy, a man was assaulted by the police in front of his 12-year-old son, which forced IT Minister K.T. Rama Rao to intervene and direct the District Superintendent of Police, Apoorva Rao, to personally meet and apologise to the child . On the first day of the lockdown, several journalists were roughed up by the police despite showing their identity papers. In Khammam, a woman doctor who was on her way to the hospital was abused and assaulted by an Assistant Commissioner of Police.

Police officers told The Hindu that they had received instructions from their seniors to use force and create an atmosphere of fear. “The zonal officers were asked not to take calls from influential personalities. Our men were told to control any situation using batons,” said a senior police officer.

“It was a tough time. Every senior officer gave us different instructions,” an inspector with the Hyderabad City Police said. “We were very confused. We all did whatever we felt was right according to the situation on the ground. Some of our men used their batons to control the situation and keep people inside. Many people were injured in the process.”

In a recent counter affidavit filed in the Telangana High Court on allegations that the Falaknuma police personnel had damaged vehicles parked outside homes in a residential area, the Hyderabad Police Commissioner, Anjani Kumar, submitted: “The police had checked the vehicles using police lathis in order to see whether coronavirus was present or not”. Though this statement was widely condemned on social media, no action has been taken against the lathi-wielding policemen.

The migrant crisis

While contact-tracing of foreign returnees as well as those who had returned from the Tablighi Jamaat congregation in Delhi was being done, a new crisis began unfolding, like in the rest of the country. Abruptly left without any means of livelihood, food and money following the imposition of the lockdown, migrant workers began their exodus from Hyderabad. Over days and weeks, thousands of workers, clutching their belongings and their children, were seen walking in Hyderabad and other districts bordering Maharashtra and Chhattisgarh. They were all desperate to go home. Even a month later, the scene did not change. Workers walked hundreds of kilometres to reach homes as far away as in Bihar and Uttar Pradesh. The Chief Minister’s attempts to woo them back with 12 kg rice and ₹1,500 in cash for each family did little to stop them. According to officials, there were more than 7 lakh migrants in the State. While some of them did choose to stay back after receiving help from the police, members of civil society and NGOs, the rest left.

Junior doctors from Gandhi Hospital stage a protest after a post-graduate student was allegedly attacked by the attendants of a patient who died of COVID-19.

 

Those who chose to stay back were not happy either. On April 29, for instance, more than 2,000 migrant construction labourers stationed in the premises of IIT-Hyderabad erupted in agitation against their employer , the construction firm L&T, for forcing them to live in poor conditions during the lockdown. They claimed that they were left to fend for themselves, without any pay or help. Clashes with the police caused injuries to at least one police officer and damage to one police vehicle. The incident changed the State government’s policy towards the workers.

Two days later, on May 1, the Telangana government started sending back the workers home in special trains . Till June 10, the South Central Railway in coordination with the State government ran 146 special trains to send back more than 1.88 lakh migrants to their hometowns in Bihar, Odisha, Uttar Pradesh, Jharkhand, Madhya Pradesh, West Bengal, Assam and Manipur. On May 23-24 alone, 41 trains took workers to five different States . The workers began going back, but many of them also carried the virus with them to the districts.

Lack of transparency

Though it was among the first States to impose a lockdown immediately after the Janata Curfew , Telangana started conducting fewer and fewer tests. Worse, it stopped sharing information on cases and samples tested, in its daily medical bulletin, from March 25 to June 15. Doctors attending to COVID-19 patients in the State started comparing the State medical bulletin with the medical bulletins of other States on WhatsApp groups or on Twitter to ask why the Telangana health department was not releasing day-wise data on tests conducted.

Telangana Health Minister Eatala Rajender and officials in the health department responded to the criticism by saying that the tests were being conducted according to the guidelines issued by the Indian Council of Medical Research. “When we strictly follow ICMR guidelines, we get more cases. Our accuracy of tests is greater. More tests can be conducted, but what purpose will it serve if tests are not focused and less positives are detected,” asked officials in the health department.

As criticism for conducting fewer tests mounted, the State government, on June 14, decided to conduct 50,000 tests in 10 days in 30 Assembly constituencies of Hyderabad, Rangareddy, Vikarabad, Medchal-Malkajgiri and Sangareddy districts. Tests and treatment at private laboratories and hospitals were allowed. On the Chief Minister’s directions, charges for tests at private establishments were capped at ₹2,200 . For samples collected from homes, the rate was fixed at ₹2,800. A huge surge in positive cases was observed after the initiative was launched, from June 15. Besides RT-PCR tests, rapid antigen tests too were used from around July 8 to detect COVID-19 cases.

The health department’s June 16 and June 17 bulletins published information about the number of tests conducted, but this information again disappeared from the June 18 bulletin only to reappear the next day. After the health department started to conduct rapid antigen tests, questions were raised again about the break-up of tests and cases between RT-PCR and the antigen tests, which was not mentioned.

Reasons for spread of virus

The lack of data was especially a problem given that by the end of May, there was a spike in cases . Though people had their theories for this, they sought answers from the government. On May 30, the State’s Director of Public Health, Dr. G. Srinivasa Rao, said increased movement of people following lockdown relaxations in May had led to the spike. Officials blamed the people for the surge in cases.

The numbers in rural Telangana also went up rapidly when workers who had migrated for work to Maharashtra, Andhra Pradesh and other States started coming back home. “The influx of migrant workers was very high, especially in the Yadadri-Bhuvanagiri, Mancherial and Jagtial districts. Thousands of them were coming back every day, many with the infection. But cautious villagers and the strategy of the police department helped us in containing the spread of the virus,” said an IPS officer.

According to the officer, the infection came to Telangana in three waves: first, with the foreign returnees; next with the Markaz returnees; and then with the migrant workers, before community spread started. “Many people who went to Cancer Hospital and other hospitals in Hyderabad for their regular treatment also returned with the infection. A few workers died within days of coming back to their native places,” the officer said.

While harsh measures were used to control the pandemic, politicians continued with their meetings. “A large number of politicians, party workers and officials gathered together when the Chief Minister launched the sixth phase of Haritha Haram, the tree plantation programme, in Medak recently. There was no physical distancing and many were not even wearing masks,” the officer said. Whether that made any difference to the number of cases or not, only time can tell. The Home Minister of Telangana tested positive for COVID-19 and was under treatment in a private hospital. He has now been discharged.

Problems in private labs

The cumulative positivity rate till July 15 was 18.85%, one of the highest in the country. Health department officials said there were discrepancies in private laboratories which had led to the high test positivity rate. Four teams inspected 16 private laboratories in Hyderabad in the last week of June. They suspected that a few labs had been conducting pool sampling. Instead of testing each sample in a pool, if even one sample in a pool tested positive, all samples were declared positive. Other discrepancies too were observed in the private labs. However, the officials did not provide precise data on the number of samples tested at government and private labs, which helps determine whether private labs have contributed to the high test positivity rate.

The State government also came under criticism for another reason. From July 7, old Secretariat buildings began to be demolished in order to construct a new Secretariat. These buildings could have been used to accommodate more COVID-19 patients, people and Opposition parties said.

Struggle in hospitals

Four and a half months after the first COVID-19 case was detected in Telangana, 39,342 cases were detected as on July 15 , the seventh highest number of cases in the country. Telangana has among the lowest test rates (tests per million people) in India and the lowest in south India (5,722 per million people). Hospitals are struggling not only with beds but also with other infrastructural and manpower-related issues. On Wednesday, rainwater from storm water drains gushed into the in-patient block of Osmania General Hospital where patients were undergoing treatment (those suspected of having COVID-19 are treated in the out-patient block). Doctors said rather than recovering, patients were likely to contract new infections in such unhygienic conditions. They are worried that such a situation, if it were to occur in the out-patient block, might cause a grave health crisis. In Gandhi Hospital, over 600 outsourced staff comprising patient care providers, sanitation workers and others boycotted duties from Tuesday demanding regularisation of job and hike in salaries. They draw only ₹9,500 per month. They called off the protest on Wednesday after daily incentives and one week of quarantine after one week of work was assured to them. In the District Hospital, King Koti, people have complained that lack of a help desk or signboards has left them clueless, forcing them to spend time waiting for help among scores of other COVID-19 patients. Private hospitals are filling up; many are not admitting patients.

Meanwhile, in one of the private hospitals, the techie’s brother is gasping for breath. The techie has fully recovered but his brother is now struggling.