In many districts of India, public health officials are bracing for cases of Covid-19 to skyrocket, and anticipating overcrowding in hospitals to follow. A bleak comparison was made between Maharashtra and China, given the mounting death toll and Covid-19 positive cases.
But there are signs of encouragement coming from many districts, and Gadchiroli in Maharashtra is one among them.
It had been only a month-and-a-half since I had taken over as District Collector when the coronavirus pandemic had begun to take over India. I was just getting the know-how of the district, its problems, administrating departments. But before I could fully assume all the responsibilities of the district, a nationwide lockdown was put in place to prevent the spread of Covid-19.
Maharashtra was one of the worst-hit states in the early stages of the coronavirus outbreak. Seeing the peril coming closer with each day passing, my team and I started preparations on a war footing. Our team developed an aggressive Covid-19 response plan which has made Gadchiroli district one of the ideal amid the pandemic, thanks to its setting up of quarantine centres and health facilities on a large scale.
The first Covid-19 case in the district was reported on 18 May. So far, 65 cases have been reported in the district, out of which 12 cases are still active. The rest have recovered, and fortunately no fatalities have been reported. The doubling rate in the district is 52.5 days, whereas it is 23.4 days for Maharashtra and 20.5 days for India on average. The district has one of the best recovery rates (78.33 per cent) in Maharashtra. The RT-PCR positivity rate against tests conducted is 1.24 per cent, and the RT-PCR test rate per against population is 0.40 per cent, as per reports on 29 June.
Also read: ‘Think tank’ control room, roping in NGOs and entrepreneurs — How Kanker district fought Covid
Efficient Covid response teams
The need for effective, efficient and responsible teams was felt as soon as the nationwide lockdown was announced. The district-level core group and Covid-19 response teams were formed for better coordination, bringing members and experts from various line departments.
These teams were assigned clearly defined roles and responsibilities, and were involved in various domains ranging from reinforcing lockdown guidelines, ensuring law and order, managing the inward and outward movements of migrant workers across borders, arranging shelter, food and health facilities for workers. They also conducted health surveys and sample collection, arranged e-passes for commuters, made arrangements for health screening, institutional quarantine centres, and coordinated with CSR partners and NGOs. The mechanism of everyday review meetings ensured grievance redressal on an immediate basis.
Institutional quarantine for migrant workers
There was a huge number of migrants going in and out of the districts, mostly including students and seasonal workers. The administration made special and strict provisions for them to stay in institutional quarantine centres. To accommodate a large number of people, many government buildings, schools and colleges were converted to institutional quarantine centres. The teams were formed locally under the leadership of elected representatives at the village level, to ensure facilities like food, drinking water, sanitation for those coming were taken care of by the district administration.
Identification of Covid patients at borders
A special team was formed under the leadership of the District Health Officer, which included doctors, police officers and officials from the revenue department. This team was deployed along the borders of the district, and helped in better coordination among various agencies and departments. This team has the responsibility to ensure 100 per cent basic screening of individuals at the time of arrival at borders of individuals. This helped to identify suspected potential Covid-19 patients, and ensure timely institutional isolation.
Also read: Quarantine centres for pregnant women & universal PDS — Rajnandgaon’s Covid crisis offering
Contact Tracing
To prevent the community spread of Covid-19, it is important to break the chain of contact. Contact tracing is an essential public health tool to control infectious disease outbreaks. The district administration immediately started using it correctly, abiding with Indian Council of Medical Research (ICMR) guidelines. A dedicated team has been created for contact tracing and managing the data at the district level. Data on migrant workers created by tracking movement in and out of the district also proved to be helpful in contact tracing.
Proper contact tracing and follow-up health interventions have ensured that Covid’s spread is limited, and that there are less chances of community infection.
Ramped-up sample collection
The district administration is determined to increase the swab sample collection from suspected patients across all blocks of the district. Although this work was not easy, owing to the lack of health workers, Gadchiroli has been managing to collect samples of suspected individuals on time as per ICMR guidelines. Pool sampling has also been done as per government guidelines.
The Gadchiroli district has pioneered in setting up TrueNAAT — a Covid-19 testing lab at the district hospital. The lab has the capacity to test 20 samples daily, and has tested more than 350 samples till date. Gadchiroli has one of the highest testing rates per million in Maharashtra. An RT PCR facility should soon come up at the district hospital.
House-to-house surveys provided important information about natives stranded outside the district. This data helped us to coordinate with other district administrations, and state nodal officers for the swift movement of migrants workers after 1 May.
Supply of protective gears and medical equipment
Public health facilities are not as strong in Gadchiroli as in many other districts of Maharashtra. There is also a significant shortage of private health sector facilities, due to which there is an additional burden on the public health sector. The concerns are not only on the infrastructure front, but there is also a shortage of specialist doctors and skilled health workers.
There was a realisation that shortage of protective gear and equipment meant doctors, nurses and other frontline workers were dangerously ill-equipped to protect themselves, as well as patients from being infected. The administration acted quickly to boost the supply of PPE kits, sanitisers, masks, gloves, medicines and thermal scanners, along with setting up a 3-tier Covid-19 treatment facility.
The daily reporting mechanism helped provide frequent updates on the availability and requirements for protective gear and medical equipment. These measures helped boost morale of health workers, and helped give reassurance to patients that they will get well soon.
Also read: Ranchi’s Covid success story — helplines for stranded workers and one lakh meals a day
Combating social stigmatisation of Covid
The district administration called upon development organisations to come together to combat social stigmatisation surrounding Covid-19. The district administration started a campaign to spread awareness about Covid-19 with the help of Self Help Groups (SHGs) of Maharashtra state Rural Livelihoods Mission (MSRLM), the Sulochana Thaper Foundation, and the Piramal Foundation.
UNICEF is the training and technical support partner in this intervention. There are more than 100 volunteers who make daily visits to villages and quarantine centres to spread awareness. They are playing a crucial role in mobilising resources with the help of gram panchayats to provide all necessary facilities in village-level quarantine centres. These volunteers have visited more than 700 villages till date.
No stone unturned
The district administration had prepared a plan to help migrants workers pass through the district. Through social media and helpline numbers, our team provided all possible help such as providing food, food packets and drinking water at key locations.
There was a time when our arrangements were inadequate during a time when there was a sudden influx of migrant workers making their way to their home states on foot. Gadchiroli happened to be on the way for many, thus we tried to minimise their hardships.
There were no clear guidelines from the government to deal with such a situation. But the district administration came up with a contingency plan. Under this, the ‘Meals-on-wheels’ scheme was introduced using District Mineral Funds. Key locations in the district were identified, and food was distributed through this scheme. Breakfast and dinner was provided to people at the reasonable rate of Rs 5. But if someone happened to have money, we provided food free of cost.
Keeping in mind future risks, the district now has 19 Covid sample collection centres, Gadchiroli has also set up 17 fever centres and 60 institutional quarantine centres. These measures have helped Gadchiroli stand up to the scourge of the virus and prepared it for future challenges.
The author is the District Collector of Gadchiroli, Maharashtra. Views are personal.
This article is part of the series ‘Districts Fight Covid’ that explores how India’s district magistrates and collectors have been fighting the coronavirus pandemic. Read all articles here.
Also read: How Kondagoan became the top-performing district in Chhattisgarh during Covid crisis