Last week, Dr K Kolandaswamy retired from his post as Director of Public Health in Tamil Nadu in the midst of a pandemic that the state is grappling to handle. The bureaucrat had held the position of Director for close to seven years and has been part of a team that has handled various public crises in the state from the 2016 floods to Cyclone Gaja. But in an interview with TNM, he explained that nothing compares to the COVID-19 crisis the state is currently facing.
What has been the most challenging crisis you faced in your tenure as Director of Public Health?
Coronavirus is definitely the most challenging problem I've faced in my tenure. In all the other cases - be it floods or cyclones, the affected area is clearly defined. You could take help from other areas, within the state or outside it, or even from another country to help solve the problem at hand. But this is a situation where we can't expect help from anywhere. We have to manage within our own geographical boundaries and with the resources that we have. And currently, we are already stretched thin.
Why do you think resources are insufficient?
We need to strengthen the public health department as a whole. For this we need more resources and attention from the government. We are invisible when there are no problems and suddenly become visible only when there is a crisis. For any country to make progress, it should be free from infectious diseases and so we need to build robust systems for this. The health department staff are already working overtime and extra shifts to manage right, so we need more resources for public health to prevail. We have a strong system, but we need to make it stronger.
You have, for some time now, stressed on the importance of herd immunity. Could you elaborate?
We don't need an indefinite lockdown. We can allow healthy adults to start moving around but in phases. Industries can start functioning now with people who have no comorbidities. Colleges can start functioning in July, classes 9,10,11 and 12 can start in August and classes 6,7 and 8 can start in September. Primary school can start in October. Kindergarten need not be opened this year. In a controlled manner, we can start allowing people to move around again. In the process of one year, herd immunity will increase. If the herd immunity increases to 60% in a year, the ability of the virus to spread will be severely crippled.
However, the challenge will be to keep the vulnerable protected.
And how can this be done?
Here, vulnerable refers to those who are above 60, people with low immunities or comorbidities. Our challenge is that we need to recognise old and vulnerable people and make sure they remain home. We are asking younger people to not stay in close contact with their parents and grandparents.
We are, however, finding it difficult to make people understand the seriousness of the disease. One way to quarantine the elderly is to allow them to go back to villages and not stay in the city if they have roots there. Another aspect is regular health campaigns to check diabetes and hypertension patients and make sure their parameters are acceptable. This will help them fight the virus better.
Since the Koyambedu cluster evolved, numbers have been steadily rising in Tamil Nadu. Why wasn't the market area protected enough?
We did take necessary actions but we had to strike a balance between epidemic control and livelihood. We disinfected all vehicles and engaged 1000 push carts to travel with vegetables and fruits through the city. But people insisted on going to the market and this was an unnecessary movement. If we cut retail, it would have affected traders and they need to sell to survive.
But why weren't vendors and traders at least tested before the market closed?
We are at a stage now where we shouldn't be scared of numbers. The bodies of healthy adults will fight the virus. They just have to make sure that their parents and grandparents don't get infected. The virus will spread, that can't be stopped. We have to work on protecting the vulnerable.
Till herd immunity comes, numbers will keep increasing.
But a state like Kerala has brought down the numbers. Isn't that the direction we should aim at?
The countries which were devastated by the virus, i.e. where most people were infected, have seen people develop herd immunity. So, those countries faced huge initial losses but they won't have a problem or losses going forward. The virus will no longer spread and people coming from those countries won't pose threat to others.
If states like Kerala don't have cases now, it means they will be vulnerable for a longer time. Now, it may be an advantage but if precautions are removed, the virus may spread in cities. In rural areas of Kerala there will be no problem as there are large spaces and houses are far from each other. But tomorrow, a Kozhikode or Thiruvananthapuram could face serious problems if the virus comes again because there is no herd immunity.
But Kerala has controlled the cases, while we haven't. Why is this?
They didn't have as many cases from the Tablighi Jamaat conference as we did. And the density of population in Tamil Nadu is much higher, especially in cities. Kerala is only as crowded as our Dharmapuri or Krishnagiri. Having no cases is dangerous because permanently the danger will persist. What we need to do is delay cases and control it in a manner that it doesn't affect the elderly and vulnerable.
What are the broad guidelines that have to come into play after the lockdown is lifted?
There are seven points of focus we are looking at -
1.Handwash facilities with soap and running water everywhere - Road side, building entrances, inside buildings, bus stands, railways stations, etc.
2.Enforcement of mask use
3. Diabetes, hypertension control campaign
4.Home isolation of 60 plus and vulnerables
5 .Retired persons or those above 60 without any demanding need in the city and having homes in native villages, small towns or ancestral farms, can move gradually.
6.Protection of cancer hospitals, orphanages, centres for persons with mental disabilities
7.Decongestion of cities.