Turning the COVID-19 tide in Chennai

With the telephones ringing off the hook and the queues of the sick turning into longer, S. Sangavi and S. Ramachandran knew higher than to place their drained ft up. In their 12-hour shifts, the duo — an emergency medical technician and an ambulance pilot connected to the 108 ambulance community — took on a number of journeys in Chennai, ferrying not less than 10 sufferers identified with COVID-19 to close by authorities hospitals every day.

Though each Sangavi and Ramachandran, employees of the Vadapalani Depot ambulance, have been dealing with COVID-19 sufferers from the begin of the pandemic, they quickly realised that the unrelenting second wave of infections was in contrast to the first. With every passing day, they slowly obtained accustomed to the lengthy queues of ambulances and longer ready hours outdoors authorities hospitals, hoping fervently that the affected person on board would get a mattress. “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 instances, their shift prolonged to so long as 15 hours. “There was no time to eat,” Ramachandran says.

As they got down to choose up a affected person, both from house or from a screening centre, they’d transcend their outlined 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 affected person was admitted, it might be time to select up the subsequent. “It was like working at the warfront,” says Mohamed Bilal, regional supervisor, 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 process was removed from simple. With many ambulances held up outdoors hospitals, the staff had to make sure that the automobiles reached the sufferers 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 changed into a COVID-19 hotspot in the blink of a watch. The second wave resulted in an exponential rise in the energetic case load. Since the starting of the pandemic, 2.36 lakh circumstances had been reported in the metropolis, as of March 5, 2021. When the State’s every day case depend crossed 500 marking the starting of the second wave, greater than 2.50 lakh individuals have been contaminated in a span of simply two and a half months in Chennai.

The fast rise in circumstances and the quick deterioration of sufferers put nice pressure on main hospitals. Hospitals ran out of beds whilst the demand for oxygen-supported and intensive care unit (ICU) beds surged. Chandru (title modified), a resident of Sithalapakkam, was considered 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 makes an attempt 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 non-public hospital with oxygen assist. “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 loss of life of his father was agonising, the variety of deaths round him as they waited numbed him.

Over two months, the metropolis noticed a whole bunch of such circumstances. There have been determined hunts for beds, heartbreaking moments of watching family members gasp for breath whereas ready in ambulances and personal automobiles, and serpentine queues outdoors counters to select up vials of Remdesivir. Meanwhile, hospital authorities spent sleepless nights ready for oxygen vans to reach.

“The numbers were huge this time,” says E. Theranirajan, dean of RGGGH, considered one of the largest hospitals for COVID-19. Since mid-March, RGGGH has handled 12,000 sufferers 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 noticed its per day oxygen requirement hovering to 40-45 metric tonnes a day. With beds in all seven flooring of Tower-3 stuffed up, Dr. Theranirajan and his staff began to open COVID-19 wards in different blocks. The variety of beds shortly rose from 1,618 to 2,050, with the variety of oxygen beds rising from 817 to 1,522 from May 5 till 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 confronted a number of challenges: decongesting ambulances on campus, beginning remedy on time, stabilising sufferers being wheeled in, and even including area for the useless.

The medical doctors knew that they needed to suppose in a different way. So, a staff of three medical doctors together with technicians was deployed to triage sufferers ready in ambulances and a respiratory care staff was despatched to evaluate each affected person’s oxygen wants and supply acceptable dosage, he says.

The surge in circumstances

The first wave peaked on June 30, 2020 in Chennai, when 2,393 every day circumstances have been reported. They steadily declined after that and have been decrease than 1,000 a day by mid-October. On February 19, 2021, Chennai noticed simply 136 circumstances.

By then, the State was making ready for the Assembly elections and all the COVID-19 management measures taken throughout the first wave in Chennai and different locations have been scaled down significantly.

The early indicators of a resurgence in circumstances have been observed in the first week of March. Cases started to go up marginally. By the first week of April, when the State went to the polls, the variety of every day reported circumstances had crossed 1,000. The quantity continued to rise sharply and on May 2, when the election outcomes introduced a change of presidency, the circumstances crossed the 6,000-mark.

More than crowding throughout elections or different elements, the sudden enhance was primarily as a consequence of 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 habits similar to sporting masks and sustaining bodily distancing, and never searching for early take care of COVID-19-like signs have been the main elements for the rise in circumstances. “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 research carried out throughout the first wave confirmed that 44.2% of the inhabitants in Tondiarpet and 34.4% in Royapuram, two of the worst-affected zones, had been uncovered 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 information confirmed that whereas the circumstances have been comparatively decrease in these two zones than the others throughout the second wave, the two however remained considerably affected.

The unfold was extra aggressive in the southern and central areas than the northern areas this time. While the northern zone accounted for 34% of all circumstances in the first wave, it accounted for under 28% in the second wave.

By the time the new authorities was sworn in on May 7, it was turning into not possible for a lot of sufferers to get oxygen-supported or ICU beds in hospitals. Social media was flooded with requests for beds or oxygen. It appeared as if the metropolis was heading in the direction of the disaster confronted 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 staff verify the oxygen saturation ranges of residents throughout a door-to-door survey for COVID-19 in Chennai’s Mogappair West space.
 
| Photo Credit: VEDHAN M

Rise in fatalities

The deaths as a consequence of COVID-19 stored rising in the metropolis. A authorities physician, on situation of anonymity, stated it was agonising to see younger individuals succumb to the an infection, primarily as a consequence of respiratory failure. “Some were brought dead to hospitals,” he says.

The disaster started to take an enormous toll on healthcare staff. “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 scholar.

On May 12, when Chennai recorded 7,564 every day COVID-19 circumstances, the highest since the begin of the pandemic, Dilli Rajan, the caretaker of Velangadu crematorium, stood beside a hearse, directing his seven assistants to work late into the night time to cremate the our bodies. Several hearses had lined up at the crematorium. Prior to COVID-19, cremations have been held solely until 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 misplaced his aunt throughout the pandemic. The scenario was comparable in most of the 41 crematoriums in Chennai. GCC information present a rise from 150 loss of life registrations a day to greater than 350 a day throughout the second wave.

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Since the final week of March, the metropolis has reported greater than 3,300 deaths, nearly near the whole deaths reported throughout the first wave until October 2020. However, the case fatality charge has remained low in comparison with the first wave. While it was round 1.8% throughout the first wave, it’s at the moment 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 additionally elevated by 300% in many crematoriums, which is a serious reason behind concern for public well being officers. One of the causes for the rise in the variety of deaths throughout the second wave in Chennai has been the crowding of tertiary care authorities hospitals by sufferers who don’t require higher-level medical care. With restricted variety of beds in authorities and personal tertiary care hospitals, many sufferers who required emergency care have been unable to get admitted to hospitals.

The turnaround

The scenario, nonetheless, was managed and stabilised via multi-pronged community-level methods earlier than it spiralled uncontrolled. The State authorities imposed an entire lockdown on May 10. While this was aimed toward curbing the fast unfold of an infection, it additionally gave the much-needed breather for hospitals and time to scale up the infrastructure.

Door-to-door fever surveillance to proactively establish circumstances at an early stage was ramped up and so have been screening centres for triaging, and telecounselling centres. While these measures existed throughout the first wave, new ones have been added to deal with the second surge. Two hundred and fifty-one automotive ambulances with oxygen assist have been launched to handle the scarcity of ambulances and guarantee zero-delay transfers to hospitals.

Another key initiative was discipline triaging. With the 13 screening centres situated in completely different components of the metropolis proving insufficient to deal with the surge, discipline triaging was launched. Two hundred and fifty-one groups, every comprising a health care provider and two nurses, have been shaped.

“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 affected person in house isolation is named not less than as soon as a day by the telecounselling centres, the place last yr MBBS college students together with medical doctors are deployed.

More than 12,000 fever survey staff have been deployed to go to each family to establish individuals with COVID-19 signs. This is in addition to round 400 fever survey camps throughout the metropolis, primarily specializing in hotspot areas. A gaggle of volunteers known as ‘Friends of COVID Citizen Under Surveillance’ was deployed to help these below house isolation. The members offered groceries and monitored adherence to guidelines.

Apart from these measures, the Medical and Family Welfare Department labored on rising the mattress capability and arrange a Unified Command Centre (UCC) for mattress allocation and oxygen monitoring, which was later transformed to the State’s battle room for COVID-19.

From the day it was arrange as a UCC on April 30 until May 25, greater than 60,000 calls have been obtained requesting beds and oxygen assist. An official working at the UCC says that whereas the UCC was capable of fulfil solely 30% of the requests in the preliminary days, it has been capable of fulfil greater than 60% of the requests in the previous one week.

Dr. Varghese additionally says expertise was used each for administrative functions (for environment friendly monitoring and deployment of assets) and for the public. An instance is the GCC VidMed software. Given the difficulties for a lot of to go to a health care provider or a hospital, the app was launched to allow sufferers to seek the advice of medical doctors on-line.

“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 talked about that he needed different cities to emulate some options of this mannequin. GCC Commissioner Gagandeep Singh Bedi says the Chennai Model of COVID-19 prevention and case administration has change into simpler as a result of it’s “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 need to report outcomes to residents via the single-window system adopted by the GCC, for higher coordination. The civic physique 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 provides.

GCC’s Deputy Commissioner (Works) Meghanath Reddy says the second wave was managed via a number of 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 services

Amid the raging pandemic, authorities hospitals continued to ramp up infrastructure. They wanted extra beds, oxygen factors, oxygen provide and manpower to deal with the rising variety of sufferers. “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 began to select up in Chennai. While Tamil Nadu’s total efficiency on vaccination leaves a lot to be desired, Chennai has performed considerably properly in comparison with most different cities with round 70% of the aged receiving not less than one dose of the vaccine.

GCC plans to vaccinate not less than 50,000 individuals a day from the current 23,000 as soon as the vaccine provide improves. Till date, the metropolis has achieved a protection of roughly 19 lakh (two doses).

Cases fall in metropolis, rise in districts

Cases have begun to point out a declining development in Chennai, dropping from a peak of seven,772 circumstances on May 12 to 2,762 circumstances on May 28. The burden of circumstances in Tamil Nadu is shifting to the rural areas.

Chennai accounted for 25% of the 30,355 circumstances reported in the State on May 12, whereas on May 26, it accounted for 10% of the 33,764 circumstances 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 share change in incidence and every day check positivity noticed from the reported information 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 began to rise in a lot of districts. As the Health Secretary factors 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