Saturday, December 9, 2023

Bhilwara Burns Bright

This small city has shown how medical and non-medical interventions can bring Covid-19 under control even as a ruthless “maha curfew” led to the entire district being sealed off. By Asif Ullah Khan in Jaipur

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It is a strange coincidence that Bhilwara, the Rajasthan district that has become a shining example in fighting Covid-19, followed the pattern used by two Communist countries—China and Vietnam.  Calling it “wartime conditions”, China’s ruthless lockdown in Wuhan, the initial epicentre of the pandemic, looked like a military campaign. Medical workers were mobilised into round-the-clock shifts to visit each home in the city, checking the temperatures of all residents and interviewing close contacts of infected patients.

Similarly, Vietnam, sharing a border with China, faced an imminent threat of being overwhelmed by Covid-19. But instead of a ruthless lockdown, it focused on aggressively isolating infected people and tracking down their second-and third-hand contacts. Unlike wealthy countries such as South Korea, Vietnam did not go for mass testing, but launched a sustained drive to trace infected people and isolate them. This won praise from WHO and Carl Thayer, professor emeritus at the University of New South Wales, Canberra, who said: “It is a one-party state; it has large public security forces, the military and the party itself; and it’s a top-down government that’s good at responding to natural disasters.”

In Bhilwara too, the situation was very serious. The crisis started from a private hospital where a 72-year-old suffering from pneumonia was being treated. He died at SMS hospital in Jaipur five days later after testing positive for Covid-19.

Dr Vivek Sharma, a Jaipur-based paediatrician, told India Legal that the Bhilwara situation was like a cluster bomb, which releases thousands of small bomblets and saturates a large area. “The Covid-19 positive patient was admitted and treated in a general ward where other patients were already in a very vulnerable state and could be infected easily. Like cluster bomb submunitions, they could have become the biggest carriers of the infection.” He said the worst part was that three doctors and three nursing staff were also infected. “One does not know the exact number of patients they must have treated or examined and where they have gone. So the hospital and medical staff, who are supposed to curb the spread of the virus, inadvertently became its biggest proliferators. It had the potential of becoming another Wuhan,” he added.

Sharma said that there are four basic principles of virology—introduction, identification, intervention and isolation. “The reason why we are seeing this spike in Covid-19 cases in India is that the last step—isolation as seen in various steps such as Janata Curfew and the lockdown—was taken as the first step,” he said. In this regard, the success of the Bhilwara model is commendable as despite being caught unawares, the Rajasthan government launched a massive drive there. It dispatched 3,000 teams, which surveyed more than six lakh households and quarantined 12,000 people. The ruthless lockdown, also known as “maha curfew”, led to the entire district being sealed off. No private vehicles were allowed in and door-to-door testing was conducted. The district administration took over five private hospitals and booked more than 1,500 hotel rooms to scale up the isolation facilities. This is the reason why out of 29 suspected cases, only two deaths were reported, while the rest turned out negative.

Sharma said that before a vaccine or some other medical invention is devised, personal hygiene, lockdown and social distancing are the best non-pharmaceutical interventions as exemplified in a new study by Imperial College’s London Covid-19 Response Team. The authors of the study say there are two routes to tackle the disease:

  • Mitigation: “Slowing but not necessarily stopping epidemic spread—reducing peak healthcare demand while protecting those most at risk of severe disease from infection.” This is done by isolating suspected cases and their households and social distancing of the elderly and people at the highest risk of serious illness.
  • Suppression: It’s basically a lockdown which “aims to reverse epidemic growth, reducing case numbers to low levels by social distancing the entire population indefinitely” and closing schools and universities.

The study’s models show that the lockdown, painful as it may be for many, works. It said that without these measures, the mortality rate may peak in approximately three months. In this scenario, 81 percent of the UK’s and the US’ populations would be infected, with 5.1 lakh dying in the former and 22 lakh in the latter. In contrast, isolating confirmed and suspected cases and social distancing of the elderly and vulnerable would “reduce peak critical care demand by two-thirds and halve the number of deaths”.

To get closer to the goal of keeping reproduction, or “R,” below one, the study says that “a combination of case isolation, the social distancing of the entire population and either household quarantine or school and university closure are required”. The study finds this intensive policy is expected to result in a reduction in critical care requirements from a peak of approximately three weeks after the interventions are introduced and a decline thereafter while the intervention policies remain in place. Overall, the study estimates that countries which used intense nationwide lockdowns have managed to reduce their reproduction number.

Sharma said: “Of course, these non-pharmaceutical interventions have played a vital role in reducing the reproduction rate but we should also not forget what WHO chief Tedros Adhanom Ghebreyesus said. His message to all countries is ‘test, test, test’. Test every suspected case. If they test positive, isolate them and find out who they have been in contact with two days before they developed symptoms and test them too.”

Bhilwara is a small city with a population of six lakh. A combination of medical and non-medical interventions nipped this illness in the bud, said Sharma. India with its population of 133 crore, he stressed, has to emulate the China and Vietnam models where all the might of the state was used to fight this enemy.

God’s own model

It is said—Cometh the hour, cometh the man. The coronavirus pandemic has become a litmus test for the leadership qualities of many chief ministers who have displayed exemplary administrative skills and great foresight during this time.

If the Bhilwara model is being hailed for the proactive and decisive approach of Rajasthan Chief Minister Ashok Gehlot (right), Kerala Chief Minister Pinarayi Vijayan (far right) has won plaudits even from the WHO for the state’s past “experience and investment” in emergency preparedness. His prompt, strict and humane response in aggressively testing, isolating, tracing and treating Covid-19 patients has made it win this crucial battle. In comparison to other states, Kerala is more vulnerable because of high foreign and domestic tourist arrivals and its large workforce employed in the Gulf.

Kerala was the first state to report a case in January because of the surveillance system at its airports. After that, the fight moved into top gear. A record of all those who had arrived from overseas is maintained and shared with multiple agencies, including primary health centres near their homes. Even those who had returned three months before the screening at airports started were traced and tested.

Kerala was the first state to announce a Rs 20,000-crore special package before the national lockdown was imposed to help the people hit hard by the illness. It included health packages, loan assistance, welfare pensions, MGNREGS, free food grains, subsidised meals, tax relief and arrears clearance.

However, its biggest success was its effective use of disseminating health-related information using both traditional and new media. Preventive steps against Covid-19, such as washing hands and social distancing, were effectively conveyed both through print and digital media platforms in this 100 percent literate state.

Kerala police also joined in and released short videos of groups of policemen dancing to the tune of a recent blockbuster where the importance and correct way of washing hands was shown. The video, after going viral, was adopted by many states. It also used Facebook, TikTok, Instagram, Twitter, WhatsApp and other platforms.

All these methods along with Kerala’s improved health infrastructure and strong human development index helped it fight this dreaded menace.

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