5. GOING OFF TRACK
WITH STATES GOING LAX ON CONTACT TRACING AND TRACKING OF POSITIVE CASES, THE VIRUS WAS LEFT TO SPREAD UNCHECKED
IN 2020, INDIAN AUTHORTIES widely used the T3 protocol (test, treat, track) in the battle against Covid-19. However, in 2021, none of the states most affected by the second wave appear to be following it, with mandatory quarantining also falling by the wayside. This is a major factor behind the rapid spread of cases in the second wave. The situation in Madhya Pradesh, for instance, is typical of what is taking place in most states. “The T3 protocol was deployed very effectively from April to August last year,” says a top official in the state government, asking not to be named. He says that these efforts began to slacken after August, and with no pressure from senior officials or political leaders to ensure that district collectors maintained it, contact tracing stopped across the state. This year, by the first week of April, the surge of cases left the state’s health infrastructure in tatters. “We need every hand on deck right now,” says an official from the health department. “We do not have the manpower to conduct contact tracing.” This is despite home ministry guidelines published on March 23 asking states to strictly adhere to the T3 protocol. Nonetheless, some state officials defend the suspension of tracing programmes. “We are testing aggressively, doing around 60,000 tests per day,” says Vishwas Sarang, MP’s medical education minister. “Contact tracing was the need of the hour when there was lesser awareness. Now, people come forward for testing themselves.”
Even in Maharashtra, which was hit hard by the second wave, contact tracing has been dismal. On May 2, there were almost 4 million people in home quarantine, but the state’s health department officials say there is no system in place to ensure contact tracing of these patients. Since last year, the state has been progressively diluting its efforts on this count. In June 2020, it launched the ‘Chase the Virus’ programme, which aimed at tracing at least 20 people who had come in contact with
each Covid-positive person. This was later replaced with a ‘My Family, My Responsibility’ programme, which put the onus on the family members of those who tested positive to inform local civic body officials of the infection. In February this year, the government abandoned its contact-tracing efforts entirely, launching a new programme that focused on mask-wearing and sanitisation. Maharashtra’s dilution of contact tracing efforts even caught the attention of the Centre. In March, Union health secretary Rajesh Bhushan wrote to Maharashtra chief secretary Sitaram Kunte on the subject: ‘There is a very limited active effort to track, test and isolate cases and quarantine contacts [in Maharashtra].’ State health minister Rajesh Tope says he has instructed all collectors and municipal commissioners to ensure that contact tracing efforts are beefed up but the situation on the ground—with officials already overburdened with ensuring availability of medical facilities—is not promising.
THE SITUATION IS SIMILAR in other states. In West Bengal, officials say that contact tracing is suffering because testing facilities are overstretched. “We can do 55,000 tests per day,” says Dr Manas Gumta, secretary of the Association of Health Service Doctors. “The daily patient load is around 17,500. If we assume just four people come in contact with each infected individual, the number of tests we would have to do is 70,000. We don’t have the capacity for that.” This is also leading to delays in test results being returned, sometimes by as much as 72 hours. “This delay is causing a rapid spread of the disease as no tracing or tracking is happening,” adds Dr Gumta. “We [cannot identify] those who have come in contact with the patient and who [therefore] need to be isolated. Unless we ramp up the number of Covid hospitals, laboratories and technicians, we will not be able to tackle the viral load.”
Even states that did well in the first wave are faltering. In Bihar, the speed at which new cases have spread has overwhelmed medical infrastructure. By May 2, the state had over 100,000 active cases, shifting the priority from tracing to treatment. In addition to this, according to a district magistrate, government officials are reluctant to carry out contact tracing. “There is an unspoken acknowledgement that the disease is spreading faster than containment measures—so there is no point in wasting our resources in doing something that will not help. Instead, we have started an awareness campaign,” said the officer.
Since most states have cited a lack of manpower as a critical problem, technology could play an important role by reducing the number of people required. For instance, the Union government’s Aaroyga Setu mobile app, which was widely promoted during the first wave, was a step in the right direction. Those who had been tested for Covid-19 were expected to upload the results onto the app, reducing the need for data entry workers—however, there is very little compliance, if any, with these requirements now.
If the situation continues, the only alternative will be lockdowns to break the chain of transmission and bring down infections rates. However, this will lead to severe economic consequences, as the national lockdown last year proved. It is widely acknowledged that when it comes to medical problems, prevention is better than cure; and on that count, a comprehensive resumption of T3 protocols is essential.