Lessons from the pandemic’s first wave

A paper by Health Dept. staff outlines the city’s response to the virus in 2020

It was a combination of interventions that slowed the transmission and resulted in the decline of cases, despite the lifting of movement restrictions, during the first wave of the pandemic in Chennai, a pre-print article published in medRxiv by Jagadeesan M., et al, has argued.

Authored by Health Department staff at the Greater Chennai Corporation, along with scientists at the National Institute of Epidemiology, an ICMR institution, the paper documents the COVID-19 response by multiple players during 2020 in the southern Metropolis.

Chennai mirrored other cities in India by a characteristic lack of compliance to restrictions, unlike in China and Europe, primarily because of the nature of these cities. Highly congested urban slums required a tweaking of strategies. The solution that emerged was a community-centric public health strategy to improve early detection of clusters, access to free testing closer to residences and free hospital-based care, the paper outlines.

Strong political will

The success of such a programme required strong political will, good governance, extensive public sector hospital and lab infrastructure and adequate dedicated human resources, and its success reflects the availability of support. In addition to these interventions, a dedicated State-level procurement agency facilitated the rapid procurement of PPE kits, consumables and other requirements, the authors outline.

An integrated data management system that pooled the information from laboratories, hospitals, and from public surveillance helped tackle the beast.

“Unlike rural India, which has a more structured public health care system with an extensive network of community health workers, urban health systems are more fragmented, with many people seeking care in private sector facilities,” the paper says. As a result of this realisation, rather early in the epidemic, additional resources were mobilised for special camps for fever and sample collection and helping with quarantine.

“Triaging helped manage the epidemic in a way so that it did not overwhelm the system. The majority of persons went home, stayed quarantined, about 70%. People with moderate disease were referred to COVID-19 Care Centres and others had to quarantine at home,” explains Prabhdeep Kaur, Deputy Director, NIE-ICMR.

Case fatality ratio dropped from 4.2 in March 2020 to 1.1 in October, for instance. The Reproductive transmission (Rt) dropped from 4.2 in March to below one by the first week of July and remained so until October 2020, even with the relaxation of restrictions. Healthcare infrastructure did not collapse under the weight of the pandemic.

In this analysis lie multiple learnings that can become become the gold standard in similar circumstances.

Given that the ongoing second wave took a geometric leap from the first wave, how will these learnings work? “The interventions are pretty much the same. This time, we will probably have to scale up much higher,” Dr. Kaur explains.

“We know this works for us. The Corporation has started reimplementing some of these interventions again. They should take the load off hospitals and prevent the panic that leads everyone to seek hospital admission,” she added.

There are also warnings from such documentation of past experience. For instance, there is convincing data that higher case fatality ratio continues amongst the elderly population. Protecting this group from infection, early detection and preventing severe disease in them must continue to be a priority issue.

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