By Dr Bhupinder Aulakh
India with 2.45 million COVID cases and 48,117 deaths has turned into a hotspot of the COVID pandemic. Though COVID has affected bigger and densely populated States like Maharashtra, Tamil Nadu, Andhra Pradesh more but smaller States are also not less affected. Uttarakhand has registered 11,302 cases and 143 deaths as on 13 August. Even though strict lock-downs have slowed the spread of the infection and have provided the much-needed time to health systems to prepare and respond, but it has adversely affected the livelihoods of the people, particularly the marginalised sections of the population. The Indian economy like that of other countries is contracting and it will take time to bounce back to its pre-COVID growth rate.
While a COVID vaccine is going to take at least a year, public health preventive measures remain as the mainstay to prevent and contain the spread of the pandemic. Strict compliance of mandatory use of face masks in public places, keeping physical distance, avoiding crowded areas, ensuring proper ventilation in closed spaces, maintaining hand-hygiene by hand-washing with soap for minimum 20 seconds and using hand sanitisers are measures which have been proven to prevent infection.
It is imperative to find out the cases through mass scale testing and contact-tracing. All suspected cases need to be tested to determine if they are confirmed cases. All cases with suspect, probable and confirmed COVID 19 need to be isolated to contain virus transmission. All persons during their first contact with the health system need to be screened in emergency or out-patient departments. In community settings, testing can be performed by community health workers. In addition to front line health workers in health departments like ASHA (Accredited Social Health Activist), ANMs (Auxiliary Nurse Midwives), etc., Anganwadi Health workers, SHG groups can be mobilised for contact-tracing.
Each health facility should ensure triage system is put in place and services are provided to, both, COVID and non-COVID patients. Use of telemedicine and digital platforms are new ways of providing medical consultations and should be promoted. This requires ramping up information technology infrastructure in the State.
All front-line health staff should be trained in Infection Prevention Control (IPC). Use of Personal Protective Equipment (PPE), face masks/face shields for frontline workers is mandatory to protect them. This requires adequate supply of PPEs. The health staff should be trained in donning and doffing of PPE. Each health facility should designate a place for donning and doffing and health workers should be allowed to come out of the facility only after removing the PPE and after observing IPC measures.
Widespread use of PPEs, face-masks within health facilities and even outside have raised another concern about proper disposal of used PPEs and face-masks. Usually, the health care waste management is either contracted out to private players or is handled by local bodies. Handling health care waste during COVID pandemic has become more challenging and unless local bodies’ staff or private players’ staff who are involved in health care waste management are trained on how to handle the waste, including used PPEs, face-mask and sharp needles, there is enhanced risk of them getting infected and spreading the transmission. Thus, their training in handling health care waste needs attention. The health department should take a leading role in this training.
Kerala has successfully managed the spread of COVID and offers lessons for Uttarakhand State. The most important factor contributing to the success of Kerala is the strong and effective local government. Each gram panchayat with a population of around 25,000 has 10-25 gram panchayat employees and 8-13 institutions work under them with 250 employees including primary health care institutions. As much of 35% of the state’s development budget is transferred to local bodies. Each local body formulates plans to deal with disasters and during emergencies, the citizens and government employees work under one command structure.
For COVID pandemic, Rapid Response Teams (RRT) were formed in each ward of the gram panchayat under the leadership of elected members and all health workers, government employees, SHG members become part of the teams. The RRTs used 3 Cs: Communication, Coordination and Community engagement, to mitigate the virus spread. In communication campaign, 3 Ws were promoted: washing hands, wearing masks, and watching physical distance. RRTs set up call centres, help desks, online counselling and WhatsApp groups to disseminate information.
RRTs identified those who were infected and ensured their home or institutional quarantine. They carried out contact tracing and ensured provision of essential health services using mobile clinics. RRTs arranged home delivery of medicines and other emergency items. They created GIS maps of migrant camps and provided support to migrant workers without any discrimination. They made lists of most vulnerable and provided protection to them. In addition, they arranged community kitchens to feed the poor and inspected grocery and fish markets to ensure hygiene practices are followed.They also created check-posts in their respective boundaries to contain the spread. Thus, Kerala’s success is based on engagement of every person in the community in COVID response. The Kerala model has demonstrated that strong, empowered and accountable local governments can handle epidemics in a better way showing the way to other states to follow.
(Dr Bhupinder Aulakh is a former IAS officer and is currently in WHO)