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.