Aggressive testing, contact tracing, cooked meals: How the Indian state of Kerala flattened its coronavirus curve

[Kool_SRG]

Medical staff collect samples from people at new walk-in coronavirus testing kiosks at Ernakulam Medical College in Kerala on Monday.

 

NEW DELHI — For hours, the health worker ticked through a list of questions: How is your health? What is your state of mind? Are you running out of any food supplies? By the end of the afternoon, she had reached more than 50 people under coronavirus quarantine. Weeks earlier, that number was 200.

Sheeba T.M. was just one of more than 30,000 health workers in the Indian state of Kerala, part of the Communist state government’s robust response to the coronavirus pandemic. Other efforts include aggressive testing, intense contact tracing, instituting a longer quarantine, building thousands of shelters for migrant workers stranded by the sudden nationwide shutdown and distributing millions of cooked meals to those in need.

The measures appear to be paying off. Even though Kerala was the first state to report a coronavirus case in late January, the number of new cases in the first week of April dropped 30 percent from the previous week. With just two deaths, 34 percent of positive patients have recovered in the state, higher than elsewhere in India.

 

The success in Kerala could prove instructive for the Indian government, which has largely shut down the country to stop the spread of the contagion but continues to see the curve trend upward, with more than 6,700 confirmed cases and more than 200 deaths. Its challenges are plenty — from high population density to poor health care facilities — but experts say Kerala’s proactive measures like early detection and broad social support measures could serve as a model for the rest of the country.

“We hoped for the best but planned for the worst,” said K.K. Shailaja, the state’s health minister, while cautioning that the pandemic is not yet over in Kerala. “Now, the curve has flattened, but we cannot predict what will happen next week.”

Kerala’s approach was effective because it was “both strict and humane,” said Shahid Jameel, a virologist and infectious disease expert.

“Aggressive testing, isolating, tracing and treating — those are ways of containing an outbreak,” said Jameel, who is also the CEO of Wellcome Trust, a health research foundation.

Sign up for our Coronavirus Updates newsletter to track the outbreak. All stories linked in the newsletter are free to access.

Henk Bekedam, the World Health Organization’s representative in India, attributed Kerala’s “prompt response” to its past “experience and investment” in emergency preparedness and pointed to measures such as district monitoring, risk communication and community engagement.

The state faced a potentially disastrous challenge: a disproportionately high number of foreign arrivals. Popular for its tranquil backwaters and health retreats, the coastal state receives more than 1 million foreign tourists a year. One-sixth of its 33 million citizens are expatriates, and hundreds of its students study in China.

 

Screening at airports was tightened, and travelers from nine countries — including coronavirus hotspots such as Iran and South Korea — were required to quarantine at home starting on Feb. 10, two weeks before India put similar restrictions into place. In one instance, more than a dozen foreign nationals were removed from a flight before takeoff because they had not completed their isolation period. Temporary quarantine shelters were established to accommodate tourists and other nonresidents.

Still, some slipped through. The arrival of a local couple from Italy in the last week of February who did not report to health officials caused an alarm. By the time they were detected, the couple had attended several social gatherings and traveled widely. Nearly 900 primary and secondary contacts were traced and isolated.

Robin Thomas, 34, the son-in-law of the couple who returned from Italy, tested positive for coronavirus, as did his wife and his wife’s grandparents. He said apart from the “excellent treatment” he received, the medical staff also helped them overcome stigma.

 

“People were blaming us on Facebook and WhatsApp,” he said. “The counselors called us over the phone regularly and gave us confidence.

Shailaja, the health minister, said six states had reached out to Kerala for advice. But it may not be easy to replicate Kerala’s lessons elsewhere in India.

In more than 30 years of Communist rule, the state has invested heavily in public education and universal health care. Kerala has the highest literacy rate and benefits from the best-performing public health system in the country. It tops India’s rankings on neonatal mortality, birth immunizations and the availability of specialists at primary care facilities.

 

The strength of its health care system allowed it to follow the World Health Organization’s recommendation on aggressive testing, even as central agencies maintained that mass testing was not feasible in a country like India. Through the first week of April, Kerala had conducted more than 13,000 tests, accounting for 10 percent of all tests done across India. By comparison, Andhra Pradesh, a larger state with a similar number of cases, had carried out nearly 6,000 tests while Tamil Nadu, with more than double the number of cases, had done more than 8,000 tests.

The state took the lead in deploying rapid testing kits, which officials say they continue to use in hotspots to check community spread. This week, Kerala began walk-in testing facilities, which reduce the need for protective gears for health workers.

Kerala also announced an economic package worth $2.6 billion to fight the pandemic days before the central government instituted a harsh lockdown that left many states scrambling. It delivered uncooked lunches to schoolchildren, liaised with service providers to increase network capacity for Internet at homes and promised two months of advance pension.

 

But there have also been some blips. The state was criticized for going ahead with a local festival in early March that drew thousands of people. Amar Fettle, the state officer responsible for health emergencies, said there was still room for improvement on aspects like social distancing in markets, cough hygiene and lockdown implementation.

Thomas and his wife have recovered, as have his wife’s elderly grandparents — 88 and 93 — who were discharged this week.

“We were very worried about them and thought they may not survive,” Thomas said. “Even when grandfather had a heart attack, the doctors told us they will keep trying.”

Shahina K.K. contributed reporting from Kochi, Kerala.

 

[Kool_SRG]

 

[Kool_SRG]

[Kool_SRG]

 

[Kool_SRG]

Understanding the ‘Bhilwara model’ of COVID-19 containment

From being one of the most affected COVID-19 districts in India to not reporting a new COVID-19 case in the last 10 days, Rajasthan’s Bhilwara has, indeed, come a long way in its fight against the novel coronavirus pandemic. The popular textile town reported its first COVID-19 case on 19th March 2020 and then quickly emerged as a hotspot, reporting 27 cases, becoming the worst-affected district in Rajasthan. A doctor in a private hospital tested positive and became the source of infection for others within the hospital. Soon after Rajasthan’s border was sealed in order to curb the inflow of people, many of whom could be carriers of the virus. 

Seeing the rapid growth in new infections, the district administration sprang into action swiftly and pursued an aggressive model of containing the spread of this virus, involving a variety of measures. The district administration took over four private hospitals and 27 hotels with 1,541 rooms. These measures began bearing fruit as the town has not reported a new case of COVID-19 since 30th March. In addition to these steps, disinfection drives were conducted all over the town. Of its total 27 cases, 17 have already recovered since then, bringing the number of active cases in Bhilwara at just ten, including two deaths (due to comorbidities), eleven patients discharged while another seven are recovering quickly. 

The success of Bhilwara in containing the transmission of coronavirus has now prompted the central government to adopt the ‘Bhilwara model of containment’ on a nationwide scale, particularly with the most-affected 62 districts in different states of India. The government is planning a targeted approach to tackle these cases as most of them are concentrated in these few geographies. It is in this context that the Cabinet Secretary Rajiv Gauba recently urged states to adopt the ‘Bhilwara model’ in their efforts to contain the community spread of COVID-19. 

The ‘Bhilwara model’ involves a strict lockdown, followed by a stricter curfew aimed at ruthlessly containing the virus’ spread and a dedicated team of medical and administrative officials leaving no stone unturned to prevent Bhilwara from becoming another Wuhan or Lombardy. In Bhilwara, more than 22 lakh people were screened, many of them more than once.

Despite its visible success, the district’s collector and magistrate, who is also the mind behind this strategy of aggressively containing the virus, Rajendra Bhatt, remains cautious of declaring Bhilwara as free from COVID-19 or securing victory over the virus. He says, “I think we have to wait until 1 May to be sure that we’ve completely eliminated the virus. I want that three cycles of isolation, testing and quarantining should be complete before we can claim victory.” Asserting that the ‘Bhilwara model’ is “no rocket science,” he credits the district’s success to the collective efforts of his juniors and seniors, thus, ensuring smooth functioning of administrative functions and their implementation on the ground. 

#Covid_19

[Kool_SRG]

This 56-year-old IAS officer is the brain behind Bhilwara model of fighting Covid-19

Rajendra Bhatt isn’t ready to declare victory over coronavirus just yet, despite no new cases in 10 days. He says the Bhilwara model was ‘no rocket science’.

New Delhi: The ‘Bhilwara model’ has been so successful in curbing the spread of Covid-19 in a hotspot that the central government has asked states to replicate its mantra of “ruthless containment”. But Bhilwara’s 56-year-old collector/district magistrate, who was in charge of implementing the plan and has been credited with its conceptualisation, remained cautious about declaring victory just yet.

“I think we have to wait until 1 May to be sure that we’ve completely eliminated the virus,” Rajendra Bhatt told ThePrint.

“I want that three cycles of isolation, testing and quarantining should be complete before we can claim victory.”

The textile town of Bhilwara in Rajasthan had become one of the hotspots of the Covid-19 outbreak, registering 27 positive cases and two deaths.

But the strategy adopted by the district administration has ensured that Bhilwara has not registered any new Covid-19 cases in 10 days, and chief secretaries of all states are now seeking to emulate it.

Bhatt humbly claimed the success was no “rocket science”. “We got full cooperation from the state government. When we (at the district level) said that we need to seal the border, the government did it immediately — no questions asked,” he said.

“When we said we cannot let anyone enter the district or leave their homes within the district, the government did it immediately. The Epidemic Act was imposed immediately giving the DM all the powers to take over hospitals, hotels, etc. So, it was a joint effort,” he added.

But while Bhatt credits his superiors and subordinates for the “joint effort”, officials in Rajasthan, including those from Bhatt’s team, say he is a DM like no other.

---

Also read: This is the ‘Bhilwara model’ Modi govt is looking to use across India to fight Covid-19

---

‘Everyone followed his instructions’ 

A young IAS officer from Rajasthan said, “He has been promoted from the Rajasthan state service to the IAS… I would say he is way better than the direct recruits of the IAS.”

Collector/district magistrate is usually the second posting of an IAS officer’s career, so the average age for the post is 28-30 years. But being from the Rajasthan state service, Bhatt became DM decades into his career. He was promoted to the IAS in 2007, and is set to retire in the next four years.

In every state, the ratio of IAS officers recruited directly and those promoted from the state services is 2:1.

The young officer quoted above continued: “It felt like Bhilwara was preparing for this kind of an eventuality over the last year or more, since Bhatt became DM. His rapport with the SP, the police, the state government, the SDMs etc. was such that everyone followed his instructions to the T.”

---

Also read: Reporting from Bhilwara was scary as the enemy was invisible. It was a virus

---

Embedded in the system

From isolating the district to mapping the hotspots, conducting door-to-door screening and aggressive contact tracing, ramping up quarantine and isolation wards to readying a monitoring mechanism for rural areas — the instructions from the DM’s office were real-time and unambiguous, officers said.

“The fact that he has so many years of experience and he is so embedded in the system in the state helped,” said another IAS officer working under Bhatt. “He would give directions, and we would just follow, and everything went on smoothly.”

Bhatt acknowledged the officer’s comment about him being embedded in the system.

“I’ve worked in the cooperative service all my life… I know how the supply and demand works in the rural and urban parts of Rajasthan, so all that experience was very useful to me,” Bhatt said.

“Before announcing the complete curfew, we sent our people to dairies, surveyed how much milk each household is consuming,” he said. “So that when we imposed the curfew, all we had to do is deliver an average amount to each house… Again, it was no rocket science.”

While IAS officers selected through direct recruitment are known to have more exposure in terms of governance, Bhatt’s model of governance at the time of a pandemic is being adopted by officers across the country, said a Rajasthan service officer.

“It is a matter of pride for all state civil services and a reminder that ‘direct recruits’ and ‘promotees’ are ultimately just tags,” this officer said.

---

Also read: How Bhilwara is dealing with its coronavirus problem — Full details of the district’s plan

---

[Kool_SRG]

[Kool_SRG]

This is the ‘Bhilwara model’ Modi govt is looking to use across India to fight Covid-19

As coronavirus cases rise across the country, Cabinet Secretary Rajiv Gauba has said states could look at adopting the ‘Bhilwara model’ of ruthless containment.

 

New Delhi: With the number of Covid-19 cases across India spiking in the last one week, Union Cabinet Secretary Rajiv Gauba has said states could look at adopting the ‘Bhilwara model’ of ruthless containment to curb the spread of the contagious novel coronavirus.

Highly-placed sources in the government told ThePrint that Amarjeet Sinha, an adviser to Prime Minister Narendra Modi, has also endorsed the Bhilwara model.

The textile town of Bhilwara in Rajasthan, home to over 24 lakh people according to the 2011 Census, had become one of the hotspots of the Covid-19 outbreak, registering 27 positive cases and two deaths.

But the strategy adopted by the Rajasthan government and the district administration has ensured that Bhilwara has not registered any new Covid-19 cases in a week, while 13 patients who had tested positive have recovered so far.

What is the Bhilwara model? 

In a telephonic interview to ThePrint, Rohit Kumar Singh, Rajasthan’s additional chief secretary in charge of the medical, health and family welfare department, said the strategy in Bhilwara comprised of six very basic but crucial steps: Isolating the district; mapping the hotspots; door-to-door screening; aggressive contact tracing; ramping up quarantine and isolation wards; and readying a monitoring mechanism for rural areas.

“Bhilwara was completely isolated from surrounding areas. We were very clear from the word go that this is not a time for niceties. People will get inconvenienced, but they will have to bear with it. Life and health of people has to be the main priority now,” Singh said.

Aggressive door-to-door screening saw about 22.39 lakh people getting screened, many of them more than once.

In all, 1,937 teams were set up in the district, which surveyed 4.41 lakh houses between 22 March and 2 April.

“We identified 14,000 people with influenza-like symptoms and put them on our watch list. Our health team carried out intense follow-up of these cases, twice a day, to see if they are exhibiting any symptoms,” Singh said.

Isolating the district

In his report on the initiatives taken by the district administration in Bhilwara, submitted to the Chief Minister’s Office, Singh said a two-pronged approach was adopted.

In the first phase, starting 20 March, five days before the nationwide lockdown, a curfew under Section 144 of the Code of Criminal Procedure (making gatherings of five or more persons unlawful) was imposed in Bhilwara district, and only essential services were allowed to open. City and district borders were sealed immediately, with check-posts set up at all entry/exit points.

 

To ensure that there are no gaps, the district magistrates of neighbouring districts were requested to seal their borders with Bhilwara. All rail services and movement of public and private vehicles were stopped, and all industries and brick kilns across the district were shut.

The second phase, starting 2 April, was even more drastic, as all services barring police and health were shut down.

“The city resembled a ghost town. We realised early enough that without this kind of ruthless containment, it would be difficult to control the spread. We made the Covid-19 epicentres in the district and the buffer areas into a no-movement zone,” Singh said.

---

 

Cluster-mapping, disinfecting and quarantine

Once the district was isolated, health teams went about cluster mapping to identify positive cases. Following this exercise, six areas were identified and special teams were deployed for continuous screening of suspected cases.

Alongside the aggressive testing and contact tracing, the district administration went about disinfecting every nook and corner of the city — from all containment and buffer zones, to localities where positive cases have been detected, to all ambulances and police vehicles, screening centres and quarantine centres, the collectorate, police stations and other public dealing offices.

A rigorous screening strategy was also adopted, prioritising the affected epicentres, as well as the migratory population. Teams were given clearly demarcated areas for conducting surveys. One supervisor was appointed for every 10 survey teams.

Quarantine facilities were also ramped up. Apart from the dedicated Covid-19 hospitals, the district administration took over and converted into quarantine centres four private hospitals, each having 25 beds, as well as 27 hotels with 1,541 rooms. At present, 950 people are in quarantine centres, while another 7,620 people are in home quarantine.

Six 24×7 control rooms were set up in the city, including at the collectorate, chief medical and health office, nagar parishad and sub divisional office. 

The human touch

To ensure that people didn’t suffer too much because of the stringent isolation measures put in place on 2 April, the district administration started door-to-door supply of essential groceries, fruits and vegetables, and milk.

Besides, packets of raw food as well as cooked food were distributed to the poor and needy. Fodder for stray cattle is also being distributed.

“One of the most important things that helped was the fact that the district administration was totally empowered to carry out containment measures optimally, without any interference from any quarter,” Singh said.

This report has been updated to accurately state Rohit Kumar Singh’s designation. He is Rajasthan’s additional chief secretary in charge of the medical, health and family welfare department, and not the principal secretary.

[Kool_SRG]

Explained: The ‘Bhilwara model’ of ‘ruthless containment’ to stop coronavirus

Bhilwara in Rajasthan was one of the early hotspots of the COVID-19 outbreak. The government responded with extraordinarily aggressive measures — and the ‘Bilwara model’ could now be replicated elsewhere in the country.

 

 

 

 

https://indianexpress.com/article/explained/explained-bhilwara-model-ruthless-containment-stop-coronavirus-6350395/

[Kool_SRG]

 

[DaatarBabu]

@Kool_SRG testing aa thati Matta na... 

Patha Basthi, Pakistan Lalo bomb lu pelav baa...! 

Aa Peaceful LK gaallu aalla place(Kerala)  ki Kakunda Anni places ki poyuntaru Ani na idi 

[Kool_SRG]

10 minutes ago, DaatarBabu said:

@Kool_SRG testing aa thati Matta na... 

Patha Basthi, Pakistan Lalo bomb lu pelav baa...! 

Aa Peaceful LK gaallu aalla place(Kerala)  ki Kakunda Anni places ki poyuntaru Ani na idi 

Attagemi ledhu gaani, Mumbai dharavi lo kuda chala mandi vaallu untaaru akkada door to door testing being done...

[bhaigan]

Guess AP and TG is using same bhilwara model and extensive testing like kerala, kerala feb 10th nunche chesindi ante thats really great, past lo kerala lo already nipha virus itlane vachindi that helped kerala a lot

[TrollBait]

14 minutes ago, bhaigan said:

Guess AP and TG is using same bhilwara model and extensive testing like kerala, kerala feb 10th nunche chesindi ante thats really great, past lo kerala lo already nipha virus itlane vachindi that helped kerala a lot

Telangana not even reporting number of tests done.

Andhra is way more transparent about what its doing.

kudos to rajasthan and kerala.

[bhaigan]

6 minutes ago, TrollBait said:

Telangana not even reporting number of tests done.

Andhra is way more transparent about what its doing.

kudos to rajasthan and kerala.

Kerala agreed one of my fav state in India in terms of disaster management and funding