5 min read.Updated: 27 Jul 2020, 07:05 PM ISTSeethalakshmi S
Active cases and deaths have risen the most in Karnataka in the past few weeks. Every day, more than 1,000 people are testing positive for the virus
Bengaluru: In March, an expert group comprising epidemiologists, doctors and public policy experts submitted a district-wise action plan to the state government to tackle a possible covid-19 emergency in Karnataka. The state had less than 100 positive cases at that time. A little over four months later, Karnataka’s cases are near one lakh, and the action plan is gathering dust.
Active cases and deaths have risen the most in Karnataka in the past few weeks. Every day, more than 1,000 people are testing positive for the virus. A predictive analysis that experts have submitted to the government says the state will have more than two lakh cases by October.
A swirl of factors has contributed to Karnataka’s slide from being a state managing the outbreak efficiently to one with the fastest growing case load. Chief minister B.S. Yediyurappa hasn’t been able to settle on a unified command to tackle the pandemic—three ministers handle the rapidly spreading virus and barely speak to one another. Planning has been inadequate, and private hospitals, which manage nearly 80% of the institutions with good infrastructure in the state, haven’t been drawn fully into the covid-19 response. Without planning, the government was unable to foresee the problems that would arise with the reopening of the economy. Karnataka went into a ten-day lockdown again from the night of 14 July, but it was a poorly enforced one.
Three ministers are in charge of covid-19 management in Karnataka—B Sriramulu who holds health and family welfare, K Sudhakar of medical education, and R Ashoka of the revenue portfolio—and there’s no coordination between them, say other cabinet members, legislators and bureaucrats. “The CM is busy managing people so that there is no dissidence in the party. In the process, crucial decisions are delayed or not taken, and we cannot afford to lose time while trying to control the spread of the virus," said a member of the state BJP.
Unlike Kerala, where chief minister Pinarayi Vijayan holds daily briefings to update the media and citizens about the covid-19 scenario in the state, there is no single go-to person in the Karnataka government who is tackling the pandemic.
“Partnership is the mode for seamless governance during hard times like this," said epidemiologist Dr Giridhar R Babu, whose committee warned the state government to prepare for a surge in July said. “Frequent consultation with all stakeholders, and ownership by every department, with robust planning is the only way to deal with a pandemic of this proportion," said Dr. Babu, who is also professor and head of life course epidemiology at Public Health Foundation of India.
This isn’t happening in Karnataka: when health minister Sriramulu and medical education minister Sudhakar did not see eye to eye just as the viral load was rising in the state towards the end of May, Yediyurappa told primary and secondary education minister S Suresh Kumar to do the daily briefings. A month later, Suresh Kumar had to turn his attention on the SSLC Class 10 board examinations for nine lakh students in the state. He exited covid management and said he would focus on the portfolio he’d been assigned—education. Later, Yediyurappa asked revenue minister Ashoka to take over the daily briefings.
As the state’s coffers emptied out, Yediyurappa decided to open up the state and the economy completely without putting in place precautionary measures. When the lockdown eased, Karnataka had fewer cases but opened its borders up indiscriminately—people from Maharashtra, Tamil Nadu and Andhra Pradesh, all states with a high case load, entered freely without tests or quarantining. As a result, districts like Chamarajanagara, which had zero cases until May, began seeing a surge in infections. “We allowed people from states with a high case numbers to enter Karnataka without having a plan or measures to control the spread. We allowed community transmission. In March and April, Karnataka had broken to chain of transmission to an extent. It is the last mile where we lost, when we opened our borders," said Dr U S Vishal Rao, member of the consultative group to the Centre’s Principal Scientific Advisor.
Other decisions added to the spread. The Class 10 exams began on 12 June just a few days after the lockdown was eased on 8 June. “Holding the SSLC examinations and getting lakhs of students together was a blunder. Like Tamil Nadu, Karnataka could have opted for an all-pass policy this year and prevented further spread," said public health analyst Dr Pramukh Natesh.
“We have done our best and are working hard to contain the virus. We obviously did not foresee such a surge. It is a complex situation and there are many lessons for the government from this pandemic. We have constituted an expert group to recommend course corrections," said Shalini Rajneesh, additional chief secretary (planning/monitoring), Government of Karnataka.
Meanwhile, labs are overburdened and testing has slowed from about 10,000 per day to 6,000 a day. Labs are short of staff because some have tested positive for the virus, and the tests are piling up. The NIMHANS lab, for instance, was closed for three days for sanitization after some of its staff tested positive.
“Testing is crucial and we cannot slacken, but we did not foresee the surge in cases. We hope to scale testing up to 25,000 a day in the coming weeks," said Dr C.N. Manjunath, who is in charge of labs in the state covid-19 taskforce.
The head of a prominent chain of private labs said his employees are clocking 18 hours a day but are still unable to clear the backlog. “We are burnt out. Covid testing is mandatory before every surgery now and we are inundated with tests. The waiting period for a test report can be anywhere from two to five days," he said.
For months, the government believed that the 500-bed facility at the Victoria hospital would be enough to handle cases. It was only in June that it roped in nearly 500 private hospitals to treat covid-19 patients. By then, cases were already rising rapidly, and planning had not been done. Hospitals, which were already reeling under severe financial crunch due the shutdown in March and April, were hesitant about opening up for covid care as there was no clarity on rates they could charge and government reimbursements.
“Even if the private sector was roped in late, there should have been centralised allocation of beds. Private hospitals told the government they would earmark 2,000 beds and began admitting patients even at the risk of cross infection. We have been asking for a centralised call centre so that there is no confusion in bed allocation. In the absence of this, patients are running from one hospital to another without knowing the availability of beds. It’s a mess," said Dr Nagendra Swamy, founder-chairman, Medisync Health Management Services.