State’s monitoring system comes up against lockdown fatigue

SANGLI: At 10 am, the Sangli fruit and vegetable market run by the Agriculture Product Market Committee (APMC) at Vasant Colony wears a deserted look. A few workers talk over a cup of tea, their masks bunched up over their chins. Dadamiya Patel, his mask over his nose, sits some distance away reading a Marathi daily. “In our business, everything runs on trust. I give credit to fruit farmers; I also give credit to small vendors who buy fruit from me. I haven’t turned a profit in the past two years [of the pandemic]. I haven’t even recovered most of what I’ve lent,” the 70-year-old fruit commission agent said.

It’s likely Patel won’t recover most of his money this year either. Parts of Sangli city were submerged on July 24, and remains under a lockdown driven by the district’s Covid-19 caseload. Both factors have put a damper on sales. “Who wants to eat fruit in such a situation?” Patel asked.

In the past two months, six districts including Sangli have contributed to the bulk of the state’s caseload share. Sangli, which lies south of Pune and shares a border with Karnataka, recorded its highest daily caseload of 2,328 cases on May 6. In the weeks starting May 29 to June 4 all the way up till July 10 to 17, its weekly positivity rate — a function of the number of tests and daily caseload — came down from 14.02 to 7.81 (the week between May 22 to 28 had seen an alarming weekly positivity rate of 20.4).

Steady rise in testing

To be sure, the number of tests conducted steadily increased starting June: from 6,944 on June 1 to 13,512 on July 17. This doesn’t indicate a daily increase — on some days, the number of tests conducted were fewer than the previous day — but it does indicate a steady rise. What’s more, the daily caseload remains plateaued between 700 and 1100 cases from June 1 to July 17.

This is both a good thing and a bad. Epidemiologists contend that a pandemic is said to be under control if the positivity rate is below 5%. As more people get tested, the number of cases that emerge will only increase, and gradually after a point, will begin to dip. However, a plateau indicates that the testing numbers aren’t high enough.

There’s another significant factor that might explain the plateauing of cases in Sangli district: the type of test kit used.

On June 18, the Maharashtra government ordered all districts to calculate their weekly positivity rates (WPR) based only on Reverse Transcription Polymerase Chain Reaction (RT-PCR) tests in a bid to ascertain localised unlock plans. Subsequently, several districts reported a rise in WPR — Sangli which was on a Level 3 restriction went back to Level 4 as its WPR calculated on the basis of RT-PCR tests between June 19 to 25 was 13.09% (by comparison, the WPR based on Rapid Antigen Test kits or RAT, in the same time period, was 7.55%). In the week ending July 17, the WPR based on RT-PCR testing was 8.01% while the WPR based on RAT testing was 7.16%.

“In the initial days of the second wave, we were testing 5,000-6,000 persons a day. Now we have increased that three times at least in the past 1.5 months.” Of these, a third of the tests conducted are RT-PCR, said Abhijit Chaudhary, District Collector, Sangli.

Even at the Sangli-Miraj-Kupwad Municipal Corporation (SMKC) labs, the use of RT-PCR kits rose steadily: from a daily average of 200 in April to over a thousand every day starting June-end. The use of RAT kits also rose, and remained higher in proportion.

This reliance on RT-PCR tests is an important one: RAT kits are prone to detect 50% of the infections. A higher reliance on RAT thus has a deleterious impact in tracking the spread.

Arresting the spread

There are two reasons for a pandemic to spread, Chaudhary said, when HT met him at his office a day after he met traders seeking the reopening of markets. “One is the presence of vulnerable populations. The other is the movement of people.”

To tackle the former, the district follows a plan that was set in place in the first wave itself: test, trace and isolate. The district continues to look for high risk and low risk contacts, and an army of Accredited Social Health Activist (ASHA) workers as well as medical staff at Primary Health Centres (PHCs) and sub-centres have been tasked with implementing this.

Yet, on ground, something seems to have shifted since the first wave. ASHA workers and PHC staff personnel said that they encountered more resistance from people this time around.

“Earlier, people were serious about the coronavirus, and felt that they needed to stay safe. Now, things are different. People move about, leave out names in contact tracing,” said Dr Sheetal Dabade, a community health officer attached to the Takli sub centre.

Tracking patients

“When the first four cases emerged in Sangli in March last year, we made a containment zone of around five kilometres, and it remained in place for 63 days. We traced 540 contacts of those cases. Now, containment zones are smaller, and we’re not tracing as many contacts as that. Also, last year, we tested at checkpoints. This time around, movement is allowed. There were elections that took place in a sugar mill factory. People conducted weddings. As the health department alone, we can’t control the spread,” said Dr Milind Pore, the district’s health officer.

Pore said that they plan to vaccinate on a priority basis those who visit the city daily from rural and periurban parts of the district — milk deliverymen, construction workers, fruit and vegetable vendors — and test them every 15 days between the two doses. “A month ago, we tested such daily commuters in mission mode. But now we must do so every fortnight to catch the breakthrough infections,” he said.

Any plan that aims to increase testing, and vaccination, particularly of those most vulnerable to catching the infection — and spreading it — is a good one. But the issue of testing hesitancy is a tough one to resolve.

“Even if they have some symptoms they say it’s probably just a seasonal cold,” said Urmila Patil, an ASHA worker in Surul village.

It is now mandatory for private practitioners to share the names of patients with influenza-like symptoms (ILI) or SARI-like (severe acute respiratory infection) symptoms.

“If the person is not willing to disclose his symptoms to the government, then that’s a big problem,” said Dr Sanjay Salunkhe, civil surgeon.

For those who do get themselves tested and turn out to be positive, there is a system that enables the district’s health and governance machinery to monitor them. The district and SKMC have separate control rooms where different teams track different things: RAT numbers, RT-PCR numbers, testing numbers from private labs and hospitals, treatment by private practitioners, home isolation, contact tracing, Covid-19 portal updation, bed availability, among others. Lists of patients’ names and their addresses are collected from each taluka and fed back to the respective health centres for monitoring.

As other districts open up, Sangli’s administrators find themselves in a bind: opening up markets, restaurants will only drive up the number of cases.