Jai Pratap Singh is the cabinet minister for medical and health, family welfare, mother and child. Singh was infected with COVID-19 in the earliest days of the pandemic and used that period to firm up his knowledge about the symptoms and forms of the disease by talking to other patients. It also allowed him to see for himself how robust the government’s system of surveillance was.
How has Uttar Pradesh responded to the pandemic so far?
The Chief Minister initiated procedures as soon as we got a message about the coronavirus entering the states. The first thing was to get beds ready in anticipation of the numbers. We have 1.55 lakh beds at different levels of care. Then came testing. We started with just 7200 tests but have now touched 1.5 lakh tests a day. We started with antigen and pool testing. Truenat machines were installed in one go in all districts. CB-NAAT machines used to test for tuberculosis were also put to use for COVID-19.
If we compare ourselves to other states, then given our population of 23 crores we have fared much better. Our strategy is testing, intensive surveillance, contact tracing and home isolation or hospitalization as need be. We had extensive containment zones initially and these would spread in a 500 metre radius of the infections. It is now down to 100 metres. For one patient, we trace at least 15 contacts. There is a control and command centre at every district which is the management centre for COVID-19. Once a patient’s name comes up on the portal, the management of the patient, whether symptomatic or asymptomatic starts. Multiple levels of surveillance are in place such as the CM’s helpline, the chief medical officers (CMO) and the local health centres. Health workers from my local community health centre (CHC) came to check on me when I was sick without knowing who I was.
What was a key intervention during the lockdown?
As migrants started to return home, we set up quarantine centres in every village. We had surveillance teams in every village, consisting of the ASHA, ANM, Pradhan, panchayat members and others. The teams collected information about every returning member, his family members, health conditions, mapped his skills etc. This firsthand, real-time information was very useful. It helped us identify and treat other diseases such as acute respiratory syndrome.
There are announcements of new/additional beds made every day. Practically though how much time does it take to set up a bed?
We are not setting up beds from scratch or even building new infrastructure like some states have done. In most cases we are taking over existing structures. For example, in Gorakhpur there was a TB hospital, construction of which had just finished when the pandemic struck. It was not being used and we set up a COVID care facility in it. In Gonda, there was a new Mother and Child Health facility which we similarly converted. Another example was an eight-floor constructed but non-functional hospital in Sector 39 Noida. We are not doing anything extensive such as laying down lines for oxygen supply. So practically when an increase in numbers is announced we can assume that it takes 15 days for the bed to be available for use. Our technical support partner, the Bill and Melinda Gates Foundation has stepped in to help with many of these new facilities.
How have you tackled the challenge of manpower?
UP has been short of medical and para medical manpower even otherwise. For the immediate situation we have permitted open tenders from the market. The response has been 50-50. The most acute need is of pharmacists and lab technicians but if doctors are willing to come, we shall welcome them. We have been asking the private sector and the Indian Medical Association (IMA) to help us. Existing AYUSH doctors have been trained to work in COVID19 care.
Do you think the state places extra emphasis on numbers at the cost of quality?
Our teams have been strictly instructed to do quality testing and not just test randomly for the sake of numbers. The kind of test and the result determine the number of tests. For example, an antigen test shows a strong positive, but if it yields a negative, it is sent for RTPCR testing.
Is there a specific strategy for cities which are reporting a very high number of new infections (including the state capital Lucknow which reported more than 900 cases every day in September)?
There are 20 cities with high transmission rates, that is more than 100 cases in a day. The maximum number of tests are being conducted in these cities and contact tracing is intensive. I monitor the number of contacts traced every day and alert the local authorities if the numbers are low. We have ensured that ambulances are available in adequate numbers. The challenge is that people do not come to get tested, and when they do it is very late. Some people insist on home isolation and go to the hospital when the disease is at an advanced stage.
Why have private laboratories been hesitant to test?
We had reduced the rate of RTPCR tests from Rs 2000 to Rs 1600 as the cost of reagents came down. Many states had introduced similar rate cuts but in a meeting with private laboratories we understood the cost they had to bear. Now the rates have been readjusted and they are testing.
Has the government relied too much on bureaucracy, instead of the experts, to manage the pandemic?
The bureaucracy is important as the challenges of the pandemic have to be met on multiple fronts by multiple departments such as the industry, police, panchayati raj, animal husbandry, revenue, agriculture and health. The Team 11 approach (at the state capital and the districts) is very good as it provides for coordinated COVID-19 management and also ensures that other essential activities do not suffer.
Did the weekend lockdown offer any gains?
The lockdown had a psychological impact. It oriented people to live with restrictions. It is not possible to keep people in their homes for a very long time. So, when the Centre said we had to unlock we did.
What is UP prepared for?
We are prepared for everything. We are using this opportunity to do up our health systems. We will have an infectious disease laboratory in every district with the help of the centre. We will have good equipment. Every CHC will have machines for ultrasound and digital X Rays. We have re budgeted our costs so that we have the money for equipment at every level. We have been trying various methods for lateral entry of specialists into the public sector including walk in interviews and trial appointments.