Telangana’s COVID-19 strategy trips on low tests, weak infrastructure

First, it was complacency. Now, it is a deliberately risky approach. The Telangana government’s strategy to fight COVID-19 has been drawing flak at every stage.

Over six weeks into the lockdown, the Telangana Rashtra Samithi (TRS) government is facing widespread criticism on three fronts — poor testing; refusal to test secondary contacts of COVID-19 patients; and failure to ramp up healthcare infrastructure. There are also concerns over the inadequate supply of protective equipment, masks and other requirements for medical and paramedical staff.

Apart from senior doctors and public health experts, the opposition Congress and BJP leaders have flagged concerns over ‘gross under-reporting’ of cases in the state and lack of ‘scientific approach’ to tackle the crisis.

The doctors at the State-run Gandhi Hospital in Hyderabad, which has been converted into an exclusive facility to treat COVID-19 patients, have also raised similar concerns.

“We are genuinely worried about the less number of tests being done in the state. Unfortunately, the secondary contacts are not on the government’s radar. We are worried that if the secondary contacts are not tested, they may remain as active spreaders, resulting in the spike in the number of cases once the lockdown is lifted,” the sources at Gandhi Hospital told The Federal.

Gaps in the government’s approach

‘Doctors for Seva,’ a Hyderabad-based NGO comprising doctors and public health experts, flagged concerns over low testing, exclusion of secondary contacts of the COVID-19 patients from the purview of testing, under-reporting of cases and poor healthcare infrastructure in the state.

They shot off a letter to the Inter-Ministerial Central Committee (IMCT), highlighting the gaps in the state government’s approach to tackling the pandemic. The NGO pointed out that the official statistics raised a lot of concerns, especially when compared to other states. To add to this, there was an order by the Telangana Health Department on April 20 that samples must not be taken from the bodies of those who succumbed to COVID-19. The government also decided not to test the secondary contacts of the patients.

“This is a risky strategy. It is a pandemic. It demands that the government follow international guidelines. We have to follow protocols to safeguard our people. The government’s decision to not test is very disturbing and will backfire very badly,” the ‘Doctors for Seva’ said.

Citing the example of Suryapet town where the second-highest number of cases in the state — 83 — was reported, the doctors said that no testing had been carried out there since April 23. “The numbers may have exploded. Without testing, there is no knowing how widespread COVID-19 is,” they said.

Falling test figures

On April 21, the government decided not to test anyone without COVID-19 symptoms or those who are not primary contacts of the patients. As a result, the officials have been reporting daily cases in single digits. According to sources, less than 400 tests are being done daily.

Based on these figures, the government began exuding confidence that the spread of the virus was being contained.

“Only the primary contacts of the positive cases shall be brought to the government-identified quarantine centres and their samples will be taken for testing. The asymptomatic secondary contacts shall not be tested,” an order issued by Chief Secretary Somesh Kumar had said.

“However, they shall be identified, stamped and placed in strict home quarantine for 28 days and monitored daily by the local multi-disciplinary surveillance teams,” it said.
According to data from the Indian Council for Medical Research (ICMR), Telangana had carried out 4,035 tests between April 19 and 26. The number fell to 2,506 for the four-day period, from April 27 to April 30 and, consequently, the positive cases fell steeply to 35.
Between April 5 and 11, the authorities had conducted 4,781 tests, the highest number done in a week in the state. During this period, 241 coronavirus positive cases were reported.

The director of the Centre for Cellular and Molecular Biology (CCMB) Rakesh K. Mishra has called for sustained testing to determine the extent of the spread of the disease.
His concerns echoed the views of many other experts as well as the World Health Organization (WHO) which has repeatedly stressed the need for increasing the rate and pace of testing to determine the true extent of the spread of the virus.

As of Tuesday (May 5), Telangana recorded 1,096 positive cases and 29 deaths. Hyderabad accounts for 66 per cent of the total number of cases.

The state healthcare authorities, however, justified the low rate of testing, saying they are following the ICMR guidelines. “Each state has its strategy in dealing with the pandemic. There is no need to compare with other states. We are doing tests where it is required and as per the ICMR guidelines. There is no question of less or more tests,” said G. Srinivasa Rao, Director of the State Public Health Department, said.
Testing all symptomatic people and all primary contacts had been the strategy of the government, Dr. Rao said. “With no big targeted group, why should we do more tests unnecessarily?” he said.

Disagreeing with the perception that Telangana was attempting to develop herd immunity with lesser tests, he said, “Herd immunity might occur sometime in future with vaccine support. As of now, there is no proof of herd immunity anywhere in the world.”

“The ICMR has recommended that only patients with COVID-19 symptoms be tested. It indicated that asymptomatic secondary contacts need not be tested. We are not lying on the number of cases,” Medical and Health Minister E. Rajender said.

The minister’s assertion comes against the backdrop of growing criticism from the state BJP and Congress leaders who accused the government of trying to ‘conceal the facts and mislead the central team.’