“There has to be a balance between lives and livelihoods”

Dr PV Ramesh, Special Chief Secretary to Chief Minister YS Jagan Mohan Reddy, is a retired 1985 batch IAS officer who wore many hats in public service–as Chairman and Managing Director of the Rural Electrification Corporation, Development Commissioner, Principal Secretary (Finance), and Principal Secretary (Health and Family Welfare). A medical doctor, he is part of the Andhra Pradesh Government’s 13-member technical advisory team constituted to chalk out the state’s COVID-19 response.

Following Reddy’s proposal to Prime Minister Narendra Modi to “implement a lockdown with a human touch”, Ramesh spoke to V Shoba about why the state cannot afford to be completely shuttered and how it hopes to keep the virus in check.

The Prime Minister today recommended a staggered two-week extension of the lockdown. Andhra Pradesh is one of the states that was hoping for a quick, phased return to normalcy. Are you disappointed?

There was an expectation that the restrictions may be lifted–not unconditionally, of course. We cannot expect to enjoy the luxury of normalcy–public gatherings or going to the movies–for a long time to come. Andhra Pradesh is not in favour of a blanket removal of the lockdown. But we believe there has to be a balance between lives and livelihoods. The economy is virtually shuttered. We are one of six states where over 50 per cent of the population is employed in the informal sector. The people are under serious stress. We are also predominantly agrarian and our farmers have to be able to sell their Rabi crop. The state is a large producer of fruits like banana and papaya and now mango season is upon us. Our godowns are full. We do not have enough storage infrastructure for all this produce. Unfortunately, there are demand constraints and movement constraints between Andhra Pradesh and Telangana. And of the one lakh industries in the state, only about 7,000 are partly functional right now. Given all this, we are tending towards a graded approach–economic sector-wise and location-wise. There is no case for relaxing of guard, but the restrictions can and should be calibrated. The Chief Minister has declared 27 of the 676 mandals as red zones and 44 as orange zones. We have identified 141 containment clusters. We are proposing a more strategic lockout, emphasising on vigilance and surveillance.

You are at 381 positive cases as on April 11. What is your plan to contain community spread?

We are better prepared than most other states. We have a large network of over 2,60,000 village and ward volunteers who have been keeping a close watch on households. We also have 40,000 Asha workers and 20,200 ANMs–a sizeable number for a population of 5 crore. So we have greater leverage when it comes to reaching out to people. In terms of medical infrastructure, we have 1,800 PHC doctors and a three-tier system with 23,000 beds across 220 quarantine centres in the state, equipped district hospitals, and four major COVID centres with 2,500 beds and 440 ventilators. The private sector has another 400 ventilators. We have asked the Centre for 500 more.

We were also one of the first states to focus on foreign returnees. We started to scan and quarantine as early as Feb 22, before the Government of India advised states to do so. From Feb 22, till the time India sealed its borders, we had an influx of 29,000 foreign returnees. We have traced all their primary and secondary contacts–about 83,000 of them–and we are monitoring them.

In fact we reported our first case on March 12 but there were no new cases between March 22 and 29, after which the cases from the Delhi event began to surface. We tracked down all the 1,164 attendees, and their primary and secondary contacts–about 4,000 of them–and quarantined them. The cases that are being reported now are mainly from this cohort.

We do suspect there could be community spread because there are 17 cases for which not all contacts are accounted for. They are scattered across urban and semi-urban areas. We want to be rigorous in monitoring the situation even in green zones. We are currently working on mass screening for antibodies in collaboration with MIT and the University of Chicago and this will be shortly implemented through a stratified random sample framework in urban and peri-urban areas and also in green zones. We are meanwhile ramping up our capacity to conduct antigen tests. Our daily RT PCR test capacity is at 1,050 tests now. The state is exploring sources of rapid PCR kits–unless we are able to test as much as we would like to, we cannot say we are fully prepared. We are not there yet.

Do you blame the congregation in Delhi for inflating the case load in Andhra Pradesh? 

One cannot be so simplistic. It was irresponsible of them, of course, but there are larger questions about how permissions were granted for a large scale event in the national capital. What we can do for now is ensure all contacts are accounted for.

Two doctors and two nurses have tested positive in the state. A doctor in Narsipatnam was suspended for saying that the government did not provide adequate protective gear. How are you protecting and supporting medical professionals, and just as importantly, keeping their morale up?

The Chief Minister had a video conference with nurses and doctors yesterday. His message very clear–that the government would stand by them and support them. We released the salaries of health workers, police and sanitation workers on priority while deferring others’.

We have adequate PPEs and we have ordered for a lot more. But health workers may want to use PPEs for non-COVID cases too. That is a tougher proposition. Ramping up production, as you know, is not easy, even as we encourage local units to make PPEs and a tech cluster in Visakhapatnam is working on scaling up test kit and ventilator production. We would like to urge medical workers to exercise discretion while using them for non-COVID cases. We are working out an incentive package to reward them for their tireless work during these tough times.

As for the doctors and nurses who contracted the infection, I wish they had been more careful. It wasn’t for want of PPEs. At this stage, any case presenting with cough or fever must prima facie be presumed to be COVID-positive even if it is later proved otherwise upon testing.

The doctor in Narsipatnam displayed regretful conduct but the situation could have been handled more sensitively. He was an important member of a hospital that is located in a catchment area for a lot of tribals. We are trying to find a replacement anesthetist now.

Do you have a fiscal plan in place for handling the crisis?

Fiscally, this is an impossible situation. We inherited a bad economy and of all the states, we are among the worst off in terms of our ability to extend fiscal stimulus. We are not alone in this. The Government of India should come up with a package. Unprecedented interventions are needed–basic monetary adjustment won’t cut it if we are expecting a 10 per cent contraction in the economy in just a quarter. Personally, I would like the state to pay all unorganised labour wages for three months, and to defer all debt servicing obligations. The path to safety is paved with direct cash transfers and home delivery of essentials.

On the plus side, you do not have to manage contagion in a mega-city like Hyderabad or Bangalore. But Andhra Pradesh is one of the states where the disease has shown up in rural districts too. Are you worried about a rural spread? 

Many rural communities have actually been protective of themselves. They are maintaining physical distance and exercising greater discipline. In urban areas, we have a sizeable slum population and that is the major worry.

Srikakulam and Vizianagaram in north-coastal Andhra seem to have remained insulated so far. Are you testing enough?

It is possible we are not testing enough, but we do have much closer community monitoring in these districts. They are largely rural and are home to tribal populations, so there is a certain degree of isolation that is natural to them. Only nine foreign returnees out of the 29,000 hail from these districts. Visakhapatnam has reported a couple of cases from tribal areas, though–perhaps because Paderu and Araku are tourist spots.

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