- Gujarat reported the first 2 cases of COVID-19 on March 19 in Surat, Rajkot
- Ahmedabad city became the first Coronavirus hotspot in Gujarat
- Currently, Surat and Vadodara are witnessing a rise in COVID-19 cases
New Delhi: “Gujarat’s situation is better in comparison to other states”, claimed Chief Minister Vijay Rupani on July 30, citing the increment in recoveries from COVID-19 and a decline in fatality rate. As on August 6, Gujarat had a recovery rate of 74.14 per cent which is higher than the national average of 67.61 per cent. However, the mortality rate which was and is the highest in the country seems to be pulling down the state’s response to the Coronavirus pandemic. In the last two months, case fatality rate in the state has dropped down from 6.16 per cent (May 30) to 3.83 per cent now. The current death rate due to COVID-19 is almost double the India’s death rate of 2.07 per cent.
Gujarat reported the first two cases of COVID-19 on March 19 in Surat and Rajkot. One was a woman from Surat who had returned from New York and another patient was a man from Rajkot, who had returned from Mecca. Since then the COVID-19 case curve has only headed North with more cases being reported every day. From July 21, the state started to report over 1,000 fresh cases daily. On the same day the state saw its biggest single-day spike in the number of deaths, with 34 recorded deaths.
At the initial stage of the pandemic, Ahmedabad city was considered as the Coronavirus hotspot with over 70 per cent of the cases but over time, new COVID-19 hotspots have cropped up. Here is how the pandemic unfolded in Prime Minister Narendra Modi’s home state Gujarat.
Ahmedabad’s COVID-19 Trajectory: Gujarat’s Worst Affected District And Once A Hotspot
In the latter half of April, Ahmedabad started to witness a surge in COVID-19 cases and on May 16, it reported a total of 5,106 cases of COVID-19. Back then Ahmedabad accounted for 70 per cent of the COVID-19 cases in Gujarat and was titled as the Coronavirus hotspot. Explaining the reason behind the peak and fast spread of SARS-CoV-2 in Ahmedabad, Padma Shri Awardee, Dr KK Aggarwal, President CMAAO (Confederation of Medical Associations in Asia and Oceania) and Medtalks, HCFI (Heart Care Foundation of India) and Past National President IMA (Indian Medical Association), said,
The outbreak first started in the densely populated old Ahmedabad (the walled city); the peak of illness was seen in last week of April and early May. Clusters in the densely populated old city area of Ahmedabad, with its many narrow by lanes, led to a spike in the number of cases. Therefore, any case detected here would already have potentially spread the infection to several others in the area.
According to Dr Mona Desai, President, Ahemdabad Medical Association, two more reasons contributed to the peak in cases – Markaz event in Delhi and the fear among people. Elaborating on the same, Dr Desai said,
A group of people attended a religious event in Delhi and when they entered Ahmedabad city, they all hid. So they became super spreaders. Also, at an early stage of the pandemic, people were afraid of coming out of their house. Whenever someone visited the hospital, it was already late and they showed serious symptoms of COVID-19 like breathlessness.
To contain the spread of COVID-19 in the city, the Corporation declared hotspots as containment zones and movement was restricted. According to Dr Mona Desai, the stringent containment measures helped. However, a senior public health expert from Gujarat who chooses to be anonymous believes that people were still travelling inside containment zones. Also, because of the restrictions, all local medical services that is private clinics and public health centres were closed. In the interiors of the city people had no medical access which further led to deaths.
Ahmedabad city has been divided into seven zones – Central; North; South; West; East; South West; North West. At the initial stage of the outbreak, central zone was worst affected; there also Jamalpur district was the biggest hotspot. But now, central zone accounts for mere 9.7 per cent of the active cases in Ahmedabad. The virus is now spreading to other zones and currently, North West Zone has the maximum active COVID-19 cases (548) followed by West Zone with 531 cases and South West Zone with 473 cases.
From having over 5,000 active cases in mid-May, to now 3,088 cases (August 5, 11 am), overall, COVID-19 cases have seen a decline in Ahmedabad.
The need for hospitalisation is reducing. When the infection was at its peak, a 1200-bed civil hospital had over 1000 occupancy; since the last 3 weeks, this has decreased to around 248. Another 800-bed civil hospital had more than 700 occupancy; this has now (July 29) reduced to around 250 in the last 3 weeks. These are dedicated COVID hospitals, informed Dr KK Aggarwal.
But the virus is now moving to other parts of the state including Surat, Vadodara, Rajkot, Bhavnagar, Gandhinagar and other districts.
Surat And Vadodara, New Hotspots Crop Up In Gujarat
As on August 5, the active COVID-19 cases in Surat (3,899 cases) have surpassed Ahmedabad (3,631 cases). Since the start of the Unlock 1 in June, Surat, the diamond city of India, started to report a sudden rise in cases. When asked about the same, Dr Ritika Patel, Medical Officer, Surat Municipal Corporation said,
The rise in cases is linked to unlock which came with relaxations in the movement of people. The more people will step out and interact with each other, the more cases will come. The majority of the cases are coming from diamond unit and textile market because they are now open. Also, in Surat, the majority of the population is migrant labourers. We are now getting cases in slums where community behaviour and lack of knowledge are acting as a roadblock.
Dr Mona Desai agreed with the reasons given by Surat Municipal Corporation and said that the workers at diamond industry are not well educated, people there are not following precautionary measures like wearing face mask.
Further talking about the measures being taken to control the spread, Dr Ritika Patel said,
If one COVID-19 case emerges in any diamond unit, then that particular floor or section will be shut for a week. If three COVID-19 cases emerge, then the entire unit or factory will be shut for one week.
‘Surat is becoming worst’, said Dr Mona Desai and suggested to follow the Ahmedabad model that is to find out the hotspots, and curb movement. She said,
You have to take some harsh decisions somewhere for the betterment. Don’t let people come out and become super spreaders. Testing will help you in knowing if someone is positive or not. But containment will help you in finding asymptomatic cases also. Because you are not going to test asymptomatic but they can become spreader.
Apart from Surat, as on August 5, Vadodara has 1,045 active cases of COVID-19 and is the third worst affected district in Gujarat. Vadodara also started seeing a spike in cases around unlock period and in the last two months, the active cases have more than doubled; from 393 on May 31 to 1,045 now.
In terms of active cases, Vadodara is followed by Rajkot having 940 cases and the number is expected to rise in the coming days.
Talking about the virus spreading to other parts of the state which were kind of untouched until few weeks ago, Dr Maharshi Desai, Critical Care Specialist, Apollo Hospital and a member of Gujarat COVID task force, said,
This kind of phenomenon has been observed everywhere; the number of cases have reduced in the erstwhile hotspots and other areas which were not affected are catching up. When the outbreak began, Delhi, Mumbai, and Ahmedabad were hotspots. Now in all these areas, things seem to be getting better and other areas like Bengaluru are turning into hotspot. Gujarat is no different.
Challenges In Gujarat’s Initial Response To Coronavirus Pandemic
Both Dr Mona Desai and a senior public health expert from Gujarat believes that fear among people was one of the biggest challenges at the initial stage. The fear of contracting the virus and the perception that one will die of it, stopped people from seeking treatment. Now, the fear has gone down, say experts.
Now they have realised that coronavirus is not so deadly. If they come early, we can treat them. If you come late, nobody can do anything, said Dr Mona Desai.
Another challenge as cited by Dr KK Aggarwal was of the healthcare workers and infrastructure. Earlier, the government was providing COVID-19 treatment only at government hospitals and no private hospitals were involved. Talking about its implications, Dr KK Aggarwal said,
Government hospitals were overwhelmed with the increasing number of patients; the problem was further compounded by the lack of personal protective equipment (PPEs), shortage of ventilators, ICUs and isolating wards. The high court had to intervene for the private health sector to start treating COVID patients. Private health sector came in only following intervention of the high court, which passed an order that made it mandatory for private hospitals to reserve 50 per cent of their beds to treat COVID-19 patients.
Currently, the government has taken over 50 per cent of the beds at 42 private hospitals. Dr Mona Desai believes that with the intervention of the private sector, the quality of treatment and service has improved.
In the fight against COVID-19, various firms have come forward with innovations and low-cost medical equipment to cater to the COVID-19 patients and contain the spread of SARS-CoV-2. In April, Rajkot based firm Jyoti CNC Automation Limited claimed to have developed low-cost ventilators ‘Dhaman-1’ in just 10 days. On April 4, CM Vijay Rupani inaugurated the indigenous ventilators at Ahmedabad Civil Hospital. According to the official press note, the manufacturing cost of Dhaman-1 is less than Rs. 1 lakh per piece. However, in May, Ahmedabad Mirror broke the news of ‘fake ventilators’ and reported that breathing apparatus inaugurated by CM and 900 ventilators already installed at several government hospitals are not ventilators per se, rather AMBU (Artificial Manual Breathing Unit) bag. The Ahmedabad Mirror also reported that ‘fake ventilators’ do not have the mandatory license from Drug Controller General of India. Also, the trial was conducted on only one patient and no ethical committee was formed to monitor the device. The manufacturers have admitted that these are not ventilators but the government promoted it as ventilators.
The report raised questions over Gujarat’s overall model of development and its ability to fight the Coronavirus and the state’s ability to tide over the crisis.
Renu Khanna, member of the Jan Swasthya Abhiyan, a national platform of health activists said that a challenge was and still exists in rural areas where people are misinformed which is leading to panic and worry. She added,
How do you follow guidelines, maintain hygiene and social distancing where women have to step out of the house and walk miles to fetch water? Women are becoming more vulnerable to contracting the disease.
COVID-19 Testing And Healthcare Infrastructure
Initially, the government had a restrictive testing policy according to which patients willing to undergo RT-PCR test had to take permission from Chief District Medical Officer (CDHO). Explaining the cons of the policy, Dr Mona Desai said,
CDHO will take two to five days to give approval and may not give only. 10 patients would apply for approval for COVID test and only three would get it. A patient with serious health conditions cannot wait for this long. Either patient’s condition will deteriorate or he/she will die. Also, how will a CDHO sitting kilometres away know about a patient’s condition?
Ahmedabad Medical Association challenged the policy and on May 26 filed a plea in the high court to allow treating doctor to take the decision whether COVID test is required or not. The High Court gave a go ahead on May 29 and said that treating doctor can send patients for RT-PCR testing without any approval. They just need to give intimation to the concerned authorities.
Dr Mona Desai says, the state government took another two weeks to agree on it but at least now the testing scenario has improved.
Dr KK Aggarwal believes the restrictive testing policy was a factor for the low testing in the state. As opposed to this, Dr Maharshi Desai thinks the policy didn’t do much harm as it was rescinded immediately.
In March, the state conducted a little over 1,200 tests whereas in April close to 70,000 tests were done and in May over 1.39 lakh. Over time, the testing has increased substantially but tests per million (13,151) are still low when compared to national average of 15,966 tests.
Further talking about the infrastructure, Dr KK Aggarwal said,
Lack of public healthcare infrastructure has been an important factor in the spread of the disease. According to the Union health ministry’s Rural Health Statistics 2019 data, Gujarat has just 704 active PHCs (public health centres) and the number of urban PHCs is 50 per cent less than what is required. If available, these could have served as isolation facilities. Gujarat only has 0.3 beds for every 1,000 people, amounting to 20,172 government hospital beds, below the national average of 0.55 beds per 1,000 population (7,13,986 total government hospital beds) as per National Health Profile 2019. Initially, there was a shortage of good quality PPE kits, but now they are being manufactured in the state itself and are more than adequate in supply.
As per the information shared by the state health department, four special COVID hospitals are operationalised at Ahmedabad (1,200 beds), Surat (500 beds), Rajkot (250 beds) and Vadodara (250 beds). The state has 484 hospitals providing treatment to COVID-19 patients; the facilities are divided into category 1, 2 and 3 hospitals. Explaining the difference between three kinds of hospitals, a senior officer looking into COVID-19 in the state said,
There are 151 category 1 hospitals, completely COVID-19 designated facilities; these hospitals are fully equipped in terms of oxygen supported beds, ICU beds, ventilators and staff. Category 2 and 3 hospitals have basic medical facilities available for pre-symptomatic or mildly symptomatic patients of COVID-19.
Dhanvanatri Raths And Awareness Campaigns Prove To Be A Boon
To create awareness about the pandemic and the ways to deal with it, the state health department undertook IEC (Information, Education and Communication) activities including short videos, radio jingles, newspaper advertisements, and hoardings.
To provide 24×7 help to citizens and address their concerns, Gujarat started helpline for COVID-19 with phone number 079-23250818 and WhatsApp number 7433000104. It also introduced a toll-free helpline – 104 and 1100.
People showing symptom of COVID-19 and wishing to get a test done at home can call the 104 helpline. A van consisting of doctors and paramedics will come and conduct an antigen test.
To enhance testing and diagnosis in the state, especially rural areas and smaller towns, 125 mobile medical vans called as ‘Dhanvanatri Raths’ were introduced. Each van consists of a doctor, a nurse and a paramedic. The mobile clinic goes from one area to another and conducts Rapid Antigen Test. The mobile clinic also conducts other tests like blood sugar and identifies high-risk patients.
Along with this, Ahmedabad Municipal Corporation has started ‘Corona Ghar Seva: Sanjivani Van’. As part of the initiative, every alternate day, paramedics visit COVID-19 patients in home isolation and check for their symptoms.
Initiatives like mobile medical vans (called Dhanvanatri Raths), 104 helpline for symptomatic people who want home testing, Sanjivani Ghar Seva to track COVID patients under home isolation have facilitated early detection and cure of the cases, said Dr KK Aggarwal.
How Should Gujarat Move Ahead In Its Fight Against COVID-19?
Dr Mona Desai suggests 3Ts trace COVID patients, test and treat and ask citizens to follow precautionary measures. She said,
People have to take care of wearing mask, hand washing, social distancing. They have started moving as if nothing is happening.
As the Novel Coronavirus gets its roots strong, Dr Maharshi Desai recommends focusing on smaller villages and towns. He said,
Now the way things are, it is going into tier 2 and tier 3 cities and towns wherein the healthcare accessibility might be less robust than in the cities. So, we need to focus on managing the cases there. Less severe COVID-19 cases can be treated at home so that severe cases can be recommended to special hospitals.
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