india

Updated: Mar 05, 2020 08:16 IST

A conference room on the third floor of the ministry of health and family welfare’s office in Nirman Bhawan has become, since Monday, India’s coronavirus-control war-room.

That was the day two men, one from Delhi, and another from Telangana, were confirmed to be suffering from Covid-19, caused by the novel coronavirus Sars-Cov-2.

Since then, it has almost become a second home to Union health minister Harsh Vardhan, and officials from the ministry’s Emergency Medical Response Unit , the Central Surveillance Unit at the Integrated Disease Surveillance Programme (IDSP), and the National Centre for Disease Control (NCDC).

Also present are technocrats, epidemiologists and directors from the three notified hospitals – All India Institute of Medical Sciences (AIIMS), Safdarjung Hospital and Ram Manohar Hospital -- dealing with coronavirus cases in the capital.

It’s here that policy decisions on how the spread of the virus should be tackled across the country are taken.

For instance, on Wednesday , the ministry directed all states to adopt the cluster-containment strategy of testing all close contacts and screening everyone who lives within a 3-km radius of a positive case following the surge in cases after 25 people tested positive for Covid-19, taking the total number of cases to 29 (including two that are waiting for a final confirmation from the National Institute of Virology, Pune). .

“Apart from the cluster-containment strategy, strategic approaches like making the district collectors more accountable, contact tracing and strengthening state and district surveillance teams have been adopted to avoid widespread community transmission and break the chain of transmission, if found,” said Harsh Vardhan.

Health ministry technocrats and bureaucrats, including joint secretaries, have been sent to the ground to review states’ preparedness, and offer support for course correction, if needed. All state health secretaries connect through video-conferencing every day to review preparedness and identify gaps, if any.

The room lacks realtime dashboards and monitors that fans of outbreak movies are familiar with. Instead, epidemiologists rely on old-school video-conferencing, hotlines, phone calls and emails to track suspected and confirmed cases from across the country.

Health ministry officials say the system is efficient.

“A suspected case reaches Safdarjung Hospital and Ram Manohar Lohia {Hospital} within two hours of being screened at the airport, the traffic accounting for most of the delay. The nose and throat swabs are collected for testing at the hospital after they are moved to an isolation ward,” said a health ministry official who asked not to be named.

Those with symptoms, including those who self-report, are isolated and tested in the hospital, along with their family and close contacts.

Prime Minister Narendra Modi is closely monitoring the Covid-19 situation, with cabinet secretary Rajiv Gauba chairing review meetings with the representatives of the Centre and the state governments. “The PMO is being briefed regularly about the preparedness and disease management. We are working as a unit to combat the threat due to Covid-19 in the nation and adopting a coordinated and collective effort in a mission mode,” said Harsh Vardhan.

Experts say the cluster-containment strategy is ideal for situations such as these.

In case of an outbreak, this means directing an army of more than 300,000 community health workers across the country, armed with a thermometer, to go door-to-door to houses and establishments within a 3-km radius of a positive case to screen for symptoms and assess their risk of exposure to the positive contact by tracing movement over the previous two weeks.

“It’s a very effective strategy and was critical to containing the highly contagious Nipah virus outbreak in Kerala and Zika virus disease outbreak in Rajasthan and Madhya Pradesh in 2018 and 2019. With Covid-19 cases increasing, all states have been directed to follow the strategy with district collectors responsible for surveillance at the grassroots level,” said a second health ministry official, requesting anonymity.

“For India, the containment of Covid-19 must remain the top priority, with a focus on protecting health workers, engaging communities to protect people who are at risk, and protecting the most vulnerable,” said Dr Poonam Khetrapal Singh, regional director of the World Health Organisation, South East Asia Region, of which India is a part.

“But in the event of community transmission, the focus would have to shift towards protecting the most vulnerable population and minimizing both the health and social impact of the outbreak. Health facilities would then have to focus on diagnosing and treating the most vulnerable and the severe cases,” said Dr Khetrapal Singh.

A high-level Group of Ministers (GOM) was constituted last month to review, monitor and evaluate the preparedness and measures taken regarding management of Covid-19; the GOM held the first meeting under the chairmanship of the health minister on February 3.

Two more meetings were held on February 13 and March 2, which were attended by ministers of all concerned ministries, including minister of civil aviation Hardeep S Puri, minister of state for home Nityananda Rai, minister of state for shipping, chemicals and fertilisers Mansukh Mandaviya, and minister of state for health Ashwini Kumar Choubey.

All nose and throat swabs are sent to one of the 13 designated labs across the country run by the Indian Council of Medical Research for testing. In Delhi, these include AIIMS and NCDC. Nineteen more laboratories will be added within a week, and if needed, testing will be scaled up to include 50 labs, the health minister has said.

The key, however, remains public support.

“The measures to engage with communities, to empower them, and enable them take correct protective measure are a bigger need of the hour,” said Dr Khetrapal Singh.