- As on June 30, Rajasthan had 17,660 active COVID-19 cases
- Rajasthan has dedicated 407 hospitals for treatment of COVID-19
- The state is testing over 15,000 people per day
New Delhi: Three out of four people in the desert state of Rajasthan live in rural areas. But large parts of rural Rajasthan remains unaffected by the COVID-19 pandemic, even as the outbreak has spread across all the 33 districts of the state. So far it is mostly the cities where people have gotten infected, with capital Jaipur being the worst affected district. During the initial days of pandemic in March, the state has received praises for controlling the coronavirus spread in Bhilwara which became Rajasthan’s first epicenter. However, another epicenter, Ramganj in Jaipur, soon cropped up in April which continues to be a challenge even now. Along with containing infection in Ramganj, there are new hotspots coming up in several districts in the state. Here is how the state is fighting the challenges of COVID-19 pandemic.
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Big Jump In Cases In April, Jaipur Became The Worst-Affected District
The first case of COVID-19 in Rajasthan was reported on March 2 in Jaipur of a 69-year-old Italian tourist. Two days later, his wife also tested positive. This brought panic among the health authorities and people of Rajasthan because the couple was part of a group of 23 people from Italy who had travelled to numerous locations in the state. On March 11, an 85-year-old man in Jaipur tested positive who had a travel history to Dubai, according to the Health Department of Rajasthan. By the end of March, the state had 93 cases, mostly traced back to those who had a travel history to COVID-19 hit countries.
On April 2, one month after the state recorded its first case, the total number of positive cases was 108. The month saw a significant spike across the state as the number increased to 2,438, despite the lockdown. This surge, according to Chhaya Pachauli, member of the Jan Swasthya Abhiyan (JSA)- a national platform of health activists, can be attributed to the influx of migrant workers, evacuees from foreign countries, participants returning from religious gatherings and the unfortunate outbreak in Bhilwara when three doctors in a private hospital were tested positive. The number of positive cases went up almost four times by the end of May and almost six times the April 30 figure by June 20. According to Ms. Pachauli, this increase in the number of cases maybe because of the increased testing and transmission caused by the movement of people after easing of the lockdown.
Further looking into the trend of rising cases shows that Rajasthan has a doubling rate of infections every 28 days which is better than the national average of 23 days.
While all the districts of the state have reported COVID-19 cases, Jaipur with a total of 2,797 cases has been the worst-hit district. Jaipur is followed by the districts of Jodhpur and Bharatpur with 2,377 and 1,316 cases respectively. According to an official of R. B. M. Government Hospital in Bharatpur, the situation in the district is a matter of concern right now. He said,
We had some problems in the last seven days because a major vegetable supply chain got infected- the producer, the intermediaries, vegetable vendors and people who bought vegetables from them. There was also a heavy migrant influx. Also, there is still a lack of awareness among people. It is challenging but we get enough support from the state government and so we are certain that we will be able to face it and bring the number down.
As of June 30, Rajasthan has reported a total of 17,660 positive cases, including 3,637active cases. The total fatalities as on June 30 are 405 deaths which is about 2.3 per cent of total cases, a little less than the national average of more than 3.5 per cent. The state has been able to cure 13,618people 77 per cent of total cases, much higher than the national average of over 56 per cent, according to the data reported by the Department of Medical, Health and Family Welfare of Rajasthan.
According to Rohit Umar Singh, Additional Chief Secretary (Medical and Health), Government of Rajasthan, who is steering the health workforce in to tackle COVID-19 and control the spread of the novel coronavirus in the state, over 70 per cent people who died were suffering from co-morbid conditions which refers to the presence of one or more additional physiological or psychological conditions like hypertension, diabetes, liver-issues among others.
He highlighted that the state that two-prong strategy to reduce mortality and improve recovery. He said,
Our first strategy is aggressive testing where we identify the patient early and treat them. The second is focusing on the vulnerable persons for which we have started a programme called Mission LISA (Life Saving). Under this program, we identify the most vulnerable groups like the elderlies and those with comorbidities and focus on saving their lives. For this we use the database of the insurance scheme AYUSHMAN Bharat to find those who are vulnerable and check their oxygen levels frequently and monitor them regularly for symptoms.
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Strategies For Tackling COVID-19 Epicenter- Bhilwara District And Current Epicenter Ramganj Area Of Jaipur
Rajasthan health authorities have received accolades for controlling the virus spread in the district of Bhilwara that emerged as the first epicentre of the state but it met with a new challenge in Ramganj, an area in Jaipur’s congested walled city area. According to Dr. Nesar Ahmed, Director, Budget Analysis and Research Centre (BARC), both case studies have different characteristics. He said,
In Bhilwara, three doctors got infected and became super spreaders infecting the people in the hospital and those who came to see them for treatment. In Ramganj on the other hand, it was a 45-year-old man who had returned from Oman, tested positive and by the end of April, more than 200 cases were traced back to him. The similarity between the two cases is the negligence of the infected persons caused the outbreak.
While explaining about the state’s response in tackling both cases, Mr. Singh said that in Bhilwara, teams were sent quickly to impose complete lockdown and the infected persons were isolated immediately. He said,
We followed the strategy of ruthless containment in Bilwara. Measures were implemented in a strict manner. The district administration also played an important role in managing things and ensuring the supply of essential items like milk and vegetables. Even local people supported us to prevent infection. Each and every person, every household was visited and asked about their symptoms which led to an identification of 14,000 people who has influenza-like conditions. We kept track of them and if anyone showed the COVID-19 symptoms, along with a history of contact or travel, he or she was isolated. We have followed a very structured standard operating procedure in Bhilwara.
On the other hand, Ramganj which is an urban slum area dominated by minority communities is densely populated, making it difficult for them to practice social distancing. According to Nishant Hussain, convener of National Muslim Women’s Welfare Society and a resident of Ramganj,
Here the situation is extremely unstable and worrying. Most people here are economically weak and are involved in the traditional art of ‘Rajasthani Juti’ making. In most houses here, big families of 15-20 people live together. There should have been testing of each person here but instead of this, the health department put so many people in quarantine centres. These quarantine centres were so shabby and lacked basic facilities. A large number of people were sharing the same toilet. There were pregnant women, children and even senior citizens who were in these quarantine centres. Our biggest concern was that people will catch COVID-19 in these centres and who will take responsibility for that? We then protested and forced the local MLA (Member of Legislative Assembly) to intervene and at least allow the vulnerable persons out from the centres.
Ms. Hussain further highlighted that because of the lockdown, people were not earning anything and while the government was distributing ration, it was not adequate for the whole month. She said,
When it comes to public welfare, along with government, individuals, NGOs and corporates need to come together. But in Ramganj, people who were willing to distribute ration kits and food packets were not given permission by the state. They only know why they did this? People have been suffering here for the past three months.
On the response of the state in handling Ramganj case, an official from the state health department said that home quarantining was risky for the people living in the area as lakhs of people live in 1-2 square kilometre zone. He said,
For Ramganj, that has around five lakh population, we adopted a different strategy. Contrary to Bhilwara, we couldn’t implement home quarantine in Jaipur as one individual may infect others. We had to take them away to institutional quarantine facility because there was a need for quarantining a far larger number of people. While there is a risk of community transmission in Ramganj, we have ramped up testing and we are isolating and treating the patients, while implementing a strict lockdown in the area. More than 600 people have been cured already out of almost 700 people who got infected since March.
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Testing Has Been Significantly Ramped Up In The State
With no testing facility in March when initial cases were reported, the test samples were being sent to the National Institute of Virology (NIV), Pune. The testing was improved in April and now more than 15,000 people are being tested every day. The state also holds a capacity of conducting 25,000 tests per day but Mr. Singh said that it is not required as of now. Rajasthan has conducted 6.5 lakh test till now. This accounts to over 10,445 tests per million people, as on July 6, according to the Department of Medical, Health and Family Welfare which is more than the national average of over 6,859 tests per million people.
The state has been charging no money for tests done in government facilities and a cap of Rs.2,200 per test has been put on testing in private facilities which was Rs. 4,500 earlier. However, according to Mr. Singh, only a few tests have been done in private labs while more than 6 lakh tests have been done in government facilities free of cost. On availability of testing kits and infrastructure, Mr. Singh said,
We are sourcing testing kits from ICMR and are also parallelly talking to private suppliers. Unlike central guidelines that say that symptomatic persons and contacts of COVID-19 patients should be tested, we are testing anybody who needs to be tested. Initially, there was a challenge but now there is no constraint. This is, in fact, vital for early detection and thus helpful in the containment of the disease.
Currently, testing is being conducted at 21 places–14 medical colleges, AIIMS Jodhpur and Desert Medicine Research Centre. Out of these, three facilities are private and others are under the government.
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Rajasthan’s Health Infrastructure
Mr. Singh said that Rajasthan’s Health Department has been able to utilize the crisis as an opportunity to augment the health setup in the state especially the life-saving infrastructure like oxygen ICU, ventilators and others. He added,
The Government’s focus is to augment health infrastructure. We have more than enough beds. The active cases in Rajasthan for the last 20 days is less than 3000 and out of the active cases, more than 900 are at home because they are otherwise healthy asymptomatic patients. So the hospital requirement is within 2,000 and against that we have 44,000 beds. All district hospitals in the state have at least oxygen supplies. By July all the sub-district hospitals will also have oxygen supply.
According to Rajasthan’s Health Department, as of June 25, there are 407 hospitals treating COVID-19 and have a total of 44,000 beds dedicated to COVID-19 patients. Apart from this, there are 8,100 beds with oxygen support, 1,700 ICU (Intensive Care Unit) beds, and 900 ventilators.
While the state is fighting the pandemic, it has also launched a home-delivery medical facility with an aim to provide health support to non-COVID patients. The state started this facility on April 22 under which it has deployed 515 mobile OPD (Outpatient Department) vans with doctors, paramedic staff and medicines. These vans go into the slums and rural areas and provide diagnosis and medicines to those in need. According to the Department of Medical, Health and Family Welfare, since its launch the facility has conducted more than 10 lakh OPDs and medicine delivery. The aim is to provide medical assistance at people’s home itself so that they do not have to rush to clinics and hospitals during the pandemic, said a health department official.
The officials also highlighted that there may be more deaths in the state because of Tuberculosis (TB) than from COVID-19 as the state has a high proportion of the population involved in stone mining which causes diseases like TB, silicosis and other respiratory diseases. Therefore, the state is also focusing on treating TB patients in the state.
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Efforts Taken To Address The COVID-19 Situation In The State
According to Mr. Singh, the state government started acting soon after the first case was reported. It imposed Section 144 across the entire state on March 19 restricting people to gather in groups. Measures included checks at railway stations and airports, sealing of the borders and the government shutting down its border in mid-March and implementing the lockdown on March 22, earlier than the nationwide lockdown. The government has also established helplines for the public. In a bid to ensure that people follow the safety protocols, the state government imposed fines on people for not wearing masks and not following social distancing.
Maternal And Child Care Challenges In The State During The Lockdown
According to the Additional Chief Secretary- Medical and Health, the large geographical size of the state was a big challenge for the state to deliver services like health, education, nutrition, vaccination and others especially in the remote areas. However, over the period of last three months, the state has been able to overcome this challenge, he added. He said,
Rajasthan is the biggest state in India in terms of geographical area, which makes the delivery of services a little difficult. We have to cover far distances to make services available. We were not able to do anything on nutrition, vaccination and maternal and child care front in April but now we have picked up the pace. The activities under the Maternal and Child Health Mission and POSHAN have now started. In the last two weeks, we have done almost 12,000 MCHN (Maternal and Child Health and Nutrition) Day sessions that happen every Thursday in every village of Rajasthan. Activities on MCHN days are outreach activities that include regular immunisation, antenatal care, postnatal checkups, iodine and other deficiency testing, promotion of breastfeeding and family planning with help of ANM (Auxiliary Nurse Midwife) and ASHAs (Accredited Social Health Activist). We have provided immunisation to over 50,000 pregnant women and 1 lakh children over the last week.
When NDTV reached out to local activists and frontline workers in various parts of the state, it was found that the nutrition and other rural healthcare services which were completely halted in March and April have slowly started coming back on track. Lali Dhakad, an Anganwadi worker in Kota said,
It was very confusing initially, whether to provide dry ration to children’s houses or not because we were scared of getting infected. There was a period initially when Anganwadi remained shut. However, since the mid of April, we have been providing dry ration to children’s house and even assist the government in conducting health and nutrition day and regular immunisation every week. We do this wearing a mask and taking all necessary precautions.
Chandrakala Sharma, Head of Ekal Nari Shakti Sangathan , an association for advocating for the right of single women- widowed, divorced, abandoned and unmarried, acknowledged the state government’s proactive approach in providing ration, food allowance called ‘Palanhar’ to the children of single women and pension to single women. She said,
It was encouraging to see those single women in rural areas were given pensions on time and were provided with ration including lentils on time without any problem, just the way it was happening pre-pandemic.
Vineet Bhambhu of Majdoor Kisan Shakti Sangathan (MKSS), an orgnaisation fighting for the rights of farmers and labourers, said that while ration cardholders were being provided to those with ration CARD, those without the card face a lot of problems initially. He said,
Most migrant workers suffered a lot during the first two months. It was only because of NGOs that they were able to survive. Things are getting a bit better for them now as they are being given work under MGNREGA (Mahatma Gandhi National Rural Employment Guarantee Act). But this may not last long because 100 days of employment provided under MGNREGA will get over soon. The government must plan something soon for providing employment to the labourers and daily wage earners who lost work during the lockdown.
According to Mr. Bhambhu, since the majority of farmers in the state are marginal farmers, they are able to grow only a little grains that get consumed by the family itself. Therefore, most farmers did not face problems related to selling their produce after harvest.
Ashwani Paliwal, Secretary of Udaipur based NGO Astha Sansthan has been, who has been working for the development of tribal communities +in Southern Rajasthan for more than a decade said,
In terms of nutrition and health of women and children in the tribal areas of Southern Rajasthan comprising of Udaipur, Bhilwara, Chittorgarh, Dungarpur and Banswara districts, a lot needs to be done by the government. A high rate of malnutrition among children here and anaemia among women was there in the tribal communities even before pandemic hit the country. They are a vulnerable and marginalised group of people who need extra support in terms of healthcare, food and finance. If we talk about the health services, immunisation that was happening earlier, I would say on that front we have come back on the track after initial problems caused due to the sudden lockdown and lack of awareness about the disease.
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Measures Undertaken By The State To Provide Relief To The Poor
According to the Food and Civil Supplies Department of Rajasthan Government, about 1.1 crore ration cardholders under National Food Security Act (NFSA) and over 95 Lakh non-NFSA people are being provided ration. Along with this, pensions under all social security schemes were paid by the first week of April and cash assistance of Rs 1,000 each is being given to 36 lakh BPL (Below Poverty Line) families as well as to 25 lakh construction workers and registered street vendors not covered by social security schemes.
Rajasthan has become the fourth state in the country to successfully perform plasma therapy for treating patients. Currently, two government hospitals and one private hospital has the capacity to treat patients from plasma therapy in the state. From being first to announce complete lockdown to improving testing from zero to over 10,000 tests per million which is higher than the national average and treating patients using plasma therapy, Rajasthan has taken up multiple measures to fight against the COVID-19 pandemic.
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NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.