The mystery of the low COVID-19 numbers in West Bengal

On March 17, West Bengal recorded its first case of COVID-19 when an 18-year-old student, who had returned from London, tested positive for the virus. The student had been admitted to the Infectious Diseases and Beliaghata General Hospital, located about a kilometre away from the Eastern Metropolitan bypass in Kolkata. Despite being thrust into the limelight, the primary referral hospital for COVID-19 cases remained quiet. People continued to walk in; the guards did not stop anyone. They did not even object to a television crew that headed to the building later that night.

The next morning, however, there was frenetic activity at Nabanna, which houses the State Secretariat, when it became public knowledge that the student was the son of a senior official in the State Home Department. The student had been in contact with his parents and his driver after his return to India on March 15. His mother had attended office till March 17 and met senior officials, including the Home Secretary of West Bengal. To make matters worse, reports said that the student had delayed his visit to a testing centre and had visited a shopping mall in the city, despite government instructions that those returning from abroad must remain in quarantine for 14 days. Several officials were furious about this serious and dangerous lapse of judgment.

Changing bulletins

Nearly a week later, on March 23, West Bengal recorded its first COVID-19-related death when a 57-year-old succumbed to the virus. The case was a matter of concern as it was unclear where the man, a resident of Dum Dum and an employee of the Eastern Railways, had contracted the virus. His family denied Chief Minister Mamata Banerjee’s statement that he had travelled abroad. The confusion over his travel history also reflected in the Heath Department’s official bulletin: it simply did not say anything about his travel history. In fact, from that day onwards, the Health Department, in its bulletins on COVID-19, stopped carrying any details about the travel histories of the infected and dead. The daily bulletin, which was first released as early as February, was initially an important tool for keeping the people informed. However, as cases grew in the State, the bulletins were constantly altered — sometimes to omit certain details and at other times to add details. This not only caused confusion and panic, but also raised eyebrows about the government’s handling of the crisis.

This was surprising given how Banerjee appeared to be making all the right moves in the beginning of the outbreak. Between the time of the first reported COVID-19 case and the first COVID-19-related death in West Bengal, the government issued dozens of notifications and orders. The most significant one was issued on March 22. Titled ‘Complete Safety Restriction’, it announced a complete lockdown in West Bengal from 5 p.m. on March 23, a day before Prime Minister Narendra Modi announced a nationwide lockdown. A meeting of major political parties was called to discuss ways of fighting the deadly virus. The Chief Minister demanded special packages from the Centre and visited markets and hospitals. An image circulating on social media at the time showed her drawing circles on the road in front of a shop to demonstrate to people how to practise physical distancing. Regular meetings with senior health and district officials were broadcast live on local television news channels. The State government announced a ₹200 crore fund and urged people to donate to the State Emergency Relief Fund that had been set up to contain the crisis. Quarantine centres were set up in every district. A separate COVID-19 hospital was identified and made functional. The police appeared to be enforcing the lockdown strictly by arresting hundreds of violators in Kolkata alone.

Setting up a task force

But in the last few days of March, it became clear that the virus had spread to different parts of the State: a resident of Kalimpong in North Bengal died, several in Howrah succumbed to the infection, and Purba Medinipur and Nadia districts also registered cases. Between March 31 and April 2, the death toll jumped from two to seven. Those who had died had no confirmed travel history outside the country.

On April 2, a committee of doctors engaged by the State government as a Special Task Force against COVID-19 met at the State Secretariat and announced that the death toll had increased to seven. However, within an hour, the government revised the number. Chief Secretary Rajiva Sinha said that the death toll was not seven but three, as four people who had died were admitted with “co-morbidities”. On April 3, the West Bengal government issued a notification announcing that an expert committee would be set up for “conducting audit of the suspected deaths due to COVID-19”. The committee’s task was to audit all those people who had died after testing positive for the virus and examine “whether they died of the viral infection or co-morbidities”. The two terms, ‘audit committee’ and ‘co-morbidities’, came to dominate the discourse on the pandemic in West Bengal over the next few weeks.

More and more reports of COVID-19-positive patients dying were published in the media, but the official death count remained low. This was because the audit committee was busy examining each and every case. The figures were updated only with its approval. Journalists, doctors and Central teams began raising questions about the committee’s method in arriving at the findings.

The bulletins caused more suspicion about the accuracy of the numbers. On April 2 and 3, the government did not release the official bulletin. The April 4 bulletin had no column on COVID-19-related deaths. This continued for a couple of days until April 7, when the government finally re-introduced the column specifying how many had died in West Bengal of SARS-CoV-2.

From bad to worse

Unlike most places in the country, the West Bengal government relaxed lockdown-related restrictions. It allowed sweet shops and flower markets to remain open, apparently to give people some relief. It issued exemptions in labour-intensive sectors such as tea and jute. These were not isolated instances but part of the government’s stated policy of having a “lockdown with a human face”. Towards the end of April, Banerjee announced that tea stalls and local paan shops would be kept open in safer areas of the State. Even buses were allowed to ply in the eight districts of the State which had not recorded COVID-19 cases yet.

Despite her advocating physical distancing, the scenes from the markets of Kolkata and Howrah presented a worrying picture. Banerjee announced that markets and shops selling essential commodities would remain open. People thronged the markets daily to stock up on groceries and other essential goods. The government struggled to implement its stated policy, while also implementing the lockdown. The police was accused of engaging in excesses in their attempts to keep people from congregating. On March 27, when Banerjee chided the police, the results were swift. In the next 24 hours, the number of people prosecuted for violating the lockdown in Kolkata fell to 182 from 453.

The nightmare of trying to enforce physical distancing got worse on March 25 when thousands of people stranded due to the nationwide lockdown packed into Howrah Station. Banerjee claimed that the government had arranged to feed about 2 lakh migrants from other States, in 711 camps. She also wrote to 18 Chief Ministers urging them to provide essentials to the migrants from West Bengal stuck in their respective States.

Even as the situation went from bad to worse, attempts continued to stonewall questions from the media on the location of hotspots in the State. Sinha said on April 4, “Everyone does not need to know everything. We are putting information which people need to know”. Instead of announcing the total number of infections, for instance, the government simply published the number of active cases. This number excluded the number of recoveries and deaths. As on April 30, the active cases in the State stood at 572, while 139 COVID-19 patients have been discharged after treatment.

Testing problems

While COVID-19 cases emerged in many districts in south Bengal, and in a few districts in north Bengal, Howrah and Kolkata especially posed a challenge. According to the 2011 Census, about 31% of the total population in Kolkata resides in urban slums. The administration struggled to deal with the large crowds in front of ration shops in urban slums. It was in the slums that the first rapid antibody tests were conducted on April 21. Of the 14 samples collected, two people tested positive.

Official records show that testing started as early as March 3, almost two weeks before the first case was detected. The National Institute of Cholera and Enteric Diseases (NICED), a facility of the Indian Council of Medical Research, was the only testing facility in the first few days of the outbreak. NICED provided training to other testing centres of the State, particularly the medical colleges and hospitals. But until April 15, one and a half months after testing started, the fourth most populous State in the country was struggling to conduct 400 tests on a daily basis.

Initially the State government said it did not have enough testing kits and urged the Centre to provide more kits. Officials of the NICED denied any shortage of kits, however, and said that the samples reaching them had reduced significantly. Their statement indicated that the State preferred its own medical colleges to the Central government institution. The State Health Department also alleged that tests conducted using the RT-PCR testing kits provided by ICMR-NICED were proving to be non-conclusive. Every sample had to be tested twice or thrice, it said, which was causing delays. “We received instructions from the ICMR not to distribute the faulty kits. The kits have lost their activity due to problems in storage level at the medical college level or during transportation,” NICED director Shanta Dutta said. This development triggered a major controversy with the Trinamool Congress accusing the Centre of not providing even the most basic resources to fight the pandemic. By the end of April, the State began testing at 14 facilities. It tested 2,000 samples a day. Yet, with over 16,500 samples tested by the end of April, West Bengal still ranked the lowest among the bigger States in terms of testing. It was testing 183 per million of the population, whereas the national average was 613.

Centre-State differences

The NICED issue was not the only one that revealed the differences between the State and Centre. The Centre’s decision to send two inter-ministerial central teams (IMCTs) triggered a public spat between the West Bengal government and the Centre. Banerjee made it very clear that she was was unhappy about the IMCTs’ visit and sent a strongly worded letter to Modi saying “such unilateral action on the part of the Central Government is not desirable at all”. The Chief Secretary said that the Central teams had arrived in the State without any consultation with the State government and would therefore not be allowed to tour West Bengal. However, the State government softened its stand after receiving a letter from the Union Home Secretary, which said that the Central teams “have been specifically restrained from making any visits” which amount to “obstructing the implementation of the orders issued by the Central government under the Disaster Management Act, 2005, and equally binding directions of the Hon’ble Supreme Court”.

For the next few days the IMCTs raised questions on almost all aspects of COVID-19 management in the State, from the number of ventilators in hospitals, quarantine facilities, delays in test reports, and the use of personal protective equipment for medical staff. Letters addressed to the Chief Secretary by the IMCTs stationed in the city and north Bengal were made public, and dominated the headlines for several days.

Meanwhile, while the Central teams were visiting the State, the Chief Minister took to the streets once again. This time, she did not distribute masks or speak to the people directly; instead, she addressed them via a microphone while being seated inside a police vehicle. She appealed to the people to remain inside their homes during the lockdown. For several days, Banerjee went around different areas appealing to people to respect the lockdown.

On April 24, the IMCTs sought to know details of the procedure which the audit committee was following to announce COVID-19 deaths. On the same day, the State government shared for the first time the total number of deaths related to COVID-19 in the State. It said that the audit committee had examined 57 deaths and found that 18 were related to the virus; the rest were due to severe co-morbidities. On April 30, the State government announced that since the outbreak of the pandemic, 105 persons who had tested positive for COVID-19 in West Bengal had died. Of these, 33 deaths had died of COVID-19 and 72 had died of co-morbidities. Interestingly, this revelation came a day after Banerjee said that it was the Health Department’s decision to set up the audit committee and that she had nothing to do with it. Banerjee holds the health portfolio in the government.

Virus infects healthcare workers

While the State and Centre were busy writing letters to each other, healthcare providers at State-run hospitals were getting infected at a rapid pace. By the end of April, more than 20 healthcare staff, including at the Medical College, Kolkata, one of the oldest medical colleges in the country, had tested positive. A doctor at the hospital said N95 masks and personal protective equipment available were not enough; that they were available only for those who had the highest risk of getting infected. This endangered the lives of medical professionals, he said. The situation was similar in other medical college and hospitals of the State.

Speaking on condition of anonymity, the doctor cited an instance that occurred on April 8 to illustrate how the government was not taking the situation seriously. A pregnant woman with COVID-19 symptoms was brought to the gynaecology department. She was not shifted to the COVID-19 facility and came in contact with doctors and health workers of three consecutive shifts. The doctor, who was working at the emergency department, later showed symptoms of the disease and was placed under quarantine. Like many of his colleagues, he stood in queue, gave his samples and waited for the reports.

On April 26, a senior health official of the West Bengal government died. The news sent shockwaves across the health sector. The Calcutta High Court, which is also hearing a matter on the spread of COVID-19, wanted to know whether enough pieces of personal protective equipment were available for frontline health workers. Highlighting the fact that more and more healthcare workers are testing positive for the virus in the State, the West Bengal Doctors Forum has emphasised the need for intensive testing for healthcare professionals.

At the Medical College, Kolkata, a doctor heaved a sigh of relief after testing negative for the virus. “My test results are negative, but my colleagues and friends are testing positive. Even today a postgraduate trainee at the hospital has tested positive. I don’t know what the future holds for us,” he said.

‘Clerical mistakes’, data updates

The West Bengal government has not only been criticised for allegedly hiding data and for its low testing rate. In the last week of April, a 70-year-old man died after being readmitted to a State-run health facility in Kolkata. The hospital had initially released him saying he had tested negative for the virus. A day after he was released, it asked him to get readmitted. The hospital said he was COVID-19 positive and that he had been released by mistake. While the government did not comment on this case, the Chief Minister said “minor clerical mistakes” should not be highlighted.

It was only in the last week of April that the State government started sharing more information about the spread of the outbreak. It released the list of containment zones in the State (444 on April 30). Almost 60% of these containment zones (264) are in Kolkata, followed by 72 in Howrah and 70 in the adjoining district of North 24 Parganas.

West Bengal has contested the Centre’s May 1 list that shows 10 districts of the State being in the ‘red zone’. It insists that only four districts should be included in the category. Communication from the State to the Centre revealed that on April 30, West Bengal had 931 COVID-19 infections. With 489 cases, Kolkata alone accounted for over 52 % off all infections in the State.

 Courtesy: https://www.thehindu.com