Explained: Why Was Coronavirus Containment Successful in Bhilwara?

Health experts have suggested that a non-punitive, non-number-driven and non-stigmatising approach to the pandemic is crucial.

Jaipur: While releasing a containment plan for the coronavirus outbreak, the Union government lauded the “Bhilwara model”. The Rajasthani region is considered to have adopted the most successful strategy to deal with the coronavirus outbreak in a hotspot.

The coronavirus outbreak in Bhilwara began when a team of doctors at the Brijesh Bangar Memorial (BBM) Hospital, the district’s biggest private hospital, operated on a patient infected with the coronavirus as a regular patient, in the first week of March.

Even though information about the spread of the coronavirus was doing the rounds, the patient was neither asked about his travel history, nor did he choose to voluntarily disclose it.

He was admitted in the ICU with six other patients. Two days later, when his condition didn’t show any sign of improvement, he was referred to a private hospital in Jaipur for treatment.

In Jaipur too, he was not tested for coronavirus despite suffering from severe pneumonia. He died on March 13.

Meanwhile, the Bhilwara doctors who had operated him travelled to Udaipur to celebrate Holi.

A few days later, some of these doctors tested positive for the novel coronavirus. This sparked panic in Bhilwara as the doctors in question had come in contact of over fifty thousand people after operating on the now-deceased coronavirus patient about a week ago.

Bhilwara was soon declared to be the first area in India to have entered the community transmission stage of the outbreak.

After doctors at the BBM hospital tested positive, the district recorded 13 cases in two days. The people who had tested positive were mostly doctors, staff and patients at the hospital who had come in contact with the infected doctors.

Also read: The Personal and Social Risks That India’s Food Delivery Workers Are Taking During COVID-19 

By March 30, a total of 26 cases had been reported. The district was put under an intense curfew whereby essential services including grocery and medical shops were also shut. The administration directed the police to ensure that home delivery remained unaffected during this period.

Like many states, Bhilwara sealed its border and restricted vehicles on the road in the initial stage itself.

It identified clusters and isolated those who had come in contact with those who had tested positive. A massive screening to detect influenza-like symptoms was also undertaken.

With nearly 850 teams comprising of doctors, auxiliary nurse midwifery (ANMs) and nursing students, the Bhilwara administration conducted surveys at about 56,000 houses and covered over 2.8 lakh people. Over six thousand people, suspected to have been infected, were kept under home quarantine.

Speaking to The Wire, additional chief secretary, department of medical health and family welfare Rohit Kumar Singh said, “Everyone knows the model, it depends on how you implement it. There were two fundamental things, one, we took action early and second, we implemented it aggressively. This caused inconvenience to people but we simultaneously juxtaposed it with a very effective system of supply of essential items such as milk, vegetables and medicines. The crux is in aggressive implementation and maintaining the supply chain of essential items.”

A medical team collects swabs from police personnel and their family members for COVID-19 tests at Yogi Nagar Police Quarters after a police inspector was found positive for the disease, in Borivali, Mumbai, Tuesday, April 7, 2020. Photo: PTI

“More importantly, it depends on how citizens take it. If you try and bulldoze a proposal, the citizens may take an adversarial position. So we had to be a mix of being tough and polite,” he added.

Experts suggest that ruthless containment without consideration of collateral damages are bound to have long term problems.

“It is really problematic that emphasis is only on aggressive lockdowns. Without considering ‘collateral damage,’ there will be long term adverse impact on health, nutrition, other diseases, security, livelihood, wages, education, food security etc,” Sylvia Karpagam, a public health doctor and researcher based in Karnataka, told The Wire.

Till date in Bhilwara, with a population of over 22 lakh people, 3,800 coronavirus tests have been conducted and the total number of cases reported is 28, of which two have died, 17 have recovered and nine have been discharged.

Also read: Free COVID-19 Testing in Private Labs: Here’s Why It’s Not Right to Criticise the SC Order

Seventeen COVID-19 patients said to have recovered were treated with Tamiflu, HIV drugs and hydroxychloroquine (HCQ).

Much of calling the containment strategy as a ‘model’ has been attributed to the claim that the Bhilwara district which had become the first coronavirus hotspot in India, has seen just two cases since March 30, one on April 4 and another on April 9.

However, health experts fear that if there is a pressure to compete or ‘prove’ that one has brought things under control, the danger of suppression of data will always exist. “Having a non-punitive, non-number-driven, non-stigmatising approach to the pandemic is very important,” said Karpagam.

“The coordination at the district level is to be appreciated and the method followed can be used by other areas,” she added.

In fact, the district magistrate of Bhilwara Rajendra Bhatt has also cautioned that it is too soon to declare Bhilwara as a model for combatting coronavirus. “I think we have to wait until May 1 to be sure that we’ve completely eliminated the virus,” Rajendra Bhatt told The Print.

“I want that three cycles of isolation, testing and quarantining should be complete before we can claim victory,” he added. Karpagam also highlighted that a model that works in one place may not work at another place.

“Devi Shetty who is on the COVID-19 task force in Karnataka had suggested that in the UK, three large government hospitals were converted to COVID hospitals but in Karnataka, this led to destabilisation of government’s essential tertiary care functions,” she added.

Karpagam feels that the inherent danger in highlighting Bhilwara model is that governments may use it as an excuse to impose clampdowns across the entire country.