The spread of COVID-19 in tier-2 cities of Tamil Nadu, including Nagapattinam, Tuticorin, Nagercoil, etc. are worrying the administration, as lack of proper awareness on wearing of masks, safe-distancing and use of sanitiser may increase the spread in these places. State Health Secretary J Radhakrishnan has already directed the district collectors of these places to be on alert and also communicated to the district Superintendents of Police to maintain vigil in these towns. Nagapattinam, for instance, recorded 172 cases as on Thursday evening and the Test Positivity Rate (TPR) is nearly 10% while Tuticorin recorded 9% TPR, and in Coimbatore, Chengalpet, Tirunelveli, Tiruppur and Tiruvallur the TPR was between 8 and 9%. While Tamil Nadu's average testing of 2,35,740 people per million is much higher than the 1,87,831 per million in India, testing in 17 Tamil Nadu districts is much below the national average. Nagapattinam with 1,14,039 tests is the least, followed by Krishnagiri with 1,19,518. Director of Public Health Dr TS Selvavinayagam while speaking to IANS said, "The spread in two tier cities and rural Tamil Nadu is a worrisome factor, but we are taking measures to contain it, and increasing testing is the immediate necessity. Already the Health Secretary has communicated to the district collectors and district police superintendents to conduct these tests. People must refrain from going out of their houses which is primarily the most important thing and if you are going out for work or in absolute necessity wear a mask and ensure physical distancing." While Nagapattinam and Krishnagiri have seen poor testing for COVID-19, most of rural Tamil Nadu is facing this stark reality that it could lead to a spike in COVID-19 cases. The administration has already taken precautionary measures in these areas and is creating maximum public awareness on wearing masks, safe distancing and use of sanitisers. M Ganeshkumar, a trader in Nagapattinam, while speaking to IANS said, "People were not wearing masks and behaving carelessly, even the police were not taking things seriously. Now we are on the threshold of the second wave and I don't know what is happening in Nagapattinam. The testing is low, test positivity rate is high, and this means we are in a pitiable situation. Hope the authorities are taking action with immediate effect so that precious lives are saved."