‘Ruthless’ strategy emerges as key to virus containment
Rajasthan city shakes off hot spot tag a week after local cluster; govt plans to implement this model in other places as well for effective containment of the infection
nJAIPUR: Bhilwara, which on March 29 was one of India’s 10 top coronavirus disease hot spots, has shaken off that tag barely one week later. The Rajasthan district is now being talked about in medical and administrative circles for the single-minded determination -some call it ruthlessness -- with which it stopped the virus’s spread.
Of the 27 people in the district of 2.8 million who tested positive for Covid-19, 13 have already been cured, and 12 are under treatment for the infection; two died. Around 720 people are being monitored in governmentrun quarantine centres. No new case has been reported between March 31 and April 3, one case was reported on April 4.
In a video conference on April 5, with chief secretaries of state governments, cabinet secretary Rajeev Gauba praised Rajasthan for the Bhilwara model of containment, said Rajasthan chief secretary DB Gupta.
“The government is planning to implement this model in other places, too, for effective containment of the infection,” he said.
The Bhilwara model of containment worked in phases. The first was to isolate the district, the second was to put in place a screening strategy for the city and rural areas; the third was to set up quarantine and isolation wards, followed by a monitoring system for the villages, district collector Rajendra Bhatt said.
To isolate the district, a fortnight-long curfew that exempted only essential services was imposed on the day the first case was reported, March 20, until April 2.
“We sealed the borders of the district and set up check-posts at all entry and exit points. Roadways and railway services were stopped and movement of private vehicles prohibited,” Bhatt said.
After isolating the district, the administration defined the containment zone of 1km from the epicentre – the Brijesh Banger Memorial Hospital (BBMH), a private institution, whose doctors and supporting staff were the first to test positive – and a buffer zone of 3km. Where the doctor who first tested positive in Bhilwara caught the infection isn’t known yet.
“On the basis of cluster mapping, we identified six areas and deployed special teams for continuous screening of suspected cases in these,” the collector said.
SCREENING, TESTING
During this phase,the containment and buffer zones were disinfected daily along with the neighbourhoods of those who tested positive; all ambulances and police vehicles; screening centres and quarantine centre; the district collector’s office, the police line and public dealing offices; and city wards.
In the second phase of curfew, from April 3 to April 13, even essential services were prohibited in the city. “During this period, there was no relaxation of any type. We are ensuring door-to-door supply of essential items such as vegetables, fruits and milk to residents and food packets to the poor,” Bhatt said.
For screening the entire population of 2.8 million, survey teams were trained by specialists on how to recognize Covid-19 symptoms and check the foreign travel history of people. One supervisor was appointed for every 10 survey teams.
“Screening and testing was prioritized for Brijesh Banger Memorial Hospital. ICU admissions, doctors and nursing staff, IPD {inpatient department} and OPD {outpatient department} patients, persons who were identified to have had contact history with the positive cases; health workers and other staff were screened and all suspected cases told to be in home quarantine,” the collector said.
He said a dedicated screening and testing centre was established at MG Hospital, which was sturned into dedicated Covid-19 hospital. People were brought to these centres for screening and testing in government vehicles and dropped back.
“In screening, doctors and nursing staff did thermal scanning and physical examination. If anyone had symptoms or was contact of a positive patient, his samples were drawn and he was sent into isolation,” Bhatt said. He said every day, government vehicles carried these samples to Jaipur for testing three times a day.
For every patient who tested positive, their close contacts were brought to isolation wards; so-called tier-2 contacts were taken to institutional quarantine facilities. The district administration used 1,541 rooms at 27 hotels as quarantine centres.
Apart from the hotel room, the administration also had 11,659 quarantine beds in 22 institutions and hostels. MG Hospital has 200 beds. The capacity could be extended up to 427 beds. Four private hospitals with isolation ward capacity of 25 beds each were also taken over.
TREATMENT
Principal medical officer, Dr Arun Gaur, who has been overseeing the treatment of those who tested positive, successfully treated 13 of the coronavirus disease patients by using a combination of drugs used to treat malaria, HIV and influenza.
Dr Gaur said the local health departments followed the standard treatment protocol and tweaked it according to their patient profiles. Their age, medical history, co-morbidity, side effects of the drugs, cardiac evaluation and other tests were done before the treatment started.
“We gave them a combination of drugs. We used azythromycin, chloroquine phosphate, oseltamivir. Those who were resistant or had respiratory problems, we treated them using a lopinavir and ritonavir combination,” he said.
Azythromycin is an antibiotic that is used to treat bacterial infections, Chloroquine ohosphate is used to treat malaria, Oseltamivir is an antiviral medicine used to treat influenza. Lopinavir and ritonavir are antiretroviral drugs used to treat HIV.
“To declare patients coronafree, two samples have to test negative. A third sample is taken on the 14th day and if that is also negative then a patient is declared corona free. Then we advise them home isolation. A seal is put on their hands and they have to stay at home for 14 days,” he said.
“Our regimen has given good results and I think in another 3-4 days, we will cure another seven patients.”
MONITORING
For monitoring, so-called corona fighters and corona captains were appointed in the city and rural areas. In the city,a sub-divisional magistrate (SDM) is the corona caption and accredited social health activists and auxiliary nursing midwifes are corona fighters. In the villages, block development officers and tehsildars are corona captains and teh sarpanchs, teachers and accredited health activists are corona fighters at the village level.
Corona captains and corona fighters monitor people in home quarantine, ensure food supplies, food packets, flow of migrant labourers and law and order, collector Bhatt said.
Asked to sum up the reason why the administration’s containment strategy had succeeded, the collector said:” A ruthless containment model and cooperation of the people in our war against Covid-19.”