 Thank you so much doctors for joining us. So to start to talk a bit about the situation in Tamil Nadu We know that it is one of the states with pretty good health facilities In fact, it's actually a center for what is called medical tourism People from various parts of the world come there for treatment It also has been known for a fairly efficient bureaucratic system At least in the past the state has dealt with disasters But right now there seems to be a lot of confusion on the ground And the lockdown is going to be reimposed in four districts So is this a question of a particular extra level of mismanagement Or is it some people of course saying that Tamil Nadu is actually ahead of the curve in declaring this in other parts might even have So how do you see the situation right now in Tamil Nadu? I don't think Tamil Nadu is ahead of the curve I think Bombay and Delhi have declared their additional deaths, the missing deaths I think looking at Tamil Nadu figures that they would also have something to declare I would not be surprised if there is a death correction from there Their current death figures are too low And part of it is the convergence problem that Bombay and Delhi had So the death figures will hide But in practice it would be much higher But relative to other states what they are saying is the same thing So we are not saying too much But this projection of Tamil Nadu has an unusually low mortality I don't think we need to go with that, it's just a bit of hype But it's not unusually high mortality either The virus does what the virus does and it does not make any particular concession for Tamilians That's particularly the situation As a health system Tamil Nadu is a very robust health system I think we should not lose sight of that despite some of the gaps that have occurred on this Tamil Nadu has had some, health system has had some fault lines Those fault lines tend to get exacerbated by this COVID-19 That has this tendency to take up and catch you on whatever weak point you have and present them One of the fault lines of Tamil Nadu other than its high degrees of iniquity Which people do not quite recognize is very much higher in Tamil Nadu compared to many states That has a very high iniquity problem And the problem could be in a level of denial of the existence of iniquity The other big problem is its Tamil Nadu health system is very bureaucratically driven Very administratively driven Very very limited or no role for panchayats and for community engagement In the corporations where the problem is worst there are no corporate electors There are no corporate councillors, there are no want members There is nobody who can speak for the community Now this is very traditional They pride themselves on administration and they are good administrators I would say I have experienced it elsewhere also They are very good in their public health departments One of the most competent departments But they don't have community engagement And here is a situation where it actually needs It's interesting that just before this pandemic broke They were thinking of correcting that weakness They were conscious of it But I think this got them on the thing So the first one month, if you look at March Tamil Nadu performed admirably well It was on par with Kerala Somewhere it got diverted and distracted by saying This Tablighi Muslims are the only people having it 90% of cases are from them Even then I was scared that we are just not looking elsewhere And true enough when they started looking into elsewhere The Coen Bailu, Flara Packard And there were other chains of transmission It was impossible, whatever the problems with that group It was impossible that there is only one chain of transmission That can account for 90% of cases Clearly they were not looking And therefore when they started looking They found the Chennai cluster Which by then had gone out of proportions Unlike what you had in Bangalore and in the Triangrum Where they were able to be on top of the problem all the time Because they were actually on the lookout for it So there was this particular chain And Chennai cooperation doesn't have some of the rural structures That are necessary for community engagement It is not necessary for primary care And therefore the Tamil Nadu, the Chennai situations kept running out Also Chennai is one of the busy airports Lots of points of entry, the February thing So these factors put together Remember that period of March When you saw the Bombay was already peaking Tamil Nadu was not doing very badly It was actually subsequently They attributed to the market But it could have been any number of markets The fish market was also doing the same thing But it was somewhere that later they did that And then when it came to contact tracing When it came to this, there was an undue keenness On forcing the figures to remain low At the cost of a wider testing Particularly one problem happened That I think Tamil Nadu really paid very much for Is that in the pursuit of keeping deaths low And numbers low, there was I think a substantial number of cases That we were hearing who were denied admission Because they were too sick Not all the sick people getting tested for COVID-19 A certain keeping up a narrative Which I think they have currently corrected Because after this new secretary You see the death rates are much more realistic I am not saying they are high People will immediately say Now you have 49, 15 deaths, there were 18 deaths before Those 18 deaths before were a problem They represented partly people who were not documented But partly who were turned away at the door That means they would be a source of strength So imagine 2000 cases coming from day If they are in search of care And they visit 1, 2, 3, 4 places before they get admission Each patient will himself infect 100 people That means not infect They would come into contact with 100 people So you would have 2 lakh contacts For the current number of cases per day So it is extremely important That when a patient has symptoms He reaches care without getting into contact With anything else in the surrounding That I think remains a weak spot So I think that is part of the reasons why Chennai was this Also a lot of distractors A lot of effort going into unproductive Types of control Paying places You have curfew after 7 pm in the night You locked on geographically a zone And declare a buffer zone That was Chennai's great solution They invented it But thoroughly did not help Because they needed contact tracing Which was not a police function It was a community function And they did not and have not yet got enough Community volunteers on this That's I think one set of problems The other set is rising The problem is not already there The problem is rising The districts Now the districts have very limited cases So here are situations Never mind Chennai is a big place Twice as big as South Korea So it can take each district separately And make sure the disease is contained there But the surveillance systems in the districts Are weak So if you have a good surveillance You will catch the clusters when you are small Implement contact tracing And isolation measures Which will limit it A lockdown is very inefficient Because you cannot know which person Is the contact But a very focused contact tracing Will help contain those cases And keep the districts small But I am worried that some districts As they start testing Are going to show up higher clusters And then you can have many more Chennai's And that would be very unfortunate Because actually they can avoid it The rural system is much better And they should be able to avoid it But if they fail to do Adequate surveillance testing Which means you must test every person With COVID-like symptoms Whether or not they have a contact history Whether or not they have a This whole business of community transmission Has lulled us from testing People who are symptomatic But without contact history So that new clusters can Rise unnoticed and become too big When they are small You can contain them When they are large, you need mitigation Extra beds, you have problems of management That is the danger They can get out of it They are on the cusp of it I think that hopefully in the coming week They will do something to Get that better So you would not for instance recommend You would not see the reimposition Of the lockdown as a very efficient solution Because like over the past couple of days There have been similar discussions With regard to Delhi Whether if there is a need for a second lockdown Whether it might actually help So if there is a mouse in the house You can burn down the house To get to that mouse Or you can search for the mouse It may be very difficult Very elusive But eventually when you burn it down The mouse may still survive You see the problem about Lockdown is an extreme Measure It could be there There could be cases and circumstances When it is merited To rule it out In all lockdowns I really think that right now They need to focus on this thing But I can see in Chennai There is some sort of a thing But let us say If there is a political compulsion to go ahead They should at least accompany it But a far, far greater Intensified contact tracing Community engagement Using this process of Mitigation for that End up something like 20,000 more bits To be ready for what will happen With the lockdown less We are likely to run into lax Because we may not Get that in control And we need to get ready for that And I think we have a problem Even now in metallation management Things like that which I think needs to be strengthened So if they use it For doing a health system preparedness That they should have done in April But everybody is Learning So they can And intensify testing But if they use the lockdown as a substitute For doing this They are really lost Then Chennai will be in a real Soap, I hope And I do think that they will not make that mistake Thank you so much Thank you