States bank on testing, tracking, containment

THIRUVANANTHAPURAM/MUMBAI/JAIPUR: As the government weighs steps to eventually ease the nationwide lockdown in a phased manner, certain successful models from across the country could prove to be a useful guide, according to experts watching the Covid-19 situation.

The government could go by the strategy of converting the so-called red zones into yellow and then green. Red zones are Covid-19 hot spots, yellow are ones where the case count sees a quick decline and green are where no cases exist. The Centre has asked states to adopt containment strategies as per local conditions, which include hard lockdowns, aggressive scanning of areas and rapid testing, all aimed to scale down the zones to green.

A health ministry document on containment areas issued last week gave a glimpse of what postlockdown restrictions may look like in the worst-hit areas.

“The cluster containment strategy would be to contain the disease within a defined geographic area by early detection of cases, breaking the change of transmission and thus preventing its spread to new areas,” the document said.

The strategy builds on experience from the 2009 H1N1 influenza pandemic, with that virus affecting bigger cities and wellconnected towns much more than rural areas.

“This suggests that while the spread of Covid-19 in our population could be high, it’s unlikely that it will be uniformly affecting all parts of the country,” the document said.

“This calls for a differential approach to different regions of the country, while mounting a strong containment effort in hot spots.” The states have adopted different strategies but some of them are seen to have potential to be replicated nationally. Here are some:

AGGRESSIVE SCREENING

Mumbai (Maharashtra): Mumbai has 381 containment zones – highest for any city in India – the result of aggressive screening of close to a million people. The city plans to start pool testing around containment zones to intensify the screening process and identify possible community transmission.

In pool testing, multiple swab samples are tested together through the RTPCR (real-time reverse transcription polymerase chain reaction) test to quickly identify Covid-19 areas.

If the test is negative, it means that all persons, whose swabs were tested together, are negative. In case of it being positive, individual tests of all persons are done.

Till Sunday, the Brihanmumbai Municipal Corporation (BMC) had traced 40,000 high and low-risk contacts of Covid-19 positive persons and managed to identify 620 cases through contact-tracing measures, up from 29,755 tracked till April 12. A total of 474 flying squads have so far screened close to a million persons for symptoms of Covid-19, officials said.

EFFECTIVE TRACKING

Pathanamthitta (Kerala): With a track, trace and treat approach, a hilly district in central Kerala,

Pathanamthitta, tasted success within a month. It was one of the early hot pots of the country with 16 positive cases in March first week and now it has eight out of the state’s tally of 364. The district was the first to identify red, yellow and green zones. At one point, the district had 20,000 people under observation and their number came down to 6,477, according to district programme manager Dr Ebey Sushan.

The district introduced flow charts tracking every movement of patients and geo-fencing people in quarantine. It set up an exclusive Covid hospital and banned the entry of pilgrims at Sabarimala hill temple.

District collector PB Nooh, said: “We literally chased the contacts of imported cases (those who came from abroad) and quarantined as early as possible. Initial slip-ups in identifying and quarantining were plugged properly.” By Sunday, the district had moved into the yellow zone.

RUTHLESS CONTAINMENT

Bhilwara (Rajasthan): The containment happened in three phases: the first task was to isolate the district, second was screening strategy in city and rural areas and third was quarantine and isolation wards, said Rajendra Bhatt, district collector. The first case was reported on March 19. Within days, cases increased to 28 and of them, 24 were cured.

For isolating the district, curfew was imposed on March 20 and continued till April 2. From April 3 to 13, even essential purchases were prohibited and door-to-door supply was done. Disinfection of the containment zone and buffer areas, all ambulances and police vehicles was done daily.

A total of 3,072 teams of health workers screened 1,071,325 people in Bhilwara city, and 1,937 teams screened 2,239,134 people in the rural areas.

THE STRATEGY BUILDS ON EXPERIENCE FROM THE 2009 H1N1 PANDEMIC, WHEN THE OUTBREAK AFFECTED BIGGER CITIES AND WELL-CONNECTED TOWNS MUCH MORE THAN RURAL AREAS