SBS Nagar, Punjab: For 28 days, Punjab’s SBS Nagar was free from Covid-19, one of a handful such districts in the country, making the local authorities proud that their efforts had paid off.
But it took one solitary truck driver with a travel history to break the calm and put the district back on the list of Covid-affected areas in the country.
Doctors, police and district administration officials now say that this only shows how nothing can be taken for granted in the fight against coronavirus. And that they have to start all over again to rid the district of the infection.
The truck driver has emerged as the 20th case in the district, which was formerly known as Nawanshahr and has a population of 6.12 lakh. While the first case was Punjab’s first casualty, the remaining 18 have recovered and been sent home.
To contain the fallout of the latest case, the administration now plans to seal the entire district by Wednesday. Meanwhile, the driver — a trader who entered the district on 22 April and has a travel history of Hoshiarpur, Delhi and Jammu — has been put in isolation at Civil Hospital Nawanshahr.
And that’s where the administration is looking to repeat its success from the four weeks before the new case came up.
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Where SBS Nagar fought Covid
Amid endless fields of wheat, Civil Hospital Nawanshahr stands at a seven-minute drive from the heart of SBS Nagar, wearing a deserted look with empty hallways barring a few staff members.
The only occupant among the 90 normal and 10 ventilator-supported ICU beds in the hospital is the truck driver. The patients before him were all treated and sent home — the last one on the same day that he entered the district. The only Covid-19 patient who couldn’t make it in SBS Nagar was Baldev Singh.
Singh, who had a travel history of Germany and Italy, succumbed to Covid-19 on 18 March. His death was initially assumed to be of cardiac arrest. But when it was revealed after post-mortem that he had the infection, 500 people were rapid-tested and his native Pathlawa village in SBS Nagar district was sealed off.
Rupinder Singh, district microbiologist at the hospital, was part of the team that went to collect samples from all those who came in contact with Baldev, including his family.
“We reached their house at 10.30 pm (18 March) to conduct sampling and were there till 1-1.30 am,” he said. Recounting how the family that had just lost a member was being subjected to testing, Rupinder said, “They were so broken because they had just lost a family member.”
When the results arrived 24 hours later, 18 positive cases emerged — six within Baldev’s family and 12 of his contacts. All of them were admitted to the hospital.
With ages ranging from 2 to 78, Rupinder said, “We had patients who were already dealing with hypertension and diabetes. But they were not severe and nobody was put on a ventilator.”
The hospital’s main focus was maintaining the patients’ diet and ensuring proper counselling for mental well-being.
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How the hospital counselled its patients
Functioning with a team of four counsellors, Civil Hospital Nawanshahr faced many hurdles when it began the process, but over time it built a rapport with patients, who received counseling during hospitalisation and later.
Mandeep Kaur, a counsellor who has worked with HIV patients for 16 years, said, “We tried reaching out to them via phone and video call to ensure they are mentally fit as well. We made a WhatsApp group with our counsellors and the patients.
“They were hesitant at first, afraid to speak for fear of being faced with the media and subsequently being ostracised,” said Kaur.
Most counselling sessions took place over phone and video calls, barring one patient who was given treatment in person, with the counsellor armed with a PPE kit and proper precautions.
Renuka Kale, another counsellor in the hospital’s Covid-19 team who has been treating injectable drug users, explained the plan devised to help the patients.
“We taught them breathing and relaxation techniques to ease their anxieties. We also asked them to make a routine, not use the mobile, and avoid looking at social media as it is a source of widely shared fake news that will not help their condition,” she said.
The patients continue to speak with the counsellors after discharge. This comes at a time when cases have come up of healthcare and airline workers being ostracised by their neighbours due to social stigmatisation.
Kaur prepared the patients to deal with this as well. “This is a kind of problem that results in social stigmatisation. We taught them how to tackle that and explained to them how isolating themselves for another 14 days is their priority,” she said.
“They are so aware that they stay in separate rooms even in their homes.”
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Surveillance in the district
Treatment at Civil Hospital Nawanshahr wasn’t the only challenge before the local authorities. It also needed to develop a strong surveillance to fight the pandemic that has abruptly halted the entire world.
For this battle, the SBS Nagar administration formed a digital surveillance team that covers more than 12,000 houses in the district every week. This week, the team entered the fifth round of surveillance.
Balwinder Kaur, health supervisor at the civil hospital, has 13 teams dispatched across the district. This all-female force consists of ASHA workers, ANMs (auxiliary nurse midwives), and teachers, who set out every morning at 8 am armed with masks, gloves, gowns and caps. The houses they check are marked with the relevant date on the wall adjacent to main doors.
“They write down details such as name of the family head, number of family members, if any one has any symptoms or any travel history. If they do suspect someone with symptoms they report back to me and I send them for sampling to the civil hospital,” Kaur explained.
In a single day, these teams cover anywhere from 2,000-2,500 houses.
This, however, hasn’t been easy. When the pandemic had just made its way in the country, people were afraid of these workers. Uncooperative residents and incomplete information only compounded their obstacles further.
“A lot of times people wouldn’t open their door when we knocked or rang the bell, they would make us wait outside for 15-20 minutes. Earlier, NRIs would hide themselves, and we would only find out from their neighbours,” Kaur said.
When the surveillance process began on 21 March, the teams were only given passport numbers of NRIs and nothing else. “We would knock on 50 doors before finding the one we were looking for,” Kaur said.
As the process became more streamlined, the surveillance teams continue their practice cautiously. Once their day comes to an end, masks and caps are burnt and the gloves are disposed of as biochemical waste. “I have asked my team to wash their hands after every 10-15 houses,” said Kaur.
The surveillance has proved effective, with no positive case reported in the district between 26 March and 22 April. But with the new case registered, the administration has again raised its guard.
“It is an ongoing process. We have to be aware. Even though we were Covid-19 free for almost a month, we cannot become complacent. This is an evolving situation, and we have to be at the top of our game,” said D. Satwinder Pal Singh, surgical specialist and head of the surveillance department in the district’s Covid-19 team.
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Role of police
While medical professionals and the surveillance teams have been working round the clock, the SBS Nagar police has aided the Covid-19 fight in coordination.
After the first positive case was recorded, 15 villages were sealed off in a phased manner beginning 19 March. They continue to remain sealed, manned by police personnel 24×7.
Explaining what happens when a positive case is discovered, SBS Nagar deputy commissioner Vinay Bublani said, “We do geographical tagging — which is basically studying the area, its entry and exit points, people’s movement paths and more — to figure out the best way to implement restrictions.”
Sub-inspector Sarinder Pal, who is stationed at a checkpoint a km away from the district thana said, “Anyone who has any difficulties with their food, medicine and other such important requirements, we help them out.”
While they help residents, the personnel remain strict over lockdown guidelines. “Action is taken against those who don’t follow the lockdown rules. In Nawanshahr city of SBS Nagar, seven FIRs have been lodged. But the public has become more aware and cooperative over time,” said Pal.
While anxieties were high among residents of sealed areas, people began easing after seeing recoveries. “They realised that had they not cooperated, this may have not been the reality,” Bublani said.
The new case
With this strong surveillance system in place, the village sarpanch informed the police about the truck driver’s entry, as is the norm. The driver was identified and put in isolation within two days — on 25 April.
“Our surveillance is strong, but it can be made stronger so we have put up more barricades,” Bublani said.
A contact list of 40 people who came in touch with the driver was made. They have now been tested and results are awaited.
Speaking about how this case hasn’t come up from inside the town, Bublani said stricter action will be taken against those who don’t perform their social responsibility.
“No outsider can go to their homes till they have been tested, and if anyone comes from outside and does not inform us we will take action against them under Section 188 CrPC (disobedience to order),” he said.
Meanwhile, the frontline health workers and counsellors at the civil hospital continue to treat the latest Covid-19 patient in the hope that he is the last one.
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