How 4 states in India with highest patient count are tracking ‘corona clusters’

The health ministry’s Containment Plan emphasises on 'cluster containment strategy' to prevent the infection from further spreading.

Locals throng a Patna grocery store after PM Modi’s 24 March announcement of a 21-day lockdown to contain Covid-19 | Representational image | PTI

New Delhi: From “aggressive contact tracing” in Maharashtra to pictorial mapping in Kerala, state governments in India are getting innovative as they race to track those exposed to the highly infectious coronavirus.

As the number of active cases crossed 600, officials are frantically working on trying to limit the spread of the infection, which typically occurs among “clusters of humans” in close social contact.

The health ministry’s Containment Plan emphasises on a “cluster containment strategy” to prevent the spread. These measures include the demarcation of a containment zone, the deployment of a rapid response team and timely surveillance.

ThePrint spoke to health and surveillance officers of the four states which recorded the highest number of cases to understand how the cluster containment strategy works.

Maharashtra

Total cases reported: 149
Current active cases: 111
Deaths: 4
(As of Friday morning, according to the Union health ministry)

Maharashtra currently has the most number of cases reported in the country, 149, of which 52 have been recorded in Pune and Mumbai. Dr Pradeep Awate, the state surveillance officer, told ThePrint that Maharashtra’s strategy of “aggressive contact tracing” has led to its high numbers.

Awate said the state’s health department sifts through the contacts of patients into high-risk and low-risk categories to determine who might test positive.

High-risk cases are defined as individuals who’ve come in close contact with the patient, which include family members and health workers.

“All the high-risk are admitted and tested, only the low-risk cases that present symptoms are admitted while the asymptomatic ones are quarantined. We are treating every single case as a cluster,” Awate said, as he explained that a majority of the people who tested positive were high-risk contacts who were asymptomatic.

So far, about 2,200 people have been admitted in hospitals, 880 are in hospital quarantine and over 11,000 people are under home quarantine (which predominantly consists of people with a travel history). More than 10 clusters have been identified so far.

“Majority of the clusters are family clusters. We’ve seen that transmission is higher among the people having close observation with that cluster. Casual contacts aren’t getting infected as per our observation till now,” he said.

The Maharashtra government is following the cluster mapping as prescribed by the Union health ministry’s guidelines. According to the containment plan, the area around the region where cases have been identified will be divided into “containment zone” and “buffer zone” on the basis of proximity. Containment zone, the area around the initial cases, is defined by the local administration based on the location of the cluster. A buffer zone is the 5-7 km area beyond this region.

In Maharashtra, a rapid response task force has been helping local health officials identify containment and buffer zones. “Local bodies are also checking up on the people under home quarantine in their wards by calling or meeting them,” he said.

Kerala

Total cases reported: 148
Current active cases: 126
Deaths: Nil
(As of Friday morning, according to the Union health ministry)

Kerala recorded the first cases of coronavirus in the country back in January. Three students had tested positive after they returned from Wuhan, the initial epicentre of the outbreak. By mid-February, they made a full recovery.

Meanwhile, the infection spread to Europe and other parts of the world. By 11 March, the World Health Organization declared it a pandemic. Three days later, the number of cases surged to 22 in Kerala.

As many as 76,542 people have been placed under surveillance, of which 76,010 are under home isolation and 532 have been sent to isolation facilities.

Talking about Kerala’s anti-nCoV task force, Dr Amar Fetle, the officer-in-charge, told ThePrint, “The initial patient is interviewed in detail. Every single word he says is recorded about where he went, who he met.”

The contact-tracing team then uses this information to construct a route map, a pictorial version of which is published in concerned areas by the local media. Dr Fetle explained that this is done so other people can know whether they need to be screened or not.

According to him, there has been no community transmission yet and the positive cases have been confined to just close relatives.

“Only the closest people who the patient engaged with were found to be positive and the biggest clusters were only found in two districts,” he said. The highest number of cases in Kerala have been reported in Kasargod (39) and Ernakulam (16). Kasargod is also the district with the highest number of cases in the country.

Rajasthan

Total cases reported: 44
Current active cases: 38
Deaths: Nil
(As of Friday morning, according to the Union health ministry)

Rajasthan recorded its first coronavirus case on 2 March — a 69-year-old Italian tourist. In less than a month, these numbers have shot up. The state government’s contact tracing strategy involves a standard follow-up of the individuals who’ve come in close proximity of the initial case. Dr Ravi Prakash Sharma, the additional director of Rural Health, explained the process.

“As soon as a patient is admitted in our hospital, we start taking a detailed history about how the person came to India and the people he/she met. Once their sample is tested positive, we find these other people and we put them under surveillance. Those who develop symptoms are put under quarantine and their samples taken. It is after this that we test and admit them in the hospital,” Sharma said.

The state health department has managed to identify more than 600 contacts. Over 4,000 people are being kept under home quarantine.

According to Sharma, three clusters have been identified in Rajasthan — in the districts of Jhunjhunu (which recorded the first case), Jodhpur and Bhilwara. The largest cluster, comprising 17 cases, was identified in Bhilwara.

Similar to the findings in the previous states as well, the official said that most of the cases were within the high-risk contacts. “We’ve found that those affected were doctors from patients or their family members,” he said.

In Bhilwara, for instance, the 17 cases included three doctors and 11 nursing staff along with the patient and their family, he said.

Uttar Pradesh

Total cases reported: 52
Current active cases: 30
Deaths: Nil
(As of Friday morning, according to the Union health ministry)

Sixteen Italian tourists and their driver who tested positive in Agra were the first cases to be reported. It was also the first cluster in the state. The number of cases has since surged to 36 with one death being recorded. Agra, Lucknow and Gautam Buddh Nagar have reported the most number of cases.

Like Rajasthan, the UP government only tests symptomatic cases. “In UP, when a person tests positive, we find out about their families. The family members are then contacted. If they had symptoms, their samples are taken,” Chief Medical Officer of Agra, Dr Mukesh Kumar Vats told ThePrint and added that others who might have come in contact with these members in schools or workplaces are also traced.

“For each person about 200-250 contacts are traced,” he said.

In Agra, four clusters have been identified, including the group of Italian tourists. “Most of these cases have been treated. (About) 1,300-1,400 people in Agra are under home isolation,” Vats said.

Other state health officials were unavailable to confirm the statewide numbers.