New Delhi: Over 9 lakh people screened for Covid-19 by more than 1,200 teams conducting household rounds. The use of technology — from mobile phone GPS to drones and a web of CCTV cameras — to monitor the movement of infected people. Keeping an eye out for large gatherings and ensuring food distribution among not just the needy, but also animals. Enlisting private help to bolster quarantine facilities.
Agra has been lauded by the central government for successful cluster containment that it credits with controlling the spread of coronavirus in the Uttar Pradesh district.
At the health ministry daily press briefing Saturday, the “Agra model of containment” was the subject of an entire presentation made by joint secretary Lav Agarwal.
Agra was the first identified cluster in India, and continues to have one of the highest district-wise caseloads. However, its success lies in being able to stop the disease from spreading beyond clusters, or areas where positive cases were first detected.
As of Saturday, Agra, which reported its first Covid-19 case in late February, had witnessed 92 cases. Sources at the district hospital told ThePrint that eight of them had recovered while one had passed away. The remaining 83, they said, were being observed in hospitals, none of whom is critical.
District magistrate Prabhu N. Singh said their success was the result of focusing on three key points — isolation, expansion and containment. According to Singh, Agra’s first brush with Covid-19 was around “25 February, when a Delhi resident reached Agra after returning from Italy and visited multiple places, including his relatives’ homes, factories and restaurants… He reached the district hospital five days later on 2 March”.
“Six persons in Agra caught the infection from the person, and the incident underscored the need to put up a containment plan to contain the cluster of cases in Agra,” added Singh, saying 1,913 samples had been collected for testing so far.
Isolation and electronic surveillance
There is no official definition of a Covid-19 cluster but it can be described as an area with a high caseload.
The cluster containment strategy is meant to contain the disease within the defined geographical area by making early detections and breaking the chain of transmission.
On the ground, the containment strategy is implemented by rapid response teams that comprise civic and police personnel working in coordination with grassroots health workers such as assisted social health activists (ASHAs).
The approach primarily consists of promptly checking and sensitising every household within a 3-km radius of a house/property where a person has been diagnosed.
This area is demarcated as a containment zone, which means complete prohibition on entry and exit except for the delivery of essentials. Adjoining areas in a certain radius are marked as a buffer zone.
The infected person is asked to divulge the places they visited and people they met over the 14 days preceding diagnosis (the incubation period of Covid-19 is 14 days).
However, Agra assistant superintendent of police (ASP) Saurabh Dixit said this information wasn’t taken “at face value”. “We conduct electronic surveillance, like checking mobile phone GPS and CCTV camera history.”
Dixit added that “electronic surveillance” was also used to ensure “the primary radius of 3 km is sealed round the clock with a drone monitoring system to ensure no one steps out from their home at all”.
The isolation stage consists of extensive contact tracing, screening of people in the containment zone, and testing of all suspected cases and high-risk contacts.
Agra chief medical officer Mukesh Vats said teams travelled door to door in the earmarked area and “urge those with symptoms such as cough, fever and breathing difficulty to get themselves tested and stay in home quarantined, besides sensitising them to stay alert and look for symptoms and report if any”.
Dixit added that it was an arduous process. “We were confronted with new challenges daily as the contact tracing of positive cases required tracing hundreds of contacts in multiple locations and monitoring their health.”
Once a cluster has been identified, the authorities also begin to expand laboratory testing capacity and making arrangements to ensure there are enough hospital beds to cater to any surge in cases and quarantine facilities for suspected patients.
According to the health ministry presentation Saturday, 1,248 teams were deployed for door-to-door screening in Agra. Each team had two workers, including an auxiliary nurse-midwife/ASHA/anganwadi worker, and they altogether reached out to 9.3 lakh people. The survey identified nearly 2,500 symptomatic patients, who were further monitored to contain the outbreak.
With private participation, some hotels were repurposed as paid quarantine centres. Agra currently has 566 beds for paid quarantine at 3-star hotels, along with another 3,000 beds arranged for free for health workers, among others.
Apart from all this, the district administration launched a citizen self-registry platform linked to the Agra smart city website. This platforms allows citizens to assess their risk of infection while also providing helpline numbers. Patients assessed as facing medium and high risk are subsequently contacted by the district administration.
‘Smart City’ command centre serves as war room
The Agra district administration also simultaneously worked on other fronts, such as ensuring distribution chain management and movement of essential commodities within and outside the city, along with providing food and shelter for the homeless and needy through a helpline that also arranged food for animals.
Technology helped streamline the process, with frontline workers coordinating their efforts by utilising the existing Smart City Integrated Command and Control Centre as war rooms.
“Cameras across the city were used simultaneously to detect a gathering in any part of the city that would appear as a red pop-up in the war room, after which details were sent to the local police teams to disperse them,” said Dixit.
“Wherever people were coming out in large numbers to purchase essential commodities in an area, local providers of food and medical supplies were identified… to set up a distribution chain for door-to-door delivery of goods,” added Dixit, saying electronic surveillance through the war room also helped curb lockdown violations as hundreds of online challans were issued.
Additionally, the Agra district administration also took a slew of other measures — those with a history of foreign travel were asked to come forward for voluntary screening at district hospitals by 31 March or face legal proceedings. Also, the tourist permit for Taj Mahal was cancelled from 17 March, and hotels and restaurants urged to shut down.
Several hotspots in 15 districts of Uttar Pradesh, including Agra, are currently sealed, until 15 April, after being identified as Covid-19 “hotspots”.