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The whole world is now under the Coronavirus pandemic and more than 3 months have already passed since December when its first case was seen. After declaring COVID-19 as a pandemic by WHO on 11th March, 2020 it has advised countries to take a whole-of-government, whole-of-society approach, built around a comprehensive strategy to prevent infections, save lives and minimize impact. While, earlier the focus of spread was centred on China, it has now spread to over 200 countries/territories, with reports of local transmission happening in more than 160 of these countries/territories.
As in India the rate of spreading has increased as it started doubling of cases in 3-4 days. Thus, government realized to take another step for preventing this Pandemic and on 4TH April the Ministry of Health and Family Welfare (MoHFW) released the plan i.e. Containment Plan for large outbreak. The document discuss the approach and highlights the actions that are required for containment. This plan is a necessary guidance document that have details of the contours of actions to be taken on the health and administrative front in case there is a large outbreak of coronavirus infections.
- Why is it introduced?
As government has found in India also, clusters have appeared in multiple States, particularly Kerala, Maharashtra, Rajasthan, Uttar Pradesh, Delhi, Punjab, Karnataka, Telangana and UT of Ladakh. 211 districts are now reporting COVID-19 cases and the risk of further spread remains very high. The central government has brought out this plan to stop the chain of transmission and reduce morbidity and deaths.
According to the document, in alignment with strategic approach, this document provides action that needs to be taken for containing a large outbreak. A large outbreak can be defined as a localised increase in the incidence of coronavirus cases occurring within a defined geographic area and it can happen within a village, town or even a big city. The document characterises it as a progression of a small cluster into bigger, multiple clusters.
Document/plan talks about Strategic approach, scope, objective, action plan, surveillance, clinical management, psychosocial support, pharmaceutical intervention, non- pharmaceutical intervention, material logistics, risk communication, information management, capacity building, financing of containment operation, scaling down of operation. So, the containment plan is detailed measures which need to be taken for different kinds of transmissions and it explains the actions to be taken to curb a large outbreak.
- Salient feature
This ‘Containment Plan for Large Outbreak’ is a guidance document for both health and administrative measures as according to experts such a guidance document is necessary because it puts in place a well-defined strategy. So, it has some salient features as follows: –
- According to the containment plan, India is following a scenario-based approach, based on five possible situations: (a.) Travel related case reported in India (b.) Local transmission of COVID19 c.) Large outbreaks amenable to containment d.) Wide-spread community transmission of COVID19 disease e.) India becomes endemic for COVID19
- Early detection, surveillance and contact tracing for those who have travelled from affected countries, early diagnosis, making of PPE stock and risk communication for creating awareness are the Strategic approach for the Scenario: “Travel related cases reported from India”.
- The strategy for large outbreaks amenable to containment are Geographic quarantine and containment strategy and for these two strategy would run tighter. As firstly defining geographic area by early detection of cases and then “barrier has to be erected around the focus of infection” which would ultimately help in preventing its spread to new areas.
- The Cluster Containment Strategy includes geographic quarantine, social distancing measures, enhanced active surveillance, testing all suspected cases, isolation of cases, quarantine of contacts and risk communication to create awareness among public on preventive public health measures.
- Differential approach to different regions of the country: – the report says that the current geographic distribution of COVID-19 mimics the distribution of H1N1 Pandemic Influenza. As during the H1N1 Influenza pandemic it was observed that well connected big cities with substantive population movement were reporting large number of cases, whereas rural areas and smaller towns with low population densities and relatively poor road/ rail/ airway connectivity were reporting only few cases. Thus, while the spread of COVID-19 in our population could be high, it’s unlikely that it will be uniformly affecting all parts of the country as said in the plan.
- Some of the Acts/ Rules for providing legal support to implement the containment plan are (i) Disaster Management Act (2005) (ii) Epidemic Act (1897) (iii) Cr.PC and (iv) State Specific Public Health Act.
- The plan includes Institutional mechanisms and Inter-Sectoral Co-ordination at Union level, State level and Institutional arrangement at the operational level.
- On increase in the incidence of a COVID-19 cases, Epidemiological intelligence will be triggered for the action which will be provided by IDSPs early warning and response (EWAR) system. Routine laboratory based surveillance of SARI cases is another trigger for action.
- Emergency Medical Relief (EMR) division, Ministry of Health and Family Welfare will deploy the Central Rapid Response Team (RRT) to support and advice the State. The State will deploy its own State RRT and District RRT.
- All suspect/confirmed COVID-19 cases will be hospitalized and kept in isolation in dedicated COVID-19 hospitals/hospital blocks. The identified VRDL network laboratories and designated private laboratories nearest to the affected area, will be further strengthened to test samples
- The National Institute of Mental Health and Neuro Sciences (NIMHANS) will be the nodal agency to plan and execute psycho-social support. NIHMANS will prepare a Psycho-Social Support plan and implement the same in the COVID affected areas.
- Hydroxychloroquine has been recommended as chemoprophylaxis drug for use by asymptomatic healthcare workers managing COVID-19 cases and asymptomatic contacts of confirmed COVID-19 cases (however till now there is no approved specific drug or vaccine for cure or prevention of COVID-19).
- In the absence of proven drug or vaccine, non-pharmaceutical interventions which includes Preventive public health measures, Quarantine and isolation, Social distancing measures be the main stay for containment of COVID-19 cluster.
- Under the heading of ‘Material Logistics’; Personal Protective Equipment (PPE), Transportation for mobilizing the surveillance and supervisory teams, Stay arrangements for the field staff, Bio-medical waste management would be done.
- The communication of risk is also necessary and thus the plan includes Risk communication material: (i) posters and pamphlets (ii) audio only material (iii) AV films (prepared by PIB/MoHFW)] for targeted roll out in the entire geographic quarantine zone & Communication channels includes: Interpersonal communication, Mass communication, dedicated helpline, Media Management.
- Plan also includes tasks of capacity building which comprises of training content, targeting trainee population, replication of training in unaffected districts.
- The operations will be scaled down if no secondary laboratory confirmed COVID-19 case is reported from the geographic quarantine zone for at least four weeks after the last confirmed test has been isolated and all his contacts have been followed up for 28 days.
- If the containment plan is not able to contain the outbreak and large numbers of cases start appearing, then a decision will need to be taken by State administration to abandon the containment plan and start on mitigation activities.
- Critical analysis
The spreading of corona virus in India, till now, can be said to be in control as compared to the developed countries. In the large number of population of 130 million people the number is small but still the implementation of the plan have some deficiencies. These deficiencies can be said to be in the timing/ release (even not very late) of this Containment plan as well as not properly implementation of plan. Implementation of such type of plan must requires observation of the status quo of the place, social context in which the plan in implementing.
Firstly on the question why the plan came approx. 10 days late and why it should come up with the lockdown itself. This is because government has not analysed how much people has come from the abroad and it was utmost requirement from the government side as if they have found it earlier then perhaps the Cases like ‘Tablighi Jamaat’ (where they failed to detect the hotspot) could be solved easily. The areas may have option to quarantine (geographic quarantine) earlier and they may have not reached other parts of the country.
Now, it has come out that many foreigners have come to India and they have participated in religious events, however visas was not issued for that purpose. If government have taken into consideration the number of people have visited India from foreign they might have taken the decision to cancel the international commercial flights earlier (22 March). Also it is defect for the administration that they unable to know that larger number of jamaatis were residing at a place. Considering the large number of population and development level of country this plan should have come up with the lockdown for early effectiveness. However, plan able to recover it but that would be a remark for the future as it should be first task of any State that they must know how many people have visited their country which are essential to know to stop spread of viruses in these types of global pandemic.
Now, on the second question why this plan was not properly implemented. Plan which came after 10 days of lockdown could be said to properly implement if it has taken into consideration of the social context as well development level of India. After the lockdown it has come into news that hundreds of thousands of migrant laborers have begun long journeys on foot to get home, having been rendered homeless and jobless, and then it was necessary that there must be some plan before the news spread for giving them proper shelter and basic needs. Only announcement of plan doesn’t itself solve the problem. Government later have taken the decision to provide the necessary things but it was requirement from their side much earlier. When one people starts travelling other after seeing him encourage and this continues and the idea to erect the barrier hit.
Further government was aware that the number of tests that happened in country till then were very less and that might be causes of less number of corona patients, but still they have not came with this plan earlier. The transmission at local level have not developed despite many places social gathering has taken place, from now or from next time it is very important to take in consideration the social context at different level. It also requires analysis by bifurcation of the different occupations of people like how much people earning depend on daily wages because they may not die from Corona but they may die from Hunger.
The rate of Corona virus patient is still rising but we are fortunate that India has not reached the third stages of this pandemic but realising the population level it is important to take one step early every time. Taking decision one step early is not about proper planning rather necessity in context of India where there is lack of awareness. Secondly, there are large number of people working on daily basis wages and any decision of lockdown or this type of plan affects them the maximum and thus it is important to analyse for future that if such stages comes how their lives can be saved.
Further it is also time to take steps for the future that people must understands the terms like quarantine, lockdown, social distancing etc. so that they may not panic. Still a long way to go for fighting with this Corona Virus but we need to be cautious, and take decisive actions. The best thing to do is to properly implement this plan with the maximum support of people by giving them confidence, with a long vision to tackle the circumstances, Patience and control over oneself we can and we will win over Corona.
Author: Shashank Shekhar from Central University of South Bihar.
Editor: Tamanna Gupta from RGNUL, Patiala.