What would happen once lockdown in India is lifted?

• India faces a similar choice as that of Goldilocks with respect to the COVID-19 pandemic, and the timing of when to ease out the nationwide lockdown.
• Ease it out too early, and the disease could rapidly spread, wiping out the hard-won gains from the 21-day quarantine.
• Ease out too slow, and the continued lockdown could wreak havoc on India’s economy, potentially causing permanent damage and losing more lives from economic hardship than from the disease.

What then is the right time to ease out the lockdown? This question can be answered after studying this Burning Issue.

Context

• The so-called sudden outbreak of a novel Coronavirus that began in the Chinese city of Wuhan has rocked the world. Now, infections have been confirmed in almost every country.
• With crumbling health infrastructure due to overburden, India’s preparedness for handling this epidemic has become a major challenge.
• The world along with India being no exception has responded with extraordinarily aggressive measures such as phased lockdowns, Bhilwara Model, Pathanamthitta Model, Taiwan model etc.
• The success of these models is attributed to various best practices which are were implemented days before the thought of nationwide lockdown was incepted.

An old African proverb says, “An ant can kill an elephant.” This effectively seems true in the current COVID-19 context. While the contagion is ravaging economies, people and livelihoods globally, governments — rich and poor — are gasping for an effective coping strategy.

There are handfuls of success stories of “Coronavirus Slayers” who have been courageously fighting the pandemic and have emerged successful.

Various models for COVD-19 containment

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(Indian Models)

1) The Bhilwara Model

• Rajasthan’s Bhilwara could have become the corona epicentre for the country had it not followed a stringent strategy, courtesy to IAS officer Tina Dabi (AIR 1, 2015) and her pro-active team.
• The “Bhilwara model” of tackling COVID-19 cases involves, simply, “ruthless containment”.

What is this ‘ruthless containment’ model about?

• It refers to the steps taken by the administration in Rajasthan’s Bhilwara district to contain the disease, after it emerged as a hotspot for coronavirus positive cases. It can be summarized as-

1. District isolation
2. Aggressive screening in the city and rural parts
3. Quarantine and isolation wards
4. Rigorous monitoring

What were the earliest measures adopted?

• The measures taken by the state govt. included imposing a curfew in the district which also barred essential services, extensive screening and house-to-house surveys to check for possible cases.
• It went for detailed contact tracing of each positive case so as to create a dossier on everybody they met ever since they got infected.

What did the administration do as part of the containment strategy?

• The administration backed up the surveys by imposing a total lockdown on the district, with the local police ensuring strict implementation of the curfew.
• Intense contact tracing was carried out of those patients who tested positive, with the Health Department preparing detailed charts of all the people whom they had met since being infected.
• The state took the help of technology, using an app to monitor the conditions of those under home quarantine on a daily basis along with keeping a tab on them through GIS.
• The patients were treated with hydroxychloroquine (HCQ), Tamiflu and HIV drugs.

Groundwork

• Within three days of the first positive case, the district health administration in Bhilwara constituted nearly 850 teams and conducted house-to-house surveys at 56k houses and of 280k people.
• Thousands were identified to be suffering from influenza-like illness (ILI) symptoms and were kept in-home quarantine.

Success:

Bhilwara which was the first district in Rajasthan to report the most number of COVID cases has now reported only one positive case since March 30.

2) The Agra Model

• Agra was the first identified cluster in India and continues to have one of the highest district-wise caseloads.
• The “Agra model” followed a localised yet massive combing operation for contacts, carried out by the district administration and Integrated Disease Surveillance Programme personnel.
• It worked on war front with devised electronic survey including smart city control centre, drones, CCTVs etc.

Various measures taken

• The State, District administration and frontline workers coordinated their efforts by utilizing their existing Smart City Integrated with Command and Control Centre (ICCC) as War Rooms.
• Under the cluster containment and outbreak containment plans, the district administration identified epicentres, the delineated impact of positive confirmed cases on the map and deployed a special task force as per the micro plan made by the district administration.
• The hotspots were managed through an active survey and containment plan.
• The area was identified within a radius of 3 Km from the epicentre while 5 Km buffer zone was identified as the containment zone.

Massive scale of monitoring

• In the containment zone, Urban Primary Health Centres were roped in.
• Health workers including ANMs/ASHA/AWW reached out to 9.3 lakh of people through household screening.
• Additionally, effective and early tracking of first contact tracing was thoroughly mapped.

Success:

The Agra model is important because it has proved effective in areas of high case density, which are being referred to as “hotspots”. Agra was also the earliest reference to community transmission.

3) The Pathanamthitta or Kerala Model

• Use of technology has been the hallmark of the Pathanamthitta model in Kerala.
• The district saw its first cases in early March when a three-member Italy-returned family ended up infecting several relatives while socializing with them. The count would eventually go up to 16.

How it differs from Agra Model?

• Border sealing and contact tracing happened here too.
• But more than just screening contacts, every person who had entered the district was screened and a database created so that they could be easily reached at short notice.

Self-reporting by people

• Graphics were created showing the travel route of the positive cases and publicized.
• This helped in self-reporting. As people realized from the route map that they had indeed come in contact with a COVID-19 positive person, many walked up to be screened or treated.

Intensive use of technology

• Those under quarantine were checked daily on phone thorough a call centre even as 14 teams of health workers monitored some 4,000 people who had entered the district before its sealing.
• There was also an app — Corona RM — designed by a few engineering students.
• Those under home quarantine were monitored through this app as their whereabouts could be tracked and if they broke quarantine that could be immediately detected through the use of GP.

Success:

The growth of new cases has slowed down in Kerala, with six of the last 10 days witnessing a single-digit rise. This success of Kerala is being attributed to its “prompt response” to its past “experience (of Nipah) and investment” in health emergency preparedness.

Global Successes

1) Taiwan Model of Total Healthcare Management

• Located less than 150 kilometres from the original viral source – China – Taiwan has seen far fewer cases of the coronavirus in the past month, with a much lower infection rate.
• It is also worth noting the practices utilized by Taiwan’s hospitals as they seek to curb the virus and protect patients and medics.

Following were the not so exceptional measures which helped Taiwan authorities contain coronavirus:

Smaller staff groups

• One of the early steps taken was the reduction of the workgroup sizes within medical facilities.
• This reduces the risk of a community spread within the hospital emerging from infected patients being treated.

Traffic control in hospitals

• Hospitals were establishing separate entrances and exits for in- and out-patients to help prevent the spread of infection via regular hospital traffic.
• In effect, hospital entry began to resemble airport customs, with visitors passing through a temperature checkpoint and showing IDs before admittance.

Maintaining a high bed-per-capita ratio

• Many countries have found that they do not have nearly enough hospital beds to care for patients suffering from a highly infectious disease like COVID-19.
• In response, Taiwan has nearly 1,000 negative pressure isolation rooms (an isolation technique used in hospitals to prevent cross-contamination from room to room) available, with the capacity to add significantly more through room reconfigurations.
• This is a remarkably high number, given the relatively small population of the island, and speaks to the country’s preparedness and advanced medical infrastructure.

Best public health policy

• Finally, Taiwan has benefited greatly from the close coordination between its hospitals and the central government.
• Within the country’s nationalized healthcare system, every citizen and resident is assigned a health card, embedded with a computer chip reflecting their identity and medical history.

Success:

As the global total of infections has neared 700,000, with over 30,000 deaths, Taiwan’s count stood at 300, with only 5 deaths.

2) Prolonged, total lockdown: The Wuhan model

Wuhan, the capital of Hubei province, and the geographic origin of the coronavirus have had the longest and most comprehensive lockdown of any region in the world, for a staggering 76 days, starting on 23 January and ending on 8 April.

Actual strategy

• In January, China effectively shut down Wuhan and placed its 11 million residents in effective quarantine — a move it then replicated in the rest of Hubei province, putting 50 million people in mass isolation.
• Across the rest of the country, residents were strongly encouraged to stay at home.

Mass mobilization

• At least 42,000 doctors and medical personnel were sent to Hubei province to shore up the province’s health services.

Masks and checks

• In cities, it quickly became necessary to wear a mask as apartment blocks, businesses and even parks barred entry without one.
• Widespread mask use may have helped slow the spread of the disease, “particularly when there are so many asymptomatic virus carriers

Success:

China had 22 consecutive days (till yesterday) of one new case or less per day, before the lockdown was lifted.

3) No lockdown, rapid testing: South Korea Model

• As countries across the world used their state machinery to impose partial or complete lockdowns, South Korea decided to follow a different route.
• A week since the coronavirus started spreading in their neighbouring country, China, the government responded quickly and ordered all the factories to start producing testing kits en masse.
• Within two weeks, South Korea was producing more than 1,00,000 testing kits per day.
• Furthermore, the government used all its resources to and had carried out over 2,50,000 tests.
• This allowed the government to gather data, monitor the spread and treat/isolate the infected individuals.
• South Korea also used surveillance footage, drone images, credit card activities, etc. to trace the contacts of the infected individuals and put them into isolation.

Success:

By acting quickly, South Korea tackled the COVID-19 crisis effectively while keeping its economy up and running. When a third of the world’s population is living under a lockdown, the relative normality of Seoul feels surreal.

All these models have something in common. Guess what?

• Capacity to contain a virus outbreak depends on the ability to identify cases and contacts in the community on clinical criteria while ensuring smart surveillance on travellers; isolate and identify the causative virus; treat severe cases while counselling mild cases.
• Dealing with pandemics required a multi-pronged approach which all models did rather than solely focussing on discovering a vaccine.
• The WHO’s mantra to tackle COVID i.e. “test, trace, isolate, treat” is the key.
• All these models have followed this strategy either way in their letter and spirit, with exemplary efficiency.

How is India responding?

• Health Infrastructure has been described as the basic support for the delivery of public health activities.
• However, current health infrastructure in India paints a dismal picture of the healthcare delivery system in the country.
• Public health experts believe that India is ill-equipped to handle such emergencies. It is not prepared to tackle health epidemics, particularly given its urban congestion.
• The healthcare administration in crowded cities like Agra, Pathanamthitta and Bhilwara have busted this myth.
• The willingness and effectiveness with which doctors and medical officials in India are working is a testament to the country’s rational and humane approach to the pandemic.

Way Forward

• The aerial spread of the pandemic can be contained with an efficient response which combines effective public health, microbiological, clinical and communication responses.
• In general, hospital services have quickly geared up to treat severe cases in urban areas but rural healthcare needs a step up.
• Effective risk communication to the general public needs to be circulated to prevent panic and provide advice on precautionary measures.
• Central and state health agencies must act in tandem and so are the public and private healthcare facilities.
• The media too must help in increasing awareness without triggering panic through community counselling.