Authors: Manorma Pandey, Pranjal Gupta, and Vasundhra Singh Panwar

The novel Coronavirus has brought about changes in the world that no one could have foreseen. One day, life was normal and then the next day the world is shutdown with stringent measures of social distancing. India is one of the many countries severely hit by the pandemic. While some states were not very successful in striding through this unprecedented crisis, a few of them have been very diligent in tackling the issue.

This paper highlights the success stories of a few Indian states that have strategically handled the outbreak of COVID-19 and have set a model for the country to look up to.

Rajasthan

Rajasthan occupied the first rank in the COVID-19 management index analysed almost two months back for ten States by the Central Government. This index included parameters like active cases, recovered cases, and mortality rates. The ‘Bhilwara Model’, from a district in Rajasthan, was lauded as an effective COVID-19 containment success story. Despite 11 lakh migrants returning from cities like Ahmedabad, Surat, and Mumbai, the infection did not spread widely in the rural areas because of micro-planning at the village and subdivision levels. The state recorded its first case of the COVID-19 pandemic on  March 2, 2020, in Jaipur. As of August 22, 2020, the total cases stand at 68,566, including 938 deaths and 52,721 recoveries, according to the state’s Health Department.

Government response

On March 19, the Rajasthan government imposed Section 144 thus, restricting the gathering of five or more people to contain the spread of the virus. The passengers reaching Jaipur via international flights were screened and the ones showing COVID symptoms were kept in home isolation for two weeks.

The state was the first to announce a complete lockdown beginning from 22 March, barring essential services. The lockdown banned public transport services in the state and two days later, using private vehicles for commutation was prohibited as the number of cases crossed 32 in the state. State borders were sealed on May 7 to prevent the entry of unauthorised personnel and interstate movement was permitted as per the MHA guidelines.

Legal action was exercised against people violating social distancing norms. During the lockdown, over eight million INR was collected as fine from over forty thousand violators, more than one lakh vehicles were seized and more than six crores INR were collected as fine from the owners. Fines were imposed on over twenty-four thousand people for not wearing masks in public places, on more than eleven thousand people for not following social distancing rules, on over three thousand shopkeepers for defying lockdown to sell goods, and four hundred forty-five people got arrested for attacking the frontline health workers.

Commendable steps:
· Free ration for two months for families covered under the National Food Security Act (NFSA),
· Financial assistance of fifty lakhs INR to the family of government employees who died due to this disease during anti-COVID-19 operations,
· Focus on healthcare initiatives like immunisation, family welfare, maternal and child health, and national health programs, to ensure that people’s needs are met, health infrastructure remains intact, and the State’s health index is not adversely impacted
· Emerged as the first Indian state to conduct a comprehensive campaign for public awareness from June 21 onwards; two ‘Swasthya Mitras’ were trained and appointed in all villages for taking forward the health awareness drive,
· Inclusion of preventive measures against COVID-19 in the school curriculum to ensure on-time awareness.

Testing

Rajasthan is counted amongst those states that have conducted the highest number of tests and have a higher per capita ratio of tests than the national average.

On April 18, the state government was the first to start rapid testing for COVID-19 using rapid testing kits that gave instant results based on the presence of antibodies in the blood. The State Health Minister stated that when the state’s first coronavirus case came to light, the sample was sent to the Pune laboratory for testing. From zero testing level, the State health department initially set a target of conducting 10,000, and then 25,000 tests daily. The target was achieved after the arrival of Cobas-8800 machines and setting up testing labs in all of the 33 districts. Later,  a target of conducting 40,000 tests per day was achieved in July and the state became capable of conducting more than 41,450 tests per day. Rajasthan has now set a target to achieve the capacity to conduct more than 50,000 tests per day.

The Health Minister explained that increasing the testing facility has improved the recovery rate. The elderly and people with high risk were identified and were kept under vigilance.

Treatment

Rajasthan became the fourth state in the country to perform successful clinical trials of convalescent plasma therapy first at SMS Medical College and Hospital, Jaipur, and later, also at Government Medical College, Jodhpur. A combination of anti-malaria, anti-Swine flu and anti-HIV drugs helped three patients recover in the state during March.

The Bhilwara Model

Bhilwara, a district in Rajasthan was among the worst affected places and a hotspot for COVID-19 patients in the first phase of the virus’ outbreak in India. However, the steps taken by the district administration proved to be a successful COVID-19 containment strategy, and the effective approach was referred to as “the Bhilwara model”.

The first known case of coronavirus in Bhilwara was of a doctor working in a private hospital who was tested positive on March 19. The hospital soon became the epicenter of the outbreak as several other doctors and health care workers tested positive for the virus. The administration estimated that at least 15,000 to 20,000 people might’ve come in direct contact with the hospital staff.  It was a daunting situation for the administration and immediate stringent steps were taken to control it.

 The government sealed a 1-kilometer area near the hospital and declared it a zero mobility zone to contain transmission. Bhilwara’s borders were sealed for private vehicles, trains passed through the district but did not stop, bus services were not allowed to function and all establishments employing more than 10 people were ordered shut.

A massive screening exercise that covered almost every household in the district was conducted, watch lists of people suffering from influenza-like illness symptoms, and those in the high-risk category were created, and nearly 2,250 such people were identified and kept in-home quarantine. In the rural areas, close to twenty-three lakh people were surveyed and around seven thousand people were quarantined at home or in isolation facilities. Hotels, resorts, hostels, and dharmshalas were acquired to set up quarantine facilities along with four private hospitals summing up to around 14,000 beds. Intense contact tracing was carried out for patients who were tested positive and a list of 498 patients who had visited the hospital for treatment from other states since the beginning of staff infection was compiled. Once the survey of an area was completed, the health teams visited the place once again after a few days to see if there was any fresh development or rise in the number of symptomatic people.

As the number of cases rose, Bhilwara accounted for the majority of the cases in Rajasthan, and the district was being called the ‘Wuhan and Italy of Rajasthan’. Being a textile hub with an estimated population of 30 lakh, and the frequent movement of local people from metropolitan cities for work, imposing a curfew uniformly across Bhilwara became a challenge for the government.

While people were initially allowed to step out to avail essential services, soon doorstep delivery of groceries, fruits and vegetables and milk for everyone began, and cooked meals and dry rations were delivered to the poor.

Bhilwara did not have a lab to conduct tests but one was immediately bought and around 160 samples started being tested there daily. With rapid test kits, the aim was to conduct mass testing followed by quarantining of the infected to break the chain. The patients were treated with HCQ, Tamiflu, and HIV drugs. A more stringent curfew was imposed from April 3 onwards wherein even essential services like medical and grocery shops remained closed and the police ensured supplies to the public by delivering the essentials at their doorstep.

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

The frequency of the cases went down after March 30 and for the first time since the outbreak, the district did not report a single case on March 31.

Kerala

 Kerala, the south Indian state is celebrated for various reasons – from its tourism, a remarkable literacy rate, to its development strategies. Kerala’s ‘Development Model’ is renowned in the world. The onset of the pandemic brought multiple challenges but the state emerged victorious in skilled planning and operations and is looked up to for effectively tackling COVID-19.

The first-ever COVID 19 case in India was reported in Kerala on 30 January 2020. Since Kerala is a major hub for international migration, this sparked up debates as the international migrants started to return to the state and Kerala saw a sudden rise in the number of COVID positive cases by the end of March. International migration is a crucial aspect of Kerala’s development and for the first time, it posed a challenge to the state.

The state government took a series of immediate and effective steps that showed results in April. Kerala’s experience & investment made during the Kerala floods & outbreak of the NIPAH virus helped Kerala to swiftly row the boat without many disturbances though the flow of water was against it.

The milestones achieved in the field of healthcare & education with ‘Kerala’s Model of Development’ came in handy for the state. Kerala has a strong health-care base, which is primary to tackle the virus, and with education comes the awareness that is important for spreading the safety instruments & reducing panic.

The World Health Organization recommended using the ‘test, trace, isolate, treat’ approach which Kerala employed meticulously and it has been possible by deploying Kerala’s public development system established over the years. The rigorous surveillance system, setting up district control rooms for monitoring, strong communication set up and community development sessions, and catering to the mental health needs of the population are some of the many commendable strategies implemented by the Kerala government. The area where Kerala wins is that it employs strategists that keep people at the epicenter and take care of not only their healthcare but mental peace & stability.

The right strategy is important but implementing it at the right time is foremost and Kerala did not leave any stone unturned when it comes to that. After the first case being discovered, Kerala declared a health emergency on 3 February after two more cases were reported. The state set up a system of screening and testing of passengers coming in from China at a very early stage predicting the crisis. The screening was also done at all seaports and as cases began to multiply, screening & scanning were done even at bus & train stations reflecting the seriousness of the government in tackling the Pandemic.

With orders, the state government developed structures to enable them, for isolation the government built many centers & shelter for migrant labourers, which was of dire need, given that the migrant labourers were the worst hit amidst the lockdown imposed, leaving them without food & shelter security. With Covid-19 came unprecedented social distancing norms and the Kerala government made sure that adequate infrastructure is available for carrying out the necessary procedures.

With a pandemic come numerous uncertainties and, like any other disaster, people’s mental health is affected. To provide support to people struggling with the new developments and getting through stressful times, helplines were set up for people to have someone to talk to and gain psychological support. For this purpose, 1143 mental health professionals were taken on board to provide the necessary support to people. This inclusive strategy of the Kerala government made it to history.

The government alone cannot stride any crisis, cooperation from people is primary and this is possible only by spreading awareness and not panic. Community Development Sessions play a salient role in equipping people to fight with situations like these. Kerala Government was successful under this category too. Awareness Campaigns like, ‘Break the Chain’ were initiated to promote sanitization, social distancing, and the pandemic etiquettes for avoiding the spread of the virus. Along with imparting knowledge about properly washing hands, machines were also set up for the same in various locations for enabling the practice of learning.

Kerala’s model highlights the importance of planning, instant action, and implementation and how the development we make today helps us in eradicating future crises or even helps us prepare better. The preparation for our crisis did not start at its inception but our policies & development strategies should be designed by keeping in mind what might come our way. Kerala’s model is distinguished because of proper healthcare & education mechanisms, the state development since the 1970s.

North Eastern States

 In the month of March, when India was entering into its first-ever complete lockdown, Manipur reported its first-ever COVID-19 case, the first amongst north-easternIndian states, when a 23-year-old student, who had travel history in the UK, tested positive for the virus. Gradually the virus spread to the neighboring states. The governments of the seven states –Assam, Meghalaya, Manipur, Tripura, Mizoram, and Arunachal Pradesh, followed the guidelines set by the central government to control the spread of the virus. The number of cases was low as the rest of the country entered the third phase of lockdown– 43 in Assam, 12 in Meghalaya, 2 in Tripura, 2 in Manipur, 1 in Arunachal Pradesh,1 in Mizoram, and zero cases in Nagaland. The government and administration made wearing masks mandatory for citizens and the seven sisters were in the green zone until May.

However, when on May 17, the inter-state borders were opened, a large number of people staying in other states headed back home. Around, 10,000 residents returned to Nagaland alone. In May, the states accounted for more than 5,000 active cases — with Assam leading the number, followed by Tripura, and Manipur not far behind. On tracing the positive cases, it was found that the significant rise in the number of cases was due to the opening of the border.

Nagaland

Three cases of the virus were reported in Nagaland on 25 May – all returnees. Within ten days, the number of COVID-19 positive cases reached 107. The main reason behind the sudden spike in cases was the opening of inter-state borders. One-time assistance of Rs 10,000 was offered by the Nagaland government to the stranded residents who opted not to return. In the interim, the government tried to improve facilities including the preparation of a network of community-level quarantine centres.

Manipur

The number of cases also rose in Manipur as people started returning to the state. Manipur recorded the highest spike in a single-day on 8 May, with 100 people testing positive for the virus. In June, there were 279 active cases, out of which 278 cases were of the returnees. Only one case was that of a frontline nurse working in Churachandpur’s district hospital.

According to the Health Commissioner Vunglunmang Vualnam, a part of the spike can be attributed to the failure in realising the importance of social distancing within the quarantine centres. Despite that, the administration believed the state to be capable of averting a bigger crisis, with coronavirus care facilities being set up in almost all the district hospitals.

Tripura and Meghalaya

A large number of people returned to Tripura and Meghalaya from Tamil Nadu, Delhi, Haryana, and Maharashtra. Around 6,000 people traveled from Assam to Tripura and Meghalaya. Most of them were tested positive, although the state had the lowest number of active cases in the Northeast at that time. Tripura placed above nine thousand people under surveillance, of whom 93 percent were under home quarantine. Tripura’s high numbers were attributed to its testing rate, which was the highest rate proportionate to the population in the NE region.

Arunachal Pradesh

The number of cases in Arunachal Pradesh rose in June. In a single day, 18 cases were reported on June 1, and 20 on June 12. The state has two hospitals — in Pasighat and Naharlagun — to treat corona patients.

Mizoram

The state had zero coronavirus cases until May but later in June, the number of cases rose like other north-eastern states, and the Mizoram government announced a total lockdown for two weeks starting from June 8 onwards, the time when the rest of the nation was preparing for ‘unlock’ phases.

State Mathematical Model

The states used State Mathematical Model to build their health infrastructure to fight against Covid-19 spread. The model helped the governments to control the spread. The actions taken by the governments are –

  1. The government announced limited movement and a night curfew.
  2. Now, the Rapid Antibody tests and RT-CPR testing is being conducted on all the returnees. This ensures a better treatment for the patients and helps in understanding how recent the exposure is.
  3. The healthcare facility in the state is not good when compared to big cities like Delhi, Chennai, and Mumbai. However, the states are trying their best to arrange the best of the facilities for instance bringing together a network of community-level quarantine centres.
  4. In Shillong, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS) was prepared to fight the virus.It is Meghalaya’s biggest testing facility, having the capacity to carry out 2,000 tests per day.

Present status of Covid-19 in the seven States

The seven sister states in India have been tackling the pandemic without highlighting the problems they are facing as the states lack in health facilities. In Arunachal Pradesh, Nagaland, and Manipur, the number of recoveries from COVID-19 is much less than 50%. Yet, the total number of cases in all the seven states is much less as compared to the rest of the country. Due to the low population and the poor access to proper healthcare due to remote locations, the pandemic is bound to affect these states more however, the death rates are at a very low level which is a commendable achievement for the administration.

The rise in the number of cases is mainly because people are moving around more and not taking proper precautions. People must take measures enlisted by the health authorities to keep themselves and their families safe and so that the burden on the health infrastructure is reduced. If these steps are not taken seriously and religiously at the micro-level, the consequences can be massive at a macro level.

Conclusion

The aforementioned information puts a light on how planning, strategizing, and rapid action response can help counter any lingering threat. These states and several others have not only outlined effective policies and governance strategies but have also developed a strong infrastructure to sustain them.

References

  1. http://www.rajswasthya.nic.in/
  2. https://www.thehindu.com/news/national/other-states/coronavirus-rajasthan-tops-in-virus-management-index/article31742889.ece#:~:text=Rajasthan%20has%20occupied%20first%20rank,recovered%20cases%20and%20mortality%20rate.
  3. https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Rajasthan
  4. https://www.thehindu.com/news/national/other-states/rajasthan-government-sets-target-of-40000-covid-tests-daily/article31786975.ece
  5. https://www.theweek.in/theweek/statescan/2020/04/17/the-bhilwara-model.html
  6. https://www.timesnownews.com/india/article/covid-19-rajasthan-sets-a-target-of-50000-tests-per-day/616383
  7. https://indianexpress.com/article/explained/explained-bhilwara-model-ruthless-containment-stop-coronavirus-6350395/
  8. https://www.businessinsider.in/india/news/rthan-govt-to-engage-swasthya-mitras-to-spread-awareness-on-covid-19-gehlot/articleshow/76737413.cms
  9. https://www.who.int/india/news/feature-stories/detail/responding-to-covid-19—learnings-from-kerala
  10. https://indianexpress.com/article/opinion/covid-19-pandemic-kerala-model-nipah-virus-coronavirus-6393517/
  11. https://www.project-syndicate.org/commentary/kerala-model-for-beating-covid-19-by-shashi-tharoor-2020-05?barrier=accesspaylog
  12. https://indianexpress.com/article/north-east-india/behind-northeasts-covid-19-surge-stranded-migrants-returning-home-6457181/
  13. https://economictimes.indiatimes.com/news/politics-and-nation/these-five-northeast-states-are-now-virus-free/manipur/slideshow/75486465.cms

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