It’s become the model for containment zones now being declared in many cities across the country. The Bhilwara model. A positive story of how a much-maligned district and state administration successfully contained the country’s first corona hotspot.
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Today, there is reason to cheer the news from Bhilwara. All the 25 COVID-19 positive cases have recovered as on April 9th. (The first positive case emerged on March 19th. Out of the total 28 infected since, two had died earlier). Though the news of a fresh positive case on April 10th came as a dampener, it is only the second case since March 30th.
All the unprecedented and stern measures taken from Rajasthan’s textile city to contain the virus now finds echo in many government corridors. Especially in the country’s 62 plus ‘hotspot’ districts containing 80 percent of COVID-19 cases who are being advised to follow Bhilwara’s aggressive containment action. “Ruthless containment is the key to prevent the spread of COVID-19 in any city,” said Rajendra Bhatt Collector and DM of Bhilwara.
It is a case study of a determined district administration and committed health and other government workers on the ground that deserves to be highlighted. Bhilwara has been under strict curfew, mahacurfew as local media described it, since April 3rd, with Sec 144 having been imposed on March 20th, four days before the countrywide lockdown. Everyone has stayed indoors and essential commodities are being supplied at citizen’s doorsteps.
“We will wait and watch till April 14th and then review whether the ‘mahacurfew’ is to be continued,” said Rajendra Bhatt. “We have to ensure 28 days’ containment, so the border will remain sealed with continuing strong public health measures and restrictions on movement”.
The team of healthcare officials under Dr Mustaq Khan, chief medical and health officer, did a commendable job as they worked simultaneously on precautions, treatment and now regularly tracking patients who have been discharged. “We are screening people at two levels: one in community survey and another in hospital OPD, then testing the symptomatic cases,” said Dr Mustaq. A COVID-19 testing laboratory has now been set up at Bhilwara’s Government hospital which awaits ICMR nod.
Bhilwara’s many firsts
Bhilwara was the first place to initiate intensive screening of the entire town’s population. “The screening teams comprised government staff, teachers and Asha workers who did a mammoth door to door survey, screening and put quarantine stickers where needed,” said Bhatt. “There were 916 people in quarantine in good facilities, some even in 3-star hotels,” said Bhatt. The MG district hospital became the dedicated COVID hospital with 200 isolation beds, with beds in four private hospitals too being commandeered.
“Over 2000 teams were made to screen the 25 lakh population of Bhilwara district. The 16,382 found with cold and cough were screened again. The 1215 still suffering from cold were isolated at home, guarded by Government staff,” said a local journalist, even as the media dubbed the town as the “Wuhan” of India. According to information shared by Bhatt, 3072 teams were deployed for door to door screening in the city in three phases and 1937 teams were engaged in the rural survey in two phases.
It had all started with the carelessness of the first corona positive person, a doctor at Brijesh Banger Memorial Hospital, who put all the 6000 patients and staff at risk. He had met foreigners from a corona-infected country at his home and continued to go about his work. The patients had spread to five states and 15 districts of Rajasthan.
“The doctor had seen so many patients both at hospital and home and there was no record of home patients,” Bhatt said. “As even the asymptomatic could transmit the virus, this was a scary situation.” The administration called each of the 36 patients from other states and 498 patients from other districts, asking if they had any COVID-19 symptoms and advised them to get checked at a local hospital. They also called up the respective district collectors, who advised these people to stay in home quarantine. Luckily none of these people tested positive.
“No one goes hungry”
The district collector immediately outlined five urgent tasks (see box). The first phase started from March 20-April 2 with essential services open. The second phase started from April 3-13 with more restrictions as everyone was instructed to stay home with essential commodities supplied at people’s doorsteps.
“We have a 3-tier system for food distribution to ensure no one goes hungry in town,” said Sunil Verma, District Supply officer, Bhilwara. “Free cooked food packets are given twice a day to those below poverty line, physically disabled and other needy people. Then free ration consisting of 10kg flour, 10kg rice and spices adequate for a week for a family of four members is supplied. These include migrant labourers, brick-kiln workers, those engaged in fishing near dams and those in kachhi basti (temporary settlements). For everyone else, essential commodities are provided on payment. Food grains are procured from Cooperative bhandars and 45 vehicles assigned to supply in city wards while 50 vehicles carry fresh fruits and vegetables from Krishi mandi.”
The five tasks
Task 1 entailed immediate sealing of Bhilwara city. Then the entire district was sealed with around 50 check posts at entry/exit points. DMs of all neighbouring districts were asked to seal their border with Bhilwara. All private and public vehicles were stopped. Any locality where a positive patient was found was declared a “no-movement zone,” so none of the residents ventured out.
Task 2 Screening strategy. Survey teams were trained by specialists in COVID/Influenza like illness (ILI) symptoms, checking persons with foreign travel history, prioritizing epicentre affected people as well as migratory population. Each team was given a clear demarcated area to survey. Every ten survey teams reported to a supervisor. A 24-hour war room was established with the help of state RRT (Rapid Response Team), WHO and Police.
Task 3: Quarantine center/home quarantine. 27 hotels with 1541 rooms. Institutional quarantine 22 institutions/hostels with 11659 beds.
Task 4: Monitoring mechanism for rural areas-officers at Panchayat Samiti, Patwari and school principals at Gram Panchayat and Sarpanch, teachers and Asha workers at village level. To monitor home quarantine, medical contingencies, food supplies, food packets, migrant labourers, law and order.
Task 5: Door to door supply of essential groceries, fruits and vegetables, milk from SARAS dairy, distribution of cooked and raw food packet to the poor and needy, complete shutdown of factories, industries and brick kilns, fodder provided to stray cattle, 24×7 control rooms established at the Collectorate, CMHO office, DSO,UIT, Nagar Parishad and at sub-divisional level.
The administration also worked proactively to procure face masks and hand sanitizers. A district control room is up and running, its contact number is circulated via social media, public announcements and portals so that anyone requiring medicines could just call and get in touch with the nearest shop for home delivery.
Everyone pitched in. “It took a while for people to understand social distancing,” said Bhatt. “A stern warning that anyone disobeying would not get grains for three days and strict handling by police did the trick,” said Bhatt. People readily complied with the even stricter curfew measures imposed later.
In far-flung villages, villagers made their own corona rules. Rampuriya and Bhadliyas villages were the first to seal their villages and ensure villagers stayed at home. Soon it spilled over to other villages. “The Sarpanch has made us aware of the virus danger and since March 22nd, hardly anyone is seen on the streets,” said Mangilal of Sarsiya village in Jahazpur Municipality. “When recently I harvested wheat, even the labourers sat far from each other wearing face masks all day. Even during cremation of a village elder only two persons accompanied the procession, something unheard of before”.
Is it here to stay?
The 13-member COVID-19 task force has suggested a partial lockdown withdrawal, with the start of a few services from April 15th, such as services/repair shops, domestic help, e-commerce, home delivery of eatables, resumption of industrial and construction activities, mining, home appliances shop and mobile shops.
Other hotspots in the state
On April 11th, Rajasthan saw its highest one day COVID-19 positive cases at 139, taking total positive cases in the state to 804 (11 deaths, 121 recovered). This includes 40 new positive cases in Jaipur, now declared a hotspot, with a total of 343 positive cases (4 deaths, 75 recovered). The state has the fourth highest positive cases in India. With two new positive cases from Hanumangarh, only eight of the state’s 33 districts are corona free.
The sudden spurt in cases in Jaipur is mainly from one single locality Ramganj in the walled city, which alone has 300 positive cases. Ramganj owes the spread of positive cases to a 45-year old man who returned from Oman and didn’t follow quarantine rules. He roamed around the densely populated locality, visiting friends, family and visiting the market, infecting around 100 people.
On April 3rd , 33 new positive cases emerged in Jaipur related to 19 Jamaat members returning from Delhi and 14 of their family members. Jamaat attendees were located in other districts too.
In the beginning as the COVID-19 infection started emerging, cases were few and sources could be identified and all the persons in contact could be identified and quarantined. As in many parts of India, the Tablighi Jamaat dramatically changed the covid situation in Rajasthan.
Rajasthan has also banned spitting in public, punishable with one-month imprisonment or Rs 200 fine or both. Also, in addition to the Centre’s assurance of a Rs 50 lakh insurance cover for health workers, the Rajasthan government has announced Rs 50 lakh financial assistance to the next of kin for any front-line covid worker who dies on duty. This covers all municipal and health workers, home guards and civil defence staff, Anganwadi workers and accredited social health activists (ASHAs).