Random checks at private hospitals on COVID-19 tariff, says Ma. Subramanian

The Tamil Nadu Government will soon set up a team to conduct random checks on private hospitals to check adherence to rates fixed for treatment of Covid-19 patients and initiate action against violators, Minister for Medical and Family Welfare Ma. Subramanian said on Tuesday.

Chief Minister M.K. Stalin has planned to have a meeting with managements of private hospitals soon to impress upon them to follow the guidelines issued by the government on the tariff. “The State Government has also fixed rates for private ambulances. A team will soon be formed to conduct random checks and take action on those violating the norms,” Mr Subramanian told The Hindu in an interview.

On allegations of under reporting of Covid deaths, the Minister said the guidelines of Indian Council of Medical Research and the Government of India were being followed to classify Covid deaths. Firm instructions were given to all hospitals that death caused directly by Coronavirus or exacerbated by the virus in the case of patients with other diseases should be declared as Covid death.

Mr. Subramanian said that the Chief Minister would launch the vaccination for people aged between 18 and 44 years in a couple of days and priority would be given to labourers, auto rickshaw drivers and differently abled persons. “We will be vaccinating differently abled persons at their doorstep.”

On World Health Organisation recommending against the use of Remdesivir, he said many private hospitals were prescribing the antiviral drug which made patients/their family members believe that it would help in recovery in the initial or moderate stage of Covid infection. “Since there is a huge public demand for Remdesivir we are making the drug available in the hospitals,” he said.

State well-prepared to handle virus peak

Denying any under-reporting of COVID-19 deaths in Tamil Nadu, Medical and Family Welfare Minister Ma. Subramanian has said a weekly death audit is being carried out to streamline proper reflection of the statistics. Edited excerpts from an interview:

How does it feel to take charge as the Medical Minister when the State is reeling from the second wave of COVID-19?

The State has given me a tremendous responsibility and the opportunity to serve the people. I would like to thank our Chief Minister for entrusting me with such an important task at a crucial stage, and I owe my complete dedication and hope to fulfil the trust he has reposed in me.

From an oxygen-surplus State, Tamil Nadu has now become a deficit State. How did this happen? Was the health infrastructure unprepared?

There are three important variables in managing oxygen supplies in a State — available oxygen production, liquid oxygen storage capacity and oxygen usage patterns. Tamil Nadu has increased the oxygen storage capacity of hospitals to around 1,200 metric tonnes, which is more than adequate. Our oxygen manufacturing capacity, including Puducherry, is around 470 MT, which is more or less adequate.

Our strategy has been to use this quantity through our storage and logistics system, but we have faced some problems since the Union government diverted some of this capacity to other States under the National Oxygen Plan. Now, we have been given alternatives from the eastern States, and production at the Sterlite plant is also likely to be up and running shortly. In addition, our per-patient oxygen consumption was found to be high, and measures have been initiated to ensure rational and optimal use of oxygen. As a result of all these initiatives, the situation will normalise this week.

There seems to be an acute shortage of oxygen beds and ventilators in government and private hospitals…

The government has come up with a protocol for the triaging of patients and their admission. Bed capacity has been increased in COVID Care Centres. About 11,550 additional beds with oxygen support are currently being set up at Primary Health Centres so that oxygen beds and ventilators at secondary and tertiary hospitals are used rationally for those who are severely ill. The government has installed 7,800 additional oxygen beds in tertiary care institutions and is planning to have 12,500 beds ready by May 20.

Since most health staff and medical infrastructure are now focused on pandemic management, have adequate facilities been created to attend to non-COVID-19 patients requiring urgent or mandatory procedures?

All emergency procedures are being carried out, and adequate disinfection and COVID-19 protocol/SOPs are being followed in hospitals. Tamil Nadu has been actively participating in the esanjeevaniopd.in portal, an online OPD facility to provide telemedicine services to the public. We are also providing door-to-door services for people who need medicines through village health nurses, mobile medical units and medical camps. We are planning to tie up with NGOs to provide services to the vulnerable.

There are serious allegations that the number of COVID-19 cases, and deaths in particular, is being under-reported. There seems to be a huge difference between the deaths recorded in hospitals, the bodies disposed of at crematoriums and those reported officially in media bulletins…

Currently, the State is classifying the deaths of all patients who tested positive during RT-PCR tests as COVID-19 deaths, based on the guidelines issued by ICMR and the Government of India. Strict instructions have been given to hospitals that all deaths caused directly by COVID-19 or due to the exacerbation of pre-existing conditions as a result of COVID-19 should be classified as COVID-19 deaths.

Many COVID-19-positive patients with severe symptoms, who got admitted to hospitals, died of pneumonia or cardiac arrest. But since they tested negative on RT-PCR before death, the hospitals are recording their deaths as non-COVID-19 deaths and handing over their bodies to their family members. Is this correct and safe?

COVID-19 is an evolving disease, and now we are getting patients with positive CT reports without an RT-PCR test report, which was not the case during the first wave. The deaths due to COVID-19 are being revised to match with the ICMR and Government of India protocols. We will keep updating the protocols in consultation with ICMR as the disease and treatment procedures evolve, and ensure that deaths among clinical COVID-19 cases also get reflected even if the person tested negative on RT-PCR. The Chief Minister has given a clear direction to ensure data accuracy as per the protocol. To streamline the proper reflection of statistics, a weekly death audit is being done.

Many people who took the first dose of the vaccine, particularly Covaxin, are not able to take the second dose due to non-availability. Does the vaccine serve its purpose when the second dose is delayed?

Tamil Nadu has received 12,07,130 doses of Covaxin through the Central government and vaccinated 10,23,043 beneficiaries till date. As of May 16, as many as 1,70,187 beneficiaries were due for the second dose of Covaxin. The recommended interval between the first and the second Covaxin dose is 28 days, as per the guidelines. The government is taking steps to vaccinate all the beneficiaries due for their second dose on priority.

Frontline workers managing the pandemic say the State would see a peak in cases in a week or a fortnight from now. How well is the State prepared? Why is contact tracing, which proved effective in the first wave, not being done now?

Yes, the persons infected before the lockdown will start showing symptoms now and get admitted during the next week. The State has prepared for this by increasing beds and issuing guidelines for oxygen utilisation and standard treatment protocol. Contact tracing is useful when isolated cases occur. It is less effective during a period of high community transmission, and that is why syndromic management is adopted to treat all symptoms as COVID-19, unless proven otherwise.

Despite warnings, many private hospitals are charging in excess of the prescribed rates for COVID-19 treatment. Has the government taken action or sought an explanation from such hospitals?

The Chief Minister has proposed a meeting with the private hospitals to impress upon them the need to adhere to the government’s guidelines. The State government has also fixed rates for private ambulances. A team will be constituted to conduct random checks at hospitals, and action will be taken on those who violate the rules.

Are you confident that the ongoing lockdown will help break the chain of infection?

With public cooperation, we are confident that the rate of infection would come down during the first week of June.

How is public compliance with safety advisories?

Most people are cooperating. The remaining few should do their bit by restricting themselves [from venturing out] to the maximum extent possible. Vaccine remains one of the best defences against the infection. The State government has called for a global tender for supply of adequate vaccines.