‘Rath’ clinics, 24×7 helpline, ‘Sanjivani’ care — how Ahmedabad reduced its positivity rate

After Ahmedabad saw one of the worst outbreaks in the country, the municipal corporation launched a series of initiatives to increase testing in the city and limit Covid-19 spreading.

Thirty five-year-old Jagdish Solanki who tested negative for Covid-19 was administered the test by a mobile clinic | Photo: Praveen Jain | ThePrint

Ahmedabad: When 35-year-old Jagdish Solanki experienced high fever for three days, he was worried that he may have contracted Covid-19. His neighbours then suggested that he dial 104 — the helpline set up by the Ahmedabad Municipal Corporation (AMC) — and get an antigen test done.

Two hours later, a mobile clinic arrived to test Solanki, and in a few minutes, he could not stop beaming after he tested negative for Covid.

The helpline is one of the many initiatives started by the AMC to arrest the spread of Covid-19 in Ahmedabad after Gujarat witnessed one of the worst outbreaks of the infection in the country.

In the initial phase of the pandemic, Gujarat had grabbed headlines due to its low testing and extremely high mortality rates. This had prompted the Ahmedabad Medical Association to file a plea with the Gujarat High Court to direct the state government to ramp up testing in the city on 7 July.

A central team headed by Dr Randeep Guleria, Director, AIIMS, had also arrived and assessed the Covid situation in the state in the past week, which prompted the state government to double the average tests conducted daily.

In a bid to ramp up testing and screening, three key initiatives have been introduced by the AMC.

According to Additional Chief Secretary Rajiv Gupta, who is overseeing Covid-19 management in the city, these initiatives “have been taken to ensure that we have an intensive, multilayered, cross-checking, system of patient tracking and we don’t track it once but multiple times”.

“Positivity rate (the number of positive Covid tests) has now also come down from 35 per cent in May to 13 per cent in June to less than 5 per cent now,” he added.

As of 27 July, Gujarat has recorded 55,822 cases of coronavirus and over 2,300 deaths.

Dhanvantri Rath — mobile clinics operating across the city

Launched on 15 May, the Dhanvantri Raths are medical vans that have been converted into mobile clinics to conduct on-field medical testing and diagnosis across the city. Each van consists of a doctor, a nurse and a paramedic.

Atul Gor, Chief Executive Officer of Ahmedabad Urban Development Authority, told ThePrint, “The ‘raths’ takes care of people’s minor or major ailments. More than 6.25 lakh people have benefitted from these clinics.”

“If a symptomatic patient tests positive, an online form is filled by our team and they are referred to a medical officer at the nearest urban care centre. Later, their residence is examined to check if the person is fit for home isolation medically and whether they have access to the required facilities,” he added.

Each ‘rath’ operates in four designated areas in the city in a day, and currently, there are 120 such vehicles in operation. 

The mobile clinic spends approximately two hours in one area, before moving onto the next. In addition to Covid antigen tests, the clinic can also test for malaria and dengue.

If a patient is above the age of 40, they also test for blood sugar to rule out any co-morbidities — underlying medical conditions that raise risk of contracting Covid-19.

According to a medical officer, in early June, each ‘rath’ used to record anywhere between 20 to 25 cases in a day. However, he noted that the number has since come down to 3 to 5 cases.

Gor told ThePrint that these clinics treat 8,000 to 10,000 patients on an average every day.

A paramedic tests patients for Covid-19 while sitting inside a Dhanvantri Rath | Photo: Praveen Jain | ThePrint

According to government data, Gujarat has now been conducting an average of 14,000 to 15,000 tests a day as opposed to 7,000 tests in early June. However, the state still stands well below the daily national average of 11,557 tests per million, recording only 9,489 tests per million.

Ahmedabad, in particular, has been conducting over 5,000 tests every day.

However, these mobile clinics have yet to access every section of the population.

The residents of Jamalpur, a district in central Ahmedabad that had become one of the biggest Covid-19 hotspots in the city in late May, informed ThePrint that no Dhanvantri Rath was operational in their area.

When asked about the same, an official from the AMC revealed that the cases in Ahmedabad have now spread to the south and north of the city, and thus, the focus of surveillance has been shifted to these parts.

24×7 helpline to test call-ins within 2 hours

A 24×7 helpline has been launched by the city authorities for citizens who display symptoms of coronavirus and wish to get tested in their homes.

After dialling the helpline 104, which was launched on 1 June, a van consisting of a doctor and a paramedic arrives at the site to perform an antigen test. Prior to the test, the patient is thermally screened and a pulse oximeter is used to measure oxygen saturation levels.

The city has been divided into seven jurisdictions and each jurisdiction has been further demarcated into 10 or 12 Covid wards. Each of these wards has been allotted a vehicle, which is used for this helpline.

“There are over 50 vehicles right now which are catering to this helpline. The response time for each query is approximately two hours,” Dilip Kumar Rana, Deputy Municipal Commissioner, told ThePrint.

However, he added that maintaining a response time of two hours has been particularly difficult, since they field about 300 calls every day. These calls are picked up by AMC’s control room and are then forwarded accordingly.

Workers in the 104 helpline control room taking calls | Photo: Praveen Jain | ThePrint

While the Gujarat government has repeatedly asserted that it will not conduct tests for asymptomatic patients citing “unnecessary treatment burden” — on the field, bystanders and neighbours are being tested by these helpline vans for better tracing and screening.

When asked if Ahmedabad was aiming towards a voluntary testing mechanism, Additional Chief Secretary Rajiv Gupta told ThePrint that not everyone who wants to get tested can do so presently.

Sanjivani Ghar Seva — to track patients under self-quarantine

The Sanjivani Ghar Seva has been developed to check up on Covid patients who are self-isolating in their homes.

There are 74 Urban Health Care Centres in the city and each centre has been allotted two teams to monitor patients who are self-quarantining in their respective jurisdictions.

Currently, over 3,500 patients are under quarantine in their homes in Ahmedabad. A doctor and a paramedic visit the quarantined patient’s house every two days to ensure that their symptoms do not aggravate and that they are abiding by social distancing measures.

The team from Sanjivani Ghar Seva check up on a couple who have contracted the virus and are currently in self isolation | Photo: Praveen Jain | ThePrint

Despite this, several doctors have expressed reservations about patients violating quarantine norms when they self-isolate.

According to Dr Chandresh Jardosh, President, Indian Medical Association, Gujarat, “If a Covid-19 patient is home quarantined, after three to four days, he feels good and takes the liberty to go out and ends up spreading the infection.”

Officials at the AMC said that, at the end of the day, it was the responsibility of the patients to maintain social distancing measures. They also added that such cases were rare.

For the patients, however, this initiative has been extremely helpful. Hema, a 35-year-old young mother, and her husband tested positive for coronavirus and have been self-isolating for the past week. The Sanjivani team visits them every other day and also advises them on how to keep their eight-month-old baby safe from infection.

Other measures

A temporary testing unit has also been set up at the Ahmedabad-Vadodara Expressway on the city border.

People arriving in the city by private or public vehicles from Vadodara or Surat are being screened at this unit. If they test positive, they are asked to self-quarantine or get hospitalised, according to their symptoms.

However, this unit has not been as robust in tracking patients who need to self-isolate since no details of these patients are noted to facilitate any form of surveillance.

Two sons and a mother are quarantined in the same hospital together. These hospital beds were made available to them under the AMC quota | Photo: Praveen Jain | ThePrint

The AMC has also purchased 50 per cent beds in 67 private hospitals in the city to prepare for another spike in infections. Currently, the corporation owns 2,409 beds in private hospitals that are allotted to patients on a need-to-need basis.

“The facilities here are really good and I am glad that I could get a hospital bed right next to my mother and brother,” Ankit Patel told ThePrint.

Thirty two-year-old Patel has been quarantined with his mother Hitikshaben and his brother Dharmik at Ahmedabad’s SGVP hospital under this AMC quota.