Rajasthan ‘Bhilwara model’: Health workers during a door-to-door survey for COVID 19 symptoms, during a nationwide lockdown imposed in the wake of the coronavirus pandemic, in Ajmer. (PTI Photo) Rajasthan ‘Bhilwara model’: Health workers during a door-to-door survey for COVID 19 symptoms, during a nationwide lockdown imposed in the wake of the coronavirus pandemic, in Ajmer. (PTI Photo)

Almost two weeks into the nationwide lockdown, with the case count from the novel coronavirus disease climbing to 4,281 (with 111 deaths) as of Monday night, the Union Health Ministry has said that over 80% of the total positive cases have been traced to 62 districts across the country.

As reported by The Indian Express on Monday, government officials say now they are mulling sealing off these places on the lines of the containment done in Rajasthan’s Bhilwara district, which had emerged a hotspot for COVID-19 cases.

The containment strategy was found to be successful in Bhilwara, and since then health officials in both Rajasthan and the Centre have been unofficially terming this specific containment plan as the “Bhilwara model”.

What is meant by the Bhilwara model of COVID-19 containment?

The Bhilwara COVID-19 containment “model” refers to the steps taken by the administration in Rajasthan’s Bhilwara district to contain the disease, after it emerged as a hotspot for coronavirus positive cases.

Bhilwara district was among the most-affected places in India during the first phase of the COVID-19 outbreak. As of Monday, Rajasthan had 274 confirmed cases of the disease.

The measures taken by the Rajasthan government include imposing a curfew in the district which also barred essential services, extensive screening and house-to-house surveys to check for possible cases, and detailed contact tracing of each positive case so as to create a dossier on everybody they met ever since they got infected.

India coronavirus lockdown: Women practice India coronavirus lockdown: Women practice social distancing while collecting ration from a government depot in Beawar, Wednesday, April 01, 2020. (PTI Photo)

The success of the model is attributed to the fact that Bhilwara, which was the first district in Rajasthan to report most number of coronavirus cases, has now reported only one positive case since March 30.

This is considered as a major success for the government and the district administration as within the first four days of the initial outbreak, the number of cases shot up to 13 and by March 30, the district had seen a total of 26 cases in 11 days.

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The total number of cases reported from Bhilwara as of Monday is 27, of which 17 have recovered and 9 people have been discharged.

Why were such drastic measures employed in Bhilwara this early in the outbreak?

The first known case of coronavirus in Bhilwara was that of a doctor at a private hospital who tested positive. After the first COVID-19 patient was reported in the district on March 19, the number of cases shot up within a very short time.

The epicentre of the outbreak in the district was a private hospital where the doctor who first tested positive was an employee. Five more cases were reported on March 21 and, by March 23, the district had recorded 13 cases.

Most of those tested positive included other doctors of the private hospital, the hospital staff, along with both IPD and OPD patients who had come in contact with the infected doctors.

India coronavirus lockdown: Medical team members during their door-to-door visit to screen people in wake of coronavirus India coronavirus lockdown: Medical team members during their door-to-door visit to screen people in wake of coronavirus pandemic at Ramganj Bazar in Jaipur, Friday, March 27, 2020. (PTI Photo)

By March 25, this figure reached 17 — all of them hospital staff and patients. On the same day, the government sealed a 1 kilometre area near the private hospital which was considered as the epicentre for the outbreak, and declared it a zero mobility zone.

The first death in the district took place on March 26 when a 73-year-old man who had tested positive for COVID-19 passed away and the person’s son and granddaughter too, were tested positive for the disease.

Within hours of the death of the person, a second death occurred in Bhilwara — a 60-year-old person who had also tested positive for COVID-19 died on the night of March 26.

However, the Rajasthan government has maintained that even though both the deceased had tested positive, the cause of their death was not coronavirus, but underlying medical conditions, such as kidney failure and high blood pressure, for which they were already undergoing treatment.

At this point of time, the situation in Bhilwara was the biggest coronavirus related crisis that the Rajasthan government was facing, as the positive cases were steadily increasing.

India coronavirus lockdown: JMC workers fumigate the area around Hawa Mahal as a precautionary measure to contain the spread of coronavirus, during the nationwide lockdown, in Jaipur, Tuesday, March 31, 2020. (PTI Photo) India coronavirus lockdown: JMC workers fumigate the area around Hawa Mahal as a precautionary measure to contain the spread of coronavirus, during the nationwide lockdown, in Jaipur, Tuesday, March 31, 2020. (PTI Photo)

What did the administration do as part of the containment strategy?

According to Rajasthan’s Additional Chief Secretary (Health), Rohit Kumar Singh, the “Bhilwara model” of tackling COVID-19 cases involves, simply, “ruthless containment”.

Within three days of the first positive case, by March 22, the Health Department and the district administration in Bhilwara constituted nearly 850 teams and conducted house-to-house surveys at 56,025 houses and of 2,80,937 people.

Nearly 2,250 people were identified to be suffering from influenza-like illness (ILI) symptoms and were kept in home quarantine.

Intense contact tracing was also carried out of those patients who tested positive, with the Health Department preparing detailed charts of all the people whom they had met since being infected.

A list of 498 people from five states — Himachal Pradesh, Madhya Pradesh, Rajasthan, Uttar Pradesh and Gujarat — was compiled by March 22. These were patients who had visited the hospital for treatment since the time when the staff got infected.

India coronavirus lockdown: Fire station officials spray disinfectants in Jaipur, Friday, March 27, 2020. (PTI Photo) India coronavirus lockdown: Fire station officials spray disinfectants in Jaipur, Friday, March 27, 2020. (PTI Photo)

By March 26, 6,445 people, who were suspected to have been infected, were kept in home quarantine. Official documents show that in the next five days — between March 22 and 27 — 4.35 lakh houses and 22 lakh people of Bhilwara, which has an estimated population of 30 lakh, were surveyed.

The state Health Department also took the help of technology, using an app to monitor the conditions of those under home quarantine on a daily basis along with keeping a tab on them through geographical information system (GIS).

The administration backed up the surveys by imposing a total lockdown on the district, with the local police ensuring strict implementation of the curfew.

The frequency of the cases went down after March 30 and for the first time in ever since the outbreak, the district, completely cordoned off from all communication, didn’t report a single case on March 31.

The patients were treated with hydroxychloroquine (HCQ), Tamiflu and HIV drugs and by April 3, 17 people were declared recovered.

India COVID-19 lockdown: A man offers morning prayers from the roof of his house, during the nationwide lockdown, imposed in the wake of coronavirus pandemic, Bikaner, Friday, March 27, 2020. (PTI Photo) India COVID-19 lockdown: A man offers morning prayers from the roof of his house, during the nationwide lockdown, imposed in the wake of coronavirus pandemic, Bikaner, Friday, March 27, 2020. (PTI Photo)

The district entered a period of 10-day-long “intense curfew” from April 3, and according to Bhilwara district collector Rajendra Bhatt, even essential services such as shops of medicine and grocery will remain closed during this period.

The police will ensure supplies to the public by delivering the essentials on their doorstep.

Ever since March 31, only one case has been reported from the district in a week, taking the total number of cases from the district to 27.

What were the challenges the administration faced in imposing these extraordinary measures?

The biggest challenge that the administration faced was containing the rising number of cases after the initial outbreak. The doctors of the private hospital who had tested positive had come into contact with numerous people including the staff and patients who visited the private hospital during the period when the doctors were already infected.

Some of these patients had come from other states and after the first case of COVID-19 was detected in the district, several other cases, mostly contact of the doctors and the infected hospital staff were reported with each passing day.

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India lockdown: Women wearing masks look out from a window of their house during the lockdown imposed in the wake of the novel coronavirus pandemic, in Jodhpur, Wednesday, March 25, 2020. (PTI Photo) India lockdown: Women wearing masks look out from a window of their house during the lockdown imposed in the wake of the novel coronavirus pandemic, in Jodhpur, Wednesday, March 25, 2020. (PTI Photo)

The government also had an uphill task ahead of them assembling the teams of doctors, auxiliary nurse and midwives and nursing students who went to conduct the house-to-house surveys.

The outbreak in Bhilwara came as a sudden shock to the administration and it was a major challenge to cover more than 22 lakh houses within a matter of days. Once the survey of an area was completed, the health teams visited the place once again after a few days in order to see if there was any fresh development or rise in symptomatic people.

Owing to the fact that Bhilwara, a thriving textile city with an estimated population of 30 lakh, it was also a difficult task for the government to strictly impose the curfew uniformly in all areas.

Here’s a quick Coronavirus guide from Express Explained to keep you updated: What can cause a COVID-19 patient to relapse after recovery? | COVID-19 lockdown has cleaned up the air, but this may not be good news. Here’s why | Can alternative medicine work against the coronavirus? | A five-minute test for COVID-19 has been readied, India may get it too | How India is building up defence during lockdown | Why only a fraction of those with coronavirus suffer acutely | How do healthcare workers protect themselves from getting infected? | What does it take to set up isolation wards?

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