Fatality rate shot up to 12%, the highest in the country.

As Indore grapples with a high fatality rate from COVID-19, the city administration is surveying all residents for Influenza-Like Illness and Severe Acute Respiratory Illness (SARIs) to check the spread of the novel coronavirus. The rate had shot up to 12% recently, the highest in the country.

Of the 28 lakh residents of the largest and most populous city of Madhya Pradesh, health workers have already screened 7 lakh. The rest will be surveyed in five days.

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With 707 COVID-19 cases as of Thursday, Indore has the third highest number of cases in the country, after Mumbai and New Delhi. With most patients having no contact or travel history, health workers are yet to locate the source of the outbreak.

In the past four days, the number of cases grew by 492. And the city, which has ranked the cleanest in the country thrice consecutively, accounts for more than half of the 1,163 cases in Madhya Pradesh.

So far, 10 nurses and paramedical staff members, and two front-line doctors have contracted the illness in the city. One private practitioner has also died. An official of the Health Department said such cases surfaced when hospitals did not provide personal protective equipment (PPE).

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Most of the 39 people who died in the city suffered from bilateral pneumonia, which worsened to Acute Respiratory Distress Syndrome that caused the death. The novel coronavirus hastened the process. “Most of those who died had not revealed their illnesses before. They reached us very late carrying a heavy viral load, their lungs severely affected,” Chief Medical and Health Officer Pravin Jadia said.

Under the treatment protocol, the illness of a patient is first classified into one of the four categories — uncomplicated illnesses such as fever or sore throat, mild pneumonia, severe pneumonia and ARDS. Then, the treatment begins.

The survey, said Jyoti Bindal, Dean of the Mahatma Gandhi Memorial Medical College, is to ensure that the patient doesn’t reach a critical stage. “Spot it early so that mortality reduces,” she said.

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Early spotting of respiratory illnesses, whose symptoms are identical to those of COVID-19 in the initial stages, may help to pre-empt the disease load in patients. As part of the door-to-door surveys, teams of health workers and teachers identify symptoms with an application-based questionnaire. Ten teams report to a doctor, who checks suspects and takes their samples. For backup, a medical mobile unit is stationed in each area.

“Only when we identify patients can we focus on certain areas and contain the spread there,” Indore Divisional Commissioner Akash Tripathi said.

The survey initially focussed on 10 hotspots, adjoining cluster habitations. Now, it is being widened to areas where at least one case has been found.

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So far, 150 of the 1,270 or 12 % of the city’s colonies, gated communities and slums have been affected by COVID-19. The 20 worst affected areas include Khajrana, Chandan Nagar, Ranipura and Azad Nagar, where 10 or more cases each have been found. Tatpatti Bakhal, where days ago two health workers were pelted with stones as they went about tracing contacts, has recorded the most, 49, until Thursday.

Cases were being detected near the epicentres, said Mr. Tripathi. “No new epicentres are emerging. Though the numbers are increasing, they are mainly direct contacts of the earlier patients. This gives us hope that the virus is being contained,” he added.

Dr. Jadia said that being contacts, most of the new cases had already been kept in isolation. So, the possibility of a community outbreak was being averted.

As of Thursday, Indore boasted the second highest testing rate nationwide of 1,200 per million, behind Jaipur, said Mr. Tripathi. New Delhi tested 822 per million as on April 15.

Major challenges for the administration include containing the spread in newer areas, preparing hospitals for a surge in patients and ensuring healthcare for non-COVID-19 patients too. Recently, a family was forced to use a two-wheeler to carry a man suffering from breathlessness to a hospital as they were denied an ambulance.