New Delhi: Beginning Friday, the Delhi government started a massive exercise to conduct door-to-door screening of 40 lakh households in 10 days (26 June-6 July) to identify potential Covid-19 cases.
Come Saturday, the Arvind Kejriwal government, in collaboration with the National Centre for Disease Control (NCDC), will launch a serological survey that will see the authorities collect samples of 20,000 people across Delhi’s 11 districts to establish the capital’s exact exposure to coronavirus.
The two exercises are aimed at helping the government get a handle on the Covid-19 situation in Delhi, where cases have been climbing up by the hundreds daily. They come days after the Ministry of Home Affairs (MHA) stepped in to aid the union territory’s Covid-19 efforts as the latter grappled with a burgeoning incidence amid reports of low testing and strained healthcare infrastructure.
The Delhi health bulletin issued Friday reported 3,460 new cases, taking the total count of Covid-19 patients in the capital to 77,240. As of Friday, 47,091 patients had recovered and 2,492 had died.
The mammoth exercise comes at a time when the number of average daily tests in Delhi has more than doubled to 13,880 for the week ending 23 June, as compared to 6,200 the week before. The positivity rate for the week ending 23 June stood at 24 per cent, which means nearly one in four persons tested was diagnosed with Covid-19.
As this gigantic screening initiative was kicked off, there was a scramble across Delhi’s districts Friday as the local authorities tried to wrap their heads around the task at hand and assess their preparedness.
The district administrations were counting if they had enough staff, and there was some confusion about the protocol to be followed once a suspected case is identified.
While some found their hands tied by the uncertainty, others had begun the task a day before on Thursday.
Over the coming days, the campaign will see multiple teams of accredited social health activists (ASHAs) and auxiliary nurse midwives (ANMs), accompanied by civic workers in some districts, fan out across different parts of the city. Through its nooks and crannies, they will knock on lakhs of doors as the clock ticks on a deadline that many districts have described as difficult to keep.
Going door to door
The Delhi government’s door-to-door screening campaign is part of the Revised Delhi Covid Response Plan, formulated after a series of meetings between Union Home Minister Amit Shah and Chief Minister Arvind Kejriwal last week.
Across districts, meetings were held Thursday, where it was decided that the civic bodies will appoint nodal officers at the ward level to monitor the process.
The municipal corporations of north, south and east Delhi and the New Delhi Municipal Council (NDMC) have about 6,800 malaria and dengue unit workers who will be helping out with the Covid-19 door-to-door survey in addition to the ANMs and ASHAs, who also led earlier screening efforts in containment zones. Each of the districts, meanwhile, is devising its own strategy to pursue the exercise.
Pradeep Tayal, the sub-divisional magistrate (SDM) for Civil Lines in Central Delhi district, said they had begun the survey Thursday with the old Chandrawal area, which has a population of 2,500.
According to him, five teams of ANMs and ASHAs were sent to the area in pairs. They reached the old Chandrawal area in the morning and returned by 6 pm, he added.
“The number of teams deputed depends on the area size. In Burari, I’ve deputed 10 teams (20 people) today, while five (10 people) were enough in Chandrawal,” Tayal said Friday.
He said he had to reach 4 lakh people spread across 1 lakh households by the July deadline. “It seems very difficult to cover all of this by 6 July but we are trying our best,” he added.
According to a municipal official from Northwest Delhi, ANMs and ASHAs have been given a target of covering 25 houses everyday.
As part of the screening process, the official said, the ASHAs will ask members of each household about symptoms like fever, cold and cough. If anyone reports any such symptom, the official added, they will be referred to dispensaries for Covid-19 testing, which is now conducted through rapid antigen tests.
Referring to the procedure adopted for earlier screening exercises in containment zones, the official said, “There is an action taken report (ART) for all positive patients, which includes steps taken, like contact-tracing, whether patients are isolated at home or institutes etc.” The official added that a similar procedure may be involved for the ongoing exercise.
The District Magistrate for South Delhi, B.M. Mishra, said that, besides ASHA and ANM workers, he will also be engaging booth-level officers and community volunteers for the process.
“We plan to have multiple teams and one person at a time will be sent to a household and will be provided with a contactless thermometer for screening. They will use the mobile app (Assess Koro Na app, a Delhi government endeavour meant for real-time data collation) to enter details,” Mishra said, adding that they were still figuring out how much staff they will need for the exercise.
Through all of the districts, the survey teams are likely to ask households for information such as name, address, age, travel history, medial symptoms, whether they use Aarogya Setu app or not.
Added Mishra, “I have also sought permission that if I already have the database for those families that have downloaded the Aarogya Setu app (the central government app that claims to alert users about Covid cases in the vicinity), say about 6 lakh, in my area, then I need not screen them again, and should target the other households,” he added.
The data collated by the teams is to be submitted to the chief district medical officers (CDMOs) at the end of each day, a leg of the exercised that is supposed to help identify areas that require immediate testing.
However, the CDMOs contacted by ThePrint said they were yet to be told the procedure to be followed after they have been given the lists.
“I think it’s being looked into by the district magistrates,” said Dr Kalpana, the CDMO for Central Delhi district, when asked about the protocol to be followed once someone with contact history was found during survey.
When asked about the protocol to be followed regarding suspect cases, New Delhi CDMO Dr Ashok Jamrani said it would be worked out later.
“I have been alerted, but right now it’s only a survey… We do not know the outcome yet, at this stage we have been simply told about the survey. It depends on when the survey analysis will happen,” the CDMO added.
Arun Kumar Mishra, the district magistrate for East Delhi, said they will begin the survey Saturday. “Not more than two workers will be deployed at a time, including ASHA workers and ANMs, as of date,” he added.
Repeated calls to New Delhi district magistrate Tanvi Garg went unanswered, but the survey was kicked off in the jurisdiction Friday, ThePrint has learnt.
North Delhi Municipal Corporation deputy commissioner Ira Singhal said the NDMC had approached her with requests for additional manpower. “I’ve been able to provide about 40 civil defence volunteers… and some extra gardeners who could be used in teams for conducting the survey,” she added.
Lack of staff was also a concern for a district magistrate who spoke to ThePrint on the condition of anonymity. “We don’t have sufficient manpower to conduct such a massive exercise in such little time,” the magistrate said. Unlike during poll-related duties, the district magistrate added, staff seem reluctant to conduct such exercises amid a pandemic.
“Earlier, many of the ANMS and ASHAs involved in screening had tested positive despite being given three-ply masks and gloves. Even as they continue to screen others, they remain at risk,” the district magistrate said.
Not the first time
This isn’t the first time such a screening exercise is being carried out amid the Covid-19 pandemic in Delhi. The Delhi government had also constituted a containment and surveillance team in the second week of April to screen the entire population, create a database of suspected cases, and enforce social distancing.
However, the process was left mid-way when many frontline workers themselves contracted infection.
Serological survey begins Saturday
The sero-surveillance due to begin Saturday aims to cover 20,000 people across 11 districts.
“As per the directives of HM @AmitShah, discussion was done on the serological survey in Delhi, which will be carried out jointly by NCDC and Delhi Government. Survey will begin from June 27, training of all the concerned survey teams was completed yesterday,” the Union Home Ministry spokesperson said on Twitter Friday.
As per the directives of HM @AmitShah, discussion was done on the serological survey in Delhi, which will be carried out jointly by NCDC and Delhi Government.
Survey will begin from June 27, training of all the concerned survey teams was completed yesterday.@PIB_India
— Spokesperson, Ministry of Home Affairs (@PIBHomeAffairs) June 26, 2020
In a tweet thread, the ministry also elaborated on how officers were being trained in this regard.
HM @AmitShah also approved the combined use of Aarogya Setu & Itihaas apps as strong predictive tools for future detection of COVID outbreaks in population clusters.
Training on combined use of apps was imparted by NCDC trainers to the district teams of the Delhi Govt yesterday.
— Spokesperson, Ministry of Home Affairs (@PIBHomeAffairs) June 26, 2020
The surveillance campaign will help government officials identify asymptomatic Covid patients who may have recovered, and possibly gauge the exact expanse of Delhi’s exposure to coronavirus.
With inputs by Swagata Yadavar
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