Test, trace, treat in Delhi’s 5T plan

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Published on Apr 08, 2020 01:24 AM IST
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ByAbhishek Dey

New Delhi: Delhi chief minister Arvind Kejriwal on Tuesday laid out a five-point blueprint to contain the coronavirus disease (Covid-19), declaring that testing will be ramped up and the scope of treatment widened – an indication that the Capital was bracing for the possible ballooning of the pathogen that has ravaged several metropolises across the world.

Fifty one new cases were reported in Delhi on Tuesday, taking the total in the Capital to 576, out of which 333 patients are linked to the mid-March congregation of a Muslim missionary group, Tablighi Jamaat, in Nizamuddin that has now become the country’s largest hot spot for Covid-19 infections.

At a news briefing, the chief minister said that Delhi has formed a “5T plan” — testing, tracing, treatment, teamwork, and tracking — and that his government was prepared to scale up resources to treat up to 30,000 active Covid-19 patients at the same time, if needed.

“The first T is testing. If you don’t test, you won’t be able to find out which houses have been affected. It will go on spreading. South Korea identified every single individual through large scale testing. We are now going to do mass testing like South Korea,” Kejriwal said.

He said the countries that did not conduct wide testing before infections climbed were unable to control the imminent spiraling of the disease. “We have ordered kits for the testing of 50,000 people. The kits have started arriving. We have also placed orders for the rapid test of 100,000 people. The deliveries of kits will begin by Friday. Random tests will be done at hot spots. Detailed tests will also be done.”

On Monday, Kejriwal said rapid testing will be doubled from next week – from around 500 samples per day to 1,000 samples per day.

Several public health experts have said that aggressive testing is the mainstay in the battle against the highly contagious disease that has killed at least 77,000 people globally because the infection often spreads undetected.

South Korea and Germany have led the charge in mass testing, which has helped control the spread of new infections over time, and more importantly, kept the fatality rate low.

“The second T is tracing,” Kejriwal said. “Tracing is being carried out at a very good level in Delhi and now we have started taking help from the police as well to check if the people who have been traced are staying under self-quarantine.”

Kejriwal said that the government has so far given contact numbers of 27,702 people for tracing to the Delhi Police. A person’s movement can be tracked through their phone, he added. “Today, we are going to give 2,000 phone numbers of people who were brought out of Markaz to find out if they roamed in the area around Markaz. The areas they went out to, will be sealed and monitored.”

The recent spike in infections has largely been propelled by the detection of hundreds of patients who attended gatherings of the Tablighi Jamaat in Delhi’s Nizamuddin Basti last month in a violation of several restrictions. Cases linked to the meet have been reported across two dozen states and Union Territories so far.

“Our third T is treatment,” Kejriwal said. “If someone gets infected with Covid-19, then we will have to provide that person with treatment. Delhi has 525 positive Covid-19 cases so far and we have made arrangements for 3,000 beds.”

He said the Delhi government-run Lok Nayak Jai Prakash Narayan Hospital (1,500 beds), GB Pant Hospital (500) and Rajiv Gandhi Super Speciality Hospital (450) have been declared as dedicated facilities to treat the new disease. The government has also earmarked 400 beds at three private hospitals – Max Saket (318 beds), Apollo (50 beds) and Sir Ganga Ram Kolmet Hospital (42 beds).

“At present, there are 2,950 beds reserved for Covid-19 cases. If the number of patients crosses 3,000, we will use 1,500 beds at GTB (Guru Tegh Bahadur) hospital, following which we will have arrangements for 4,500 cases,” Kejriwal said.

“In this manner, we can go up to 30,000 beds if needed. We will have 8,000 beds at hospitals,12,000 hotel rooms will be taken over, and around 10,000 patients will be kept in banquet halls and dharamshalas. Most serious patients with heart, liver, cancer, diabetes and above 50 years of age will be kept in hospitals. Patients below 50 years and with minor symptoms will be kept in hotels and dharamshalas, but with all medical facilities,” he added.

A spokesperson at Max Healthcare said: “We believe that to fight the Covid-19 pandemic, it is essential for us to have dedicated hospitals. We are working closely with the Govt of Delhi and have established a dedicated COVID 19 facility at Max Hospital Saket, East Block.”

A review of Delhi’s preparedness by a five-member expert panel recently showed that Delhi’s current facilities would be able to handle 100 cases of Covid-19 every day. While detailing the findings of the review, Kejriwal had said that the Capital needed to be ready for the worst scenario and that his government was in the process of ramping up the health care infrastructure.

Experts maintain that it important for Delhi to massively upgrade its infrastructure to pre-empt a crisis similar to the one that has befallen New York, which has in the past boasted of hi-tech hospitals. With the Covid-19 cases skyrocketing, New York’s health care system is overwhelmed and teetering on the brink of collapse.

Late in March, New York City mayor Bill de Blasio said that the strained health care system had the personnel and supplies to make it through only one more week, but beyond that, things appeared uncertain.

In Delhi, Kejriwal said that 400 ventilators and 1,200 oxygen beds will be needed if there are 30,000 active patients in Delhi and arrangements were being made.

“Calculations have been done regarding PPE (personal protective equipment) kits. It has been an area of concern. We have received help from the Centre and we have placed an order for the kits which we’ll start to receive from next week. The Centre will be providing 27,000 PPE kits to us,” said Kejriwal.

The CM said that the fourth T was teamwork, and stressed on cooperation between the Centre and state governments, and the public and health care professions.

The fifth T, he said, is tracking and monitoring. “I have spoken so much, but these things need to be tracked and monitored as well and it’s my responsibility to track the moment-to-moment plan we have prepared. I am tracking it 24 hours. We can win this battle as a team if we remain three steps ahead of Covid-19,” he added.

A senior official in the chief minister’s office said that Kejriwal’s first briefing every day is scheduled through a conference call with the health department at 10am. It is compulsory for the health minister, the chief secretary and the health secretary to be part of it. Usually, he prepares his briefs and joins the lieutenant governor’s meeting after that through video-conferencing. Later in the day, the CM heads review meetings with representatives of the state task force that he heads, the official said on condition of anonymity.

Health experts and private hospitals welcomed the action plan presented on Tuesday.

Nevin Kishore, head of the bronchology department at Delhi’s Max Hospital, said: “Random tests are important to understand the burden of the disease and the severity of the patients who are positive. Such understanding helps in designing predictive models for prevention, something very crucial in the next 7-10 days.”

Vikas Maurya, head of the pulmonology at Delhi’s Fortis Hospital, said: “Rapid antibody tests result is a faster diagnosis. It is faster, cheaper and accurate – a smart way strategy in dealing with a large number of potential patients in cluster hotspots. There is one issue. This test is more accurate when dealing with a person who is infected for at least 8-9 days. Negative results may require repetition of tests after certain intervals.”

Charu Hans, former head of the microbiology department at Delhi’s Ram Manohar Lohia Hospital, said: “We have limited resources, so we need a smart strategy. One has to have a clear protocol on what nature of individuals is to be tested under the said strategy. At this juncture, it is recommended to conduct tests only among symptomatic individuals in hot spots.”

Jugal Kishore, head of the department, community medicine, at Delhi’s Safdarjung Hospital, said: “Simple random sampling is a scientific method and can provide a signal on possible community spread. But, when there is a resource constraint; the government should explore the possibility of conducting snowball sampling.”

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Wednesday, December 01, 2021