State grapples to locate the source of the outbreak.

The Madhya Pradesh Directorate of Health Services is floundering to locate the source of the coronavirus (COVID-19) outbreak in its office building which had infected 32 officials, from the senior-most bureaucrat to personal assistants and peons, in the past five days. This makes up the largest chunk of the 62 patients in the capital city.

On Sunday and Monday, 29 of the 44 who had tested positive for the virus were health officials, including doctors. Currently, every second patient in Bhopal belongs to the department. Whereas 20 patients were members of the Tablighi Jamaat in the city, five belong to the police.

“We don’t know the source yet,” admitted Sapna M. Lovanshi, Additional Director at the Directorate. “We have not been able to secure any information on it so far and found anything conclusive”

Direct contact

The infected included the Principal Secretary of the State Public Health and Family Welfare Department, Deputy Directors, Additional Directors and even class-4 employees, she added. “Almost all the employees at the Directorate had had direct contact with at least one of the infected officials,” she said.

At a time when the mortality rate due to the disease hovered around 6% in the State, one of the worst in the country, the Additional Director tasked with implementing strategies to combat the outbreak State-wide, the Managing Director of the Madhya Pradesh Public Health Services Corporation Limited, also the State Ayushman Bharat Yojana CEO, who is tasked with procuring drugs and instruments, the Joint Director tasked with managing hospitals and the Additional Director in-charge of managing manpower, all have been infected.

“What is astounding is that none of us stepped out into the field or in areas where cases were detected. We all worked from the Directorate, held meetings in offices,” said a senior official of the directorate, requesting anonymity.

In addition, officials heading different verticals had gone into quarantine, and held meetings through videoconferencing now, said a Deputy Director. “An official, who returned from Indore after meeting his wife there, is suspected of being the source. But this is yet to be established,” he added.

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Contingency plan

Besides health officials, even secretaries of 14 other departments had gone in isolation, with the government preparing a list of second-line officials as a contingency plan. “Even the Health Commissioner has kept replacements ready if the need be,” said the Deputy Director. The leadership vacuum at the top, with the post of Health Minister still lying vacant, was aggravating the crisis.

The office could be construed as a cluster where the virus transmitted in a similar fashion as it did in a congested housing cluster, said a doctor from the community medicine department of a college in Bhopal. Congested localities had become a COVID-19 hotspot in Indore, where the cases had menacingly climbed to 135, even as officials grappled to locate the outbreak source. Most patients hadn’t travelled abroad and didn’t record a contact with another patient.

At a workplace cluster, like the Satpura Bhavan, where the Directorate was located, most officials had a cabin quite small where three-four of them worked. “The density and frequency of contact owing to urgency of combating the outbreak is probably spreading the virus within the department rapidly. Officials need data and updation, and they mingle more frequently for this, with the number of interactions being more than usual. All of them are working in an emergency mode,” he said.

Spiking density

Tens of officials from the State National Health Mission unit, which has a separate office building, had begun coordinating tasks from the Bhavan itself, spiking workspace density further. “It may be easy to distance workers in an industrial setting, but not in an office. Probably, the government may change office spacing norms once the virus spread is controlled,” he said.

Moreover, he explained, as several carriers of the disease were asymptomatic, that made locating the source even more challenging. “For around 100 cases, there will be at least 20 cases which will never be detected unless tested. Asymptomatic transmission has become a known fact, that is why offices are shut across, and the stay-at-home policy has come about,” he said.

From the 3,711 passengers and crew of the Diamond Princess cruise ship that had departed Yokohama, Japan, he explained as many as 18% carriers of the disease remained asymptomatic throughout. “Every case transmits a virus starting from two days before the onset of symptoms and then for four-five days after the symptoms go away. That is the reason the spread is so fast, and people unknowingly transmit the disease.