Tamil Nadu on Friday became the second state in India to cross the grim milestone of a million cases, with a total of 102,721 people infected with Covid-19 disease in the state where five districts, including Chennai, are under an intense lockdown to prevent the spread of the coronavirus.

However its high case load must be seen in relation to another important figure: its testing numbers. As of Friday, a total of 1.27 million people have been tested in 91 testing facilities, which is the highest in the country in absolute numbers. Between June 19 and June 30, when the state announced a hard lockdown in Chennai, Kancheepuram, Thiruvallur, and Chengalpattu (Madurai was put under lockdown on June 23, and the lockdown was extended to July 5 earlier this week), 327,214 peoplewere tested across the state. Since June 20, there has been a spike in testing, with over 30,000 people tested everyday on average.

Health department officials say that high caseload shouldn’t scare people as it is a result of Tamil Nadu’s strategy of “aggressive and increased testing” and that the state’s focus is to reduce its fatalities. The state has a case fatality rate of 1.3%, which is low when compared to the national average of 2.9%. Experts said the high numbers can also be attributed to the movement of people across the state post Unlock 1 which started on June 8.

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“We have a free hand in high testing which we will continue and allow cases to come down organically,” TN health secretary J Radhakrishnan told Hindustan Times. “Even if a person has a single symptom of fever, sore throat, cough or body pain, they can get tested now.”

The state government initially announced a 12-day intense lockdown in Chennai and three of its adjoining districts from June 19 allowing people to commute for only medical emergencies, airports, train stations and walk for essentials like groceries. On June 23, Madurai district also came under a lockdown to arrest the spike in cases in the district. On Monday, Tamil Nadu extended the lockdown, even though the expert health panel appointed to advice it in dealing with the pandemic felt that improved public health measures were the need of the hour rather than a lockdown.

However, the state felt that the lockdown was warranted, as officials found that even symptomatic people were avoiding getting tested because they didn’t want to be in quarantine. Besides this, people were also not following norms of social distancing or wearing masks while in public. The intense lockdown was meant to address all of this.

“Because of less movement we are able to identify people and test the same day very close to their homes through mobile and static sample testing facilities. Earlier they had to wait for 2-3 days to be tested even if they had symptoms,” Radhakrishnan said.

Experts agree that Tamil Nadu was able to scale up testing – it had started sending samples to the National Institute of Virology in Pune in March itself — owing to a robust public health infrastructure that had been in the making since the AIDS epidemic, and the H1N1 outbreak in 2010, when Reverse Transcription-Polymerase Chain Reaction (RT-PCR) testing facilities, widely used to test Covid-19 samples, came up across several districts.

Chennai with 64,689 cases accounting for 62.9% of the total case load in the state had scaled up testing to 10,000 per day during the most recent lockdown period. Though the state health department hasn’t shared district-wise testing data, health officials said that Chennai was testing in the range of 3,000 to 5,000 people per day in May and June respectively.

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The Greater Chennai Corporation (GCC) increased fever camps from 300 in May to 520 camps currently across Chennai’s 200 wards. Between May 8 and July 2, a total of 29, 051 swabs haven taken at these fever camps and 33,090 people with detected with influenza like illness (ILI) symptoms.

In June, the GCC also recruited over 4000 volunteers, called Friend of Covid Person Under Surveillance (FOCUS), to assist the existing Covid-19 network of health workers. The job of the volunteers was two-fold: watching families under home quarantine, and helping them with essential services. These volunteers are paid Rs 500 a day and have been recruited till September.

The civic body came up with a new strategy pegged on home quarantining even those who were likely to be infected to prevent the spread of the coronavirus disease. Called the home quarantine and isolation monitoring system (HQIMS), it focused on 18 categories of people include those awaiting Covid-19 test results, positive patients undergoing home treatment, discharged patients, international and domestic passengers coming via flights, trains, road or sea, family and extended contacts, and people with influenza-like illness.Most people in these categories were already mandated to be in 14-day isolation, but the strategy widened the net on who must undergo isolation.

This new system was developed to keep up with the evolving situation of the pandemic. “In April, all positive patients were treated at the hospital. The concept of home quarantine for treatment progressed at a later stage,” GCC deputy commissioner for revenue and finance, Meghanathan Reddy who is overseeing this project, told HT.

Surveyors had already been going door-to-door checking people for symptoms since May and during the lockdown they were armed with thermal scanners. Anyone with fever, cough or any other symptoms, would be asked to visit the nearest fever camp.

“We are in a better position now in terms of testing and surveillance compared to April. Corporation has also home quarantined a large number of people who are likely to infect others. All these measures and the current lockdown has reduced transmission in Chennai. We can reassess that in two weeks. But when we open up again transmission will increase which we can manage through mask compliance and continue surveillance, testing and isolation,” a member of the expert panel said on condition of anonymity, adding that specific restrictions like suspending public transport and large gatherings in Chennai and other districts, should continue after the lockdown is lifted.

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