Why COVID-19 Cases Are Rising Steeply in Tamil Nadu
2,000 cases so far has been traced to the Koyambedu market cluster.
With 716 cases of COVID-19 on 12 May and almost 800 cases the previous day, Tamil Nadu has now overtaken Delhi as the state with the third most number of cases in the country. The state has 8,718 positive cases, of which 5,848 are males, 2,867 are females and 3 are transgenders.
‘Highest single day spike’- has been the words used to describe the rise in cases for every single day for the past two weeks. This sharp rise can be attributed to the number of infections in the Koyambedu market cluster, which has contributed to more than 2,000 cases so far.
In comparison, the Tablighi Jamaat cluster in the state, which had been the source of major headlines stands at 1,350, with 631 primary contacts infecting 719 close contacts.The other key sources of infections are those who have returned from foreign countries and other states, with 715 such persons infecting 2,464.
Chennai accounts for 4,882 cases which is more than half the number of cases in the entire state. FIT has done a deep-dive to understand why the state government couldn’t preempt this super spreader and if the state’s strategy to increase testing in the past fortnight has helped contain the spread.
How a Market Became a Super Spreader
What began as a single case on 9 March has snowballed into a major crisis that has left health officials and the state government deciding that a lockdown is the only way to contain the spread of the virus.
For the last one week, the Koyambedu wholesale market in Chennai has turned out to be a super spreader. The vegetable and fruit market is the primary supplier for markets throughout Chennai. A number of vendors from neighbouring districts Cuddalore, Tiruvallur, Chengalpattu, Villupuram, Ariyalur, Perambalur and Kancheepuram also bring in produce to this market.
A Deputy Commissioner of Police in Chennai, who was supervising crowd control measures at the market, has also tested positive for COVID-19.
There are almost 3,750 vegetable, fruit, flower and grain shops and over 10,000 labourers in the market complex. Several Swiggy and Dunzo delivery men were also frequenting the market.
Even though the lockdown was in place, the market witnessed rush a day ahead of Tamil New Year that falls on 14 April. From then on, the same situation persisted as people resorted to panic buying.
Failure in Planning
The Koyambedu market was kept out of bounds for retail, as in consumers were denied access as early as 20 April and only wholesale was permitted. However initially, this rule was only on paper and not strictly enforced, many experts chimed in.“The mess in Koyambedu lies with the CMDA. Unlike all other markets which come under Corporation, this comes under CMDA. They were tasked with ensuring social distancing. But the ban on retail trade was done only on paper but people just kept going and weren’t stopped,” said political analyst Sumanth Raman.
Mohan, a vendor in Mambalam market who procures vegetables from Koyambedu said, “Actually this is not a surprise. We knew this was coming but we couldn’t stop ourselves from going right? This is our livelihood and if I don’t bring vegetables here, what will the people do? The government should have segregated better.”
While social distancing norms were enforced by the officials, it was quite difficult to manage a huge number of vendors gathered at the same place, said a source.
While Chennai was recording a maximum of 140 -170 cases until 2 May, the numbers began surging from 3 May. On 4 May, the state acknowledged in their health bulletins that this was due to the number of infections in the market.
However, the biggest flaw in the planning, said a health official, was allowing workers from other districts to leave the market without testing them, once this surge began. The market was shut as soon as cases were detected and vendors were shifted to Madhavaram and other locations.
In a normal case, a person who tests positive for COVID-19 will have 10 to 30 contacts, but if a vendor in this cluster test positive, there could be 100 - 200 contacts, said public health officials.
Only Contact and No Primary at All?
On 11 May, the state recorded the highest single day spike ever with 798 cases, of which 538 were from Chennai. What is interesting to note is how the history of cases recorded in the last one week in the entire state have only been ‘contact’ and no ‘primary’ cases.
“Even today, I don’t believe all 700-800 cases are linked to only Koyambedu. How can everyone be contact? Unless you are testing only contact cases, then yes there won’t be any primary cases. But that also means you are not doing any random sampling. And that is worrying.”Sumanth Raman, Political Analyst
‘Community Transmission is Obvious’
Many experts pointed out that the ‘complete lockdown’ that was announced in Chennai, Madurai, Coimbatore, Salem and Tiruppur from 26 - 28/29 April also made matters worse. Since, the announcement was made only a day earlier, thousands of panic-stricken people thronged the local markets.
A source close to the health department said that this panic is because people are not sure if they can trust the government. “Today, the government will call for a two-day complete lockdown but they could just extend it. That has been the case since the first lockdown was announced. Too many officials announcing rules and people are bound to panic,” he said.
Dr T Jacob John, Senior clinical virologist and emeritus professor at Christian Medical College, Vellore explained, “Inadvertently, instead of flattening the curve, they’ve done the opposite. They didn’t ‘expect’ people to crowd in the marketplace, which means you didn’t expect people to behave like people.”
He called the government’s way of dealing with the situation as ‘not a planned response,’ but ‘ad-hocism repeated.’
“There is a concept government applies to people -yo-yo : you are on your own,” he explained as the primary reason for panic amongst people.
“You find what you look for. If you are looking at contact, then you will get only contact history. If you think there is no community transmission in Tamil Nadu, then you are mistaken. There is a lot.”Dr T Jacob John, Senior clinical virologist and emeritus professor at Christian Medical College, Vellore
Ramped Up Testing - The Golden Ray of Hope for TN
Tamil Nadu refrained from testing aggressively in the initial stages of the COVID-19 outbreak, with only a few hundred persons being tested every day until mid-April. However, the state has now considerably ramped up testing with over 10,000 persons on an average every day.
Analysts and medical professionals too lauded the state for increasing the number of testing at least now. Many believe media should not put pressure on the number of cases announced every day. “Even if there are 1,500 cases recorded in a day, that is okay. It is better than sitting like Bihar and West Bengal who have no clue of what is happening,” said Raman.
Overall, the state has tested almost the same number of persons as Maharashtra, which held the top position for testing until recently, though the latter’s population is around 35% higher than Tamil Nadu’s.
The state health minister has assured that Tamil Nadu is leading in the race in terms of testing and they have specific teams to do contact tracing with respect to this cluster.
Several experts in the state proposed that the health department needs to provide more information about the number of testing being done district wise as it will help understand the rate at which cases are rising. They explained that it was essential to know the ICU admission rate, patients on ventilators, patients with severe acute respiratory illness being admitted to hospitals everyday.
‘TN and India Not Ready to Tackle COVID-19’
Tamil Nadu boasts of one of the best public healthcare system in the country.
COVID19 testing is done in 37 government and 16 private labs all over Tamil Nadu. Till now 2,54,899 samples have been taken and sent for testing. The state has also been arranging for COVID care centres in case of an influx of cases. Government doctors in Chennai told FIT that the supply of Personal Protective Equipment (PPE)s and incentives have been fairly good in the state, compared to the rest of the country. “As far as testing is concerned, they are doing well. They are two weeks late, but after that they ramped it up. This is also not enough but compared to rest of India, we are much better,” said Raman. However, many doctors feel that when countries abroad, like the United States have failed to safeguard their people from COVID-19, it is a known fact that our public health system is not equipped to deal with the crisis. Many experts also appreciated the efforts by the state to ensure all people, including those stranded and migrant labourers, have access to food and shelter. There have been no major case of labourers walking back home because they are starved.
Dr Jacob T John proposed that the present solution to this problem that is equal to the lockdown, but also helps in maintaining economic stability, is ‘100% mask wearing.’
“You can come two feet closer if you are wearing masks. But otherwise you have to maintain 6 feet. Physical distancing can become less stringent, if 100% mask wearing is not just promoted but enforced. This is proven and tested which has to be adopted. A study in the United States has shown that if 80% persons consistently wore masks, then the graph can be flattened,” he said.
(Subscribe to FIT on Telegram)
Subscribe To Our Daily Newsletter Now.