Hyderabad: Telangana Chief Minister K. Chandrashekar Rao (KCR), leading India’s youngest state and the bustling metropolis of Hyderabad, announced a Covid-19 lockdown two days before the central government, on 22 March.
He described the move as being in “sarvajana hitam (public interest)”. Telangana had an early headstart, but the story of the state in the days since has cast a shadow on its response to the pandemic.
Its testing rate pales in comparison to that of neighbours, including fellow Telugu-speaking state Andhra Pradesh, and its mortality rate is much higher. The number of cases and deaths is increasing at a frenetic pace, and infections among doctors and healthcare staff are growing.
The KCR government has come under question for its continued refusal to engage private labs for testing, despite the approval of the Indian Council of Medical Research (ICMR) and directions from the Telangana High Court. And the state’s decision to do away with the mandated quarantine for railway passengers arriving in Telangana hasn’t helped curb the scepticism.
Amid all this is a chief minister who courts the image of a tough taskmaster who brooks no dissent, with the opposition labelling his style of functioning as autocratic.
Through the surge of criticism, the KCR government has defended its response to Covid-19. It claims to have followed ICMR guidelines all along the way, and dismissed all questions about what is seen as a very low testing rate. To his followers, KCR’s attitude is the mark of a leader with no patience for incompetence.
While the state is believed to have done well by its farmers, its conduct towards migrant labourers has been termed less than satisfactory. Even the state’s doctors have raised complaints about poor-quality personal protective equipment (PPE) and the work conditions. Overall, the state appears to be struggling to control the vast crisis Covid-19 has spawned, on the medical front as well as on the larger humanitarian aspect.
Between 28 March and 27 May, a span of two months, Telangana saw 63 Covid-19 deaths. In the following 12 days, from 27 May until 7 June, the number of deaths more than doubled to 137.
With a mortality rate of 3.79 per cent (as of 10 June), Telangana fares poorer than Maharashtra (3.66 per cent), which has the highest number of Covid-19 cases in India, Andhra Pradesh (1.49 per cent) and Karnataka (1.14 per cent).
The number of Covid-positive cases increased from 2,098 to 3,650 between 27 May and 7 June, a rise of 1,500. By 10 June, the figure had increased to 4,111 and the number of deaths to 156.
The state seems to be testing more than it was doing until last month, but even then it’s trailing neighbours like Andhra Pradesh, Maharashtra and Karnataka.
According to government data accessed by ThePrint, Telangana had conducted nearly 29,000 tests until 27 May, which rose to 36,851 by 8 June.
Telangana’s testing rate is 1,053 per million (as of 8 June), compared to 8,694 per million in Andhra Pradesh, 4,628 in Maharashtra, and 5,843 per million in Karnataka. Even its northern neighbour Chhattisgarh has a better testing rate at 3,095 per million.
At 6.6 per cent (as of 8 June), the test positivity rate of Telangana — the number of tests yielding a positive diagnosis — is higher than the national average of 4.4 per cent. The only states with a higher test positivity rate are Maharashtra (14.6 per cent), Delhi (10.3 per cent) and Gujarat (8 per cent).
A high test positivity rate suggests widening infection, and calls for the state to increase testing. The KCR government has been under the central government’s as well as the Telangana High Court’s scanner for its testing numbers, but it continues to disallow private players from stepping in to conduct more tests.
The state government claims its testing protocol adheres to ICMR guidelines. It has constantly defended itself against criticism for keeping private labs out of testing efforts, saying that doing so could stoke panic in the public.
Telangana’s testing rate has also appeared to be at fault in light of the findings of an ICMR study that found the state had the highest ‘secondary infection rate’ among southern states.
Secondary infection attack rate is a term used by epidemiologists to refer to individuals who have been infected after coming into contact with a Covid-19 patient.
A study published in the ICMR’s Indian Journal of Medical Research, which analysed data of people infected and tested between 22 January and 30 April, India’s average secondary infection attack rate is 3.9 per cent, while Telangana’s is 5.6 per cent.
However, Telangana’s number would be higher than it appears because it’s based on an analysis of 14 immediate contacts, as compared to 20 for the nationwide figure.
Acknowledging that the high secondary infection attack rate is a matter of concern, state Health Minister Eatala Rajender told ThePrint that “the state has been following the ICMR guidelines regarding testing but the health department is trying to figure out why the spurt in secondary infection was in the rise to this extent”.
Senior Congress leader and member of legislative council Jeevan Reddy said the numbers speak for themselves, adding that the “government is using ICMR guidelines as an excuse to not test more people”. “While others are testing in lakhs, we are still testing in thousands,” he said.
Reddy claimed the government wants to pretend everything is under control because the Hyderabad municipal elections are only nine months away. “But it isn’t in control,” he said.
Key covid hospital a hotspot
As of 8 June, there were 159 containment zones across the state, including Hyderabad and districts on its outskirts like Rangareddy and Medchal.
But it’s another hotspot that sticks out like a sore thumb — the biggest Covid-dedicated facility in the state, Gandhi Medical College and Hospital at Secunderabad, Hyderabad’s twin city.
While patients can be treated for Covid-19 at other hospitals in Hyderabad, all positive cases are eventually transferred to Gandhi hospital, said Dr Prabhakar, the nodal officer of the facility.
Across the state, 153 healthcare workers have tested positive so far, of which 79 are doctors at government hospitals, diagnosed over the past two weeks.
As many as 49 doctors have tested positive at Osmania Medical College, Hyderabad, and 26 at Nizam’s Institute for Medical Sciences (NIMS), also in the Telangana capital. Four doctors have tested positive at Gandhi hospital.
Dr Vishnu, president of the Telangana Junior Doctors Association (T-JUDA), said the state’s healthcare staff wasn’t equipped with the requisite protective gear.
“The quality of the PPE (personal protective equipment) kits is compromised upon. Initially, we didn’t even have sufficient kits… we got them later through donations from private companies,” he added. “The government has failed to address our concerns.”
With an increasing number of healthcare workers testing positive, he said, fears among doctors have heightened.
“We have met the health minister thrice, asking him to provide accommodation and let frontline doctors work in shifts, but we haven’t heard from them,” he added. It’s not just a question of their own safety, he said, but also that of their colleagues and families.
A doctor at Gandhi hospital said it could all be boiled down to the state’s low testing rates.
“The government’s low testing strategy is now costing its own doctors and healthcare workers. We can’t go on like this… Some protocol must be followed.”
The Telangana State Medical Employees and Workers Union, which represents workers and employees of the state health department, government hospitals, etc, has demanded that 3,000 healthcare workers be tested. The workers have also sought immediate release of the 10 per cent salary incentive announced by the state three months ago. If this is not done, there will be an agitation by the end of this week, said M. Narsimha, president of the union.
Concerns about alleged government apathy were echoed by a doctor at NIMS. “The CM has never even visited any hospital during the pandemic. And we haven’t been able to get an appointment with him, what more is there to say?”
On Tuesday, nearly 200 junior doctors at the Gandhi hospital started a dharna, which continued Wednesday, demanding basic security after a colleague was allegedly beaten up by the attendants of a Covid-19 patient who died.
“While director of health and medical education arrived at the hospital and condemned the act, we haven’t been given any assurance,” said Dr Khizer Hussain, general secretary of the Telangana Junior Doctors Association, Wednesday.
He added that there was only one elderly ward boy on duty for a 65-bed ward and that the doctors were overburdened. “Two-thirds of the junior doctors have been exempted as they have exams in 10 days while 1/3rd are in home quarantine, which means the rest of us are doing three shifts back to back,” Hussain added.
Despite repeated attempts through phone calls and texts, the Telangana director of medical education, K. Ramesh Reddy, who is part the state’s Covid-19 control efforts, didn’t respond to ThePrint’s queries about the allegations of poor-quality PPE kits. Telangana director of public health G. Srinivas Rao didn’t respond to phone calls and texts either.
However, Dr G. Srinivas, president of the NIMS Resident Doctors Association, said the government had informed them that the quality is not in their control. “When we take it up with them, they say sufficient quantity is being supplied but quality is not in their hands. But, as a result, doctors are getting dehydrated too,” he added.
76% migrant workers didn’t get rations: Survey
Migrant labourers who form the backbone of economic activity in urban centres were among the worst hit by the lockdown.
Left without a job in cities that they felt had abandoned them, lakhs started journeys of hundreds of kilometres to get home.
On 30 March, KCR urged migrant workers against making desperate attempts to leave Telangana, telling them they were like his “family members”. “You are the partners in the development of this state. We will take care of you,” the CM had said, drawing much praise.
However, the government’s sops are believed to have not reached thousands of beneficiaries, be it migrants or the state’s own labour force.
According to a survey done by the Hyderabad campus of Tata Institute of Social Sciences (TISS) in collaboration with the Rachakonda Police Commissionerate, 76 per cent of the migrant workers in Telangana did not receive the 12 kg rice and Rs 500 monthly aid announced by the state government from 1 April. The survey was based on a sample size of 10,672 workers across eight police station limits.
In May, the government was told off by the Telangana High Court for reportedly failing to provide the promised lockdown cash assistance of Rs 1,500/household for white ration card holders (those below the poverty line).
This came after the KCR government reportedly cancelled the cards of those local workers who hadn’t drawn the 12kg/month free rice promised by the government from January to March. The payment was subsequently released.
However, Bala Devi, chief rations officer in the state civil supplies department, said “34,283 people received 12 kg rice each in the first spell while another 39,844 migrant workers received rice in the second spell”. “We sent out 890 metric tonnes in Greater Hyderabad itself,” she added.
The opposition has also lashed out at the state government. Telangana Pradesh Congress Committee (TPCC) president Uttam Kumar Reddy questioned the “poor ration management” in an open letter to the state government.
Kiran Kumar Vissa of the Rythu Swarajya Vedika, an organisation involved in the welfare of farmers in Telangana and Andhra Pradesh, said the state government’s “estimate for the number of migrants here was never accurate”.
“The effort was half-hearted and lacking in empathy for migrants, their dignity and their value to society,” Vissa said. “It was a flawed policy to put 80 per cent of the burden on civil society to serve the migrants,” he added, pointing to the government’s “highly flawed policy decision to mobilise civil society groups and CSR efforts of companies to provide food and rations to migrants”.
“When the government finally recognised the real number of migrant workers and their value, officials tried to slow down the migrant return — resulting in further misery for them,” he added.
So far, only 1.5 lakh of an estimated 20 lakh migrants have managed to return home aboard Shramik trains arranged by Telangana, activists say. They had promised 40 trains daily for a week in the second week of May but they only ran three a day, said Vissa.
On 9 June, the railways informed the Telangana High Court that the state had not sought any trains for migrants since the start of the month, leading the court to tell off collectors for “failing in their duty”.
Some relief for farmers
During the lockdown period, the Telangana government organised village-level procurement for paddy, maize and Bengal gram, the three most widely grown crops during the rabi season in the state.
“While paddy procurement faced some hiccups due to lack of bags, etc, but village-level procurement was carried out successfully from farmers who were willing to sell,” said Vissa. According to Vissa, while thousands of farmers sold their crop before the government procurement began, as much as 50 per cent of the harvest was secured by the administration at the minimum support price (MSP). The same happened with Bengal gram, thus alleviating the lot of farmers to a large extent.
However, this did not extend to vegetables and other crops like groundnut, resulting in major losses for another section of farmers due to lack of transportation and marketing.
For example, the prices of some vegetables in the cities dropped from as much Rs 40-50 per kg (before the lockdown) to Rs 30 per kg.
Among the other measures taken for farmers, the state also claims to have become the first in the country to tell its tillers what to grow when as part of a pilot project. Announced earlier this month, the project aims at helping increase demand and get farmers better prices.
‘No room for dissent’
KCR, sources said, has consulted several epidemiologists abroad to get expert views on understanding the strain of the virus and the level of the outbreak in India.
He has also constituted a nodal group to guide the state government’s efforts, comprising Chief Secretary Somesh Kumar, Health Minister Eatala Rajender, and three senior IAS officers, including Hyderabad Collector Swetha Mohanty.
However, the final decision is believed to be that of KCR, who is said be micro-managing every aspect of the state’s Covid-19 response.
Senior civil servants engaged in the coronavirus effort remain on their toes since the chief minister “does not forgive easily”, sources told ThePrint.
The chief minister, it is learnt, holds meetings until midnight at his residence, Pragathi Bhavan, and makes surprise calls to verify the the claims of his team. According to former Nizamabad MP K. Kavitha, also the chief minister’s daughter, he doesn’t like to take no for an answer.
“He will give one or two chances at the maximum, else he doesn’t spare… As his daughter, I can say he doesn’t even spare his own children.”
TPCC leader Reddy said the government’s decision to keep private labs out of the testing framework amounts to “autocracy”, but Kavitha said it is wrong to describe the chief minister as such.
“The CM is monitoring things to the extent that it was he who decided the menu for Covid patients at Gandhi hospital or, for that matter, that 12 kg rice/atta will be provided to BPL households.” Another senior official said KCR decided to outline a packed menu — including two packets of poha, 2 packets of bread, one bottle of jam etc — for each migrant travelling on the Shramik Express.
A. Santikumari, special health secretary, who works closely with the minister during Covid meetings, said: “His memory is very sharp, so he will remember things even from five years ago. If something is not done right, one is taken to task.”
This is an updated version of the report