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Four cases to 900 in 20 days: What went wrong in Indore
The spike in cases in Indore resulted mainly from people violating lockdown norms and the administration’s failure to engage with the community in an effective way, found a central team sent to review the situation a week ago.
A government team is investigating what the city administration of Indore did wrong to lead to coronavirus disease (Covid-19) positive cases jumping from 4 on March 24 to 900 in 20 days.
The spike in cases in Indore resulted mainly from people violating lockdown norms and the administration’s failure to engage with the community in an effective way, found a central team sent to review the situation a week ago.
“People in Indore initially never thought they could get the disease as they were smug about their clean city tag. So the approach initially it seems was quite lax. The lockdown measures weren’t adequately followed, and since the virus had already reached the city, people were transmitting,” said a Union health ministry official in the know of things, requesting anonymity. Indore is ranked India’s cleanest city in the Union government’s cleanliness survey.
One of the members of the investigating team told HT that people were on the streets during the lockdown, which led to the wide spread in infection.
“The movement of people wasn’t effectively restricted and the local administration did not seem have managed to engage with the community effectively as their health workers met with a lot of resistance on ground. That also limited the implementation of preventive measures. Later when they woke up and started aggressive testing, the numbers had already shot up,” said the team member on condition of anonymity.
The local administration, while agreeing that the sudden spurt of cases caught them off guard and admitting it should have started preparing to deal with the infection much earlier, said it is now on track to contain the spread.
“Initially, we were caught off guard, and it took us some time to figure out a strategy and to build capacity to deal with the infection. Our response was later than what it should have been. The first case, a bunch of four people, came on March 24, but when the numbers kept on increasingly quickly we realised that the virus probably was in circulation since long. March 24 was too late to wake up as we had limited testing capacity then, and we were faced with a situation where we had a very limited time to ramp up capacity. It happened too suddenly,” says Mohammed Suleman, additional chief secretary, state health department.
After about 30-40 cases started pouring in on a daily basis, the state government, which was working with one testing laboratory and Indian Council of Medical Research’s viral research and diagnostic laboratory in Bhopal, added 11 more labs within a month, and have also been sending samples for testing to National Centre for Disease Control in Delhi, and National Institute of Biologicals in Noida (Uttar Pradesh).
“From one lab in March end to 12 testing labs in a matter of few weeks, we scaled up our testing facility literally on war footing to be able to conduct aggressive testing. Between April 7 to April 15 we have lifted 5,000 samples. Currently, within Indore we can test 2,000 samples a day but we need to test at least 1,000 more in a day. We are working on it but it will take some time,” said Suleman.
As for people on streets, Suleman says initially there was a lot of interstate movement of people that took time to curtail.
“Indore is a commercial city, and a lot of people come here on business. Since there was restriction on cargo movement, several people were hiding in trucks to make their way out of the city. We even tracked many of those people till the border. Within the city we managed to curb movement but it was this section that created problems,” he said.
Another major challenge was engaging with the community. “Initially our healthcare workers met with a lot of resistance. Many localities here are congested and I thought of taking people out from these localities to spacious quarantine facilities to break the transmission chain but people weren’t willing to leave their homes, especially those who did not have symptoms. We had to involve religious leaders, and communicate through them to convince these people. That took a lot of effort and time,” said Suleman.
Finally some 3,000 people were moved to various quarantine facilities in the city.
The main focus for the state administration is now to further increase the testing facility as it is taking long for the results to come. “About 2,000 of my samples are in Delhi right now, that we send by air. In Bhopal also we lifted some 6,000 samples last week that will be tested in batches. We are in the process of increasing our testing capacity but it will take some time before equipment is bought, manpower trained and put on job. We are really hurrying up the process though,” said Suleman.
Experts have reiterated the need for effective implementation of lockdown measures for breaking the transmission chain.
“The incubation period of SARS CoV2 is 5-7 days. The range is 2 to 14 days. Lockdown is essentially a strategy to buy time. By restricting movement of infected individuals who may or may not be symptomatic, we are curtailing the chances of the person infecting large number of people. In various countries lockdown has been given the credit to flattening the peak of the epidemic. This is an extreme example of social distancing,” said Dr Lalit Kant, infectious disease expert.
