The first statewide information, education and communication (IEC) outreach about the coronavirus in Odisha was conducted on March 8, the same day when the first international passenger was screened in the state. Two days later, the state government declared COVID-19 to be a ‘disaster’. The state also empowered public officials to combat the spread under the Disaster Management Act 2005 and imposed the Epidemic Disease Act 1897 where necessary.
The next day, masks, gloves and sanitisers were qualified as essential commodities and a database of all persons arriving in Odisha from other states was activated. The state also declared an incentive of Rs 15,000 for anyone who had returned to Odisha and self-imposed a 14-day home quarantine.
At this point, when the chief minister was addressing the state to prepare for a pandemic which could last for six months, the number of cases in the state stood at zero and the first case was diagnosed only on March 16.
Odisha barely features on the list of well performing public health systems in the country. In NITI Ayog’s Health Index 2019, Odisha did not even feature in the top ten among large states. Kerala, unsurprisingly, topped the index and indeed has been lauded for its response to COVID-19, with reports that the curve may already have flattened in the state.
However, on April 25, when India’s COVID-19 case count stood at about 26,283, Odisha was posting numbers in double digits at 94 cases and on April 30 it was 33,067 and 142 positive cases, respectively. It could be argued that COVID-19 never picked up in the state which is not exactly known for an effective health system.
Since the beginning, the state’s response to the pandemic has seen increased testing, effective resource allocation, swift private sector partnerships, infrastructure set-up, capacity building of human resources in health care, and incentives for citizens to test. This may have directly resulted in a low case confirmation ratio, low case fatality rate, and a high recovery and discharge ratio. Odisha’s COVID-19 management strategy could offer insights into effective pandemic management.
Resource mobilisation and decentralised outreach
The chief minister’s alert to prepare for a six-month pandemic was followed by advanced disbursement of welfare resources to the entitled beneficiaries. About 48 lakh pensioners were paid for the next four months and 82 lakh ration card holders received ration stocks for three months. Students also received pre-matriculation scholarships for the coming three months.
Panchayats emerged as central to the state’s communication and response strategy. Rs 5 lakh were disbursed to each panchayat to set up temporary medical camps and to equip them for any unforeseen need for basic amenities. By April 14, 7276 temporary medical camps with a total of 1,62,659 beds had been set up across 6798 gram panchayats in the state with a nodal representative appointed at each. Awareness meetings were being conducted with each panchayat and zila parishad as early as March 19 with extensive information campaigns on COVID-19, its prevention and case reporting. Swachchta Sathis were made responsible for awareness programmes at the zila parishad level.
In another push for a decentralised response, the state directed the inclusion of required manpower for different activities to counter COVID-19, procurement of materials for temporary health camps, provision for infrastructure including toilets, hiring of ambulances and other vehicles for transportation of patients, provision of food, and drinking water to the Local Area Development (LAD) funds of the state’s MLAs.
Capacity building and response infrastructure
The state’s response to educate the healthcare personnel was to use online training programmes. To provide informed healthcare in the state, about 500 faculty members and staff of medical institutions, 1,600 medical officers of AYUSH, and about 900 residents and faculty members of dental colleges were trained in basic management through video-conferencing apps. Among frontline health workers, about 5,542 nursing students, 1.17 lakh ASHAs and auxiliary nurse midwives were trained online.
The state also designated ‘coronavirus hospitals’ across Odisha, with 31 such hospitals as on April 24, the latest of which is a 200-bed facility in Sambalpur. The state has been quick to partner with existing non-government hospitals, including those in the private sector by signing agreements specific to their roles and contribution to the state’s response. Involvement of medical colleges and private hospitals has meant an addition of at least 1,500 hospital beds.
Migrants’ database and cash incentives
Odisha had prepared a database of returning migrants before the chief minister’s alert and the first case in the state. On the day of the national lockdown, the state government knew 78,233 persons had returned to Odisha from other states, with district and panchayat specific tally. The data was shared with gram panchayats and the panchayat samitis and district administration was intimated about those arrivals. Through IEC, the state had already prepared panchayat members on encouraging returning migrants to self-isolate or quarantine.
However, to incentivise self-isolation of returning migrants, the state announced a cash incentive of Rs 15,000 to all those who had completed home quarantine according to the standard operating procedures issued by the state. To motivate the healthcare staff, the chief minister announced early disbursement of salaries for all healthcare personnel in the state.
COVID-19 spread in Odisha
The total number of cases on April 30 – when total cases in India were at 33,067 – stood at just 142, of which 55 had recovered. On only four days thus far, have the state registered cases in the double digits. Importantly, the recovery ratio in the state stands at 38% compared to 25% nationally. The state has so far seen only one death keeping the fatality rate at 0.7% compared to 3.2% nationally and about 7% globally.
Early and comprehensive response seems to be paying off
The low number of cases in Odisha doesn’t appear to be due to a low number of tests. Odisha has conducted about 723 tests per million people compared to the national average of about 519. The case confirmation ratio – the percentage of cases that are positive out of total tested – is 0.4% for Odisha against the national case confirmation ratio of 3.5%.
Recently, the Indian Council of Medical Research has used the sample test multiple – the number of tests required to identify each new patient – as an indicator of spread. India is currently detecting one new case after about 24 tests, while in Odisha, a new case is being identified after 223 samples, as on April 30.
Flattening the curve
Most states in India have increased the number of tests per day since the lockdown began, but a high number of tests per million and a high number or tests required to identify a positive case indicates that COVID-19 may not have spread in the state as much as in some others. The number of cases in Odisha haven’t risen exponentially and the growth has been linear. In the last two weeks, the number of active cases has remained the same as more start recovering.
It is perhaps too early to isolate the reason for containment of COVID-19 in Odisha, but timely on-ground preparedness and decentralised information campaigns have shown an impact. Overall, Odisha is doing something right in its strategy to manage the pandemic.
Dr Amar Patnaik is Member of Parliament, Rajya Sabha from Odisha, a former CAG official with a Master in Public Management from the Lee Kuan Yew School of Public Policy, Singapore and the Kennedy School of Government, Harvard University, an academic with a PhD in management.
Anshuman Sharma is a public health and communication sciences specialist with MPH from the Harvard TH Chan School of Public Health.
Dr Asit Mohanty is a Professor of Finance at the Xavier Institute of Management, Bhubaneswar.