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Covid-19: Bhilwara model aside, could India have managed outbreak better?

The Bhilwara model cannot hide the lackadaisical approach to monitoring international travelers and tourists

Bhilwara

An estimated 15 lakh people flew into India between January 18 and March 23, the day when India put a stop to all international arrivals. On January 21, the Civil Aviation Ministry directed that thermal screening of passengers arriving from China (including Hong Kong) be conducted at seven international airports; Delhi, Chennai, Mumbai, Kolkata, Bengaluru, Hyderabad and Cochin. Thermal cameras were installed in the pre-immigration area. But this screening was limited to people arriving from China. 

According to a press release by the Ministry of Health and Family Welfare (MoHFW) dated January 20, 2020, “As per WHO update (as of 11th January, 2020) in all, 41 cases of Novel Coronavirus have been reported so far from China [including one death (further update is awaited)]. As per WHO risk assessment, the risk for global spread, as of now, remains low.”

The press release also lists efforts made by the MoHFW in coordinating with other ministries and government department. This includes a letter to the Ministry of Civil Aviation (MoCA). It says, “MoHFW has written to Ministry of Civil Aviation (MoCA) to facilitate thermal screening at the International airports of Delhi, Mumbai, Kolkata, Chennai, Bengaluru, Hyderabad and Cochin for the airlines to follow International Civil Aviation Organization (ICAO) guidelines for managing and notifying anybody reporting illness on flights originating from China and disembarking in India.”

It adds, “MoHFW has also written to Ministry of External Affairs to provide details of travelers from Wuhan city who have sought visa to travel to India, since 31stDecember, 2019 and to counsel the applicants while issuing visa. They have also been requested to provide daily details. As for E-visa issue Ministry of Home Affairs is being approached.”

The entire press release may be read here: 

On January, the World Health Organisation (WHO) declared the coronavirus a global emergency. Within a few days, cases were reported from Philippines, Russia, Spain, Sweden, the United Kingdom, Australia, Canada, Germany, Japan, Singapore, the US, the UAE and Vietnam. 

However, screening of other international tourists and travelers began only from March 3. This after a man who travelled from Italy via Vienna entered the country without screening at Delhi airport on February 25 tested positive for the coronavirus on April 2. In fact, on April 3, Air India requested passengers of the February 25 AI 154 Vienna-Delhi flight to come forward for tests.

New rules by the DGCA expanded thermal screening to people arriving from 12 countries. These were China, South Korea, Japan, Italy, Hong Kong, Macau, Vietnam, Malaysia, Indonesia, Nepal, Thailand, Singapore and Taiwan. The DGCA also issued an advisory to airlines to disinfect aircraft arriving from an affected zone, and also cabin crew and operation staff at airports to wear protective gear.

Meanwhile, the Bureau of Immigration issued a directive saying that all foreign and Indian nationals entering India from any port were required to self-declare their travel history, and also provide particulars such as phone number and address of stay in India.

However, despite though measures being put in place at major airports to monitor and isolate people showing symptoms of a coronavirus infection, and such people also being placed under quarantine, many people found ways to beat the system. Instances of people allegedly popping paracetamol tablets to cover up symptoms like fever to dodge temperature guns were reported. There have also been cases of people leaving quarantine facilities because of abysmal hygiene standards.

Cases emerge in China, tourist season in full swing in India

A 55-year-old man from Hubei may have been the first reported case of Covid in China. On December 31, China reported to the World Health Organisation (WHO) several cases of an unknown virus affected people in Wuhan. Most of these people developed pneumonia like symptoms. On January 1, when the Huanan Seafood Wholesale Market was shutdown, China’s official number of infected people stood at 40. The country has been repeated accused of under-reporting cases of infections and deaths, charges China denies.

But what cannot be denied is that December, January and February are a traditional tourist season in many travel destinations across India, chief among them are Rajasthan, Gujarat, Madhya Pradesh, Kerala and Goa. This is also the time when NRIs return to India for their winter vacation. Out of these destinations, it was Rajasthan that was faced with a massive challenge and ended up facing it with what has become popular as the Bhilwara model.

Rajasthan: The curious case of Bhilwara

Every year thousands of European, American and British tourists flock to Rajasthan, with Jaipur, Udaipur, Jodhpur and Ajmer being key attractions. However, many times they venture to smaller towns hoping to get a more authentic slice of life experience. Many of their travel guides as well as people working in the tourism industry like drivers, conductors, waiters, house-keeping staff in hotels and other junior level employees often hail from interior villages. Thus, when tourists infected with the coronavirus first came to Rajasthan, the disease that takes anywhere between 10-14 days before symptoms become visible, spread quickly. In fact, authorities are flummoxed that it spread all the way to Bhilwara.

But the BBC sheds light on this mystery. It reported that a 52-year-old patient was treated for pneumonia at Bhilwara’s Brijesh Bangar Memorial Hospital Dr Alok Mittal, a doctor of internal medicine, and his team. Unfortunately, the patient was neither asked about any travel history, nor did he disclose anything. There were six other patients in the ICU, all of whom may have been vulnerable to the virus. When his condition did not improve, the patient was sent to the state capital Jaipur for specialized treatment. He was admitted to two different hospitals before he died on March 13.

Meanwhile, it is alleged that on March 9, Dr Mittal and a few others travelled to Udaipur for Holi celebrations. After being informed about the patient’s death, Dr Mittal and a colleague checked themselves into a quarantine ward at a government facility. But between coming into contact with the infected patient and being isolated, the doctor and his team had examined over 6,000 patients from 13 districts.

Alarmed, the Rajasthan government held door to door surveys in Bhilwara and neighbouring villages between March 18 and 25, asking people if they had hosted international guests, or if they were showing symptoms like cough, cold and fever. The administration has also stepped up arrangement for testing, quarantine and increased the availability of hospital beds by roping in private hospitals.

Bhilwara, with a population of over 4 lakh people is a major textile hub. Over 21 people had tested positive before stringent testing and social distancing measures were put in place. Another elderly man became the second man to die. He was a 73-year-old kidney disease patient who had also been admitted to Bangar Hospital.

The Bhilwara model

Invest India, a national investment promotion and facilitation agency, set up in 2009, is a non-profit venture under the Department for Promotion of Industry and Internal Trade, Ministry of Commerce and Industry, Government of India. Its website describes the Bhilwara model as, “The ‘Bhilwara model’ involves a strict lockdown, followed by a stricter curfew aimed at ruthlessly containing the virus’ spread and a dedicated team of medical and administrative officials leaving no stone unturned to prevent Bhilwara from becoming another Wuhan or Lombardy. In Bhilwara, more than 22 lakh people were screened, many of them more than once.”

It further showcases the exemplary measures taken by the local administration saying, “The district administration took over four private hospitals and 27 hotels with 1,541 rooms. These measures began bearing fruit as the town has not reported a new case of COVID-19 since 30th March. In addition to these steps, disinfection drives were conducted all over the town. Of its total 27 cases, 17 have already recovered since then, bringing the number of active cases in Bhilwara at just ten, including two deaths (due to comorbidities), eleven patients discharged while another seven are recovering quickly.”

What is noteworthy is that if the virus spread at such an alarming rate in Bhilwara, a town that is lower in ranking than bigger tourist hotspots like Jaipur and Udaipur, it is possible that the number of people infected across the remainder of the state could be much higher.

Padharo mhaare des?

It is shocking is that how even in early March, the Tourism Department was more interested in advertising various Holi related events and public gatherings organized for tourists, instead of focusing on checking the spread of a virus that clearly came from outside the country. Sample these tweets from March 6, 2020 about a Holi event organized at Deeg Kaman in Bharatpur:

 

 

 

This is the only warning about Covid-19 tweeted by the handle on March 5, 2020, in the run up to the Bharatpur event. Even this is rather generic and doesn’t warn people against gathering together in large numbers:

 

 

Had they started monitoring, testing and isolating tourists in February itself, the number of infected would have been much lower and the geographical spread of the infection could also have been curtailed.

In fact, it was only on March 13, 2020, that Rajasthan began shutting down schools, colleges, coaching classes, gymnasiums, cinema theatres, etc.

 

 

On March 17, Chief Minister Ashok Gehlot held a meeting with leaders of different faiths and urged them cooperate in the efforts to control the spread of the epidemic. However, despite prohibiting large gatherings, there was no announcement even at this stage to shut down all places of worship and disallow religious gatherings.

 

 

 

More stringent measures began with sealing of borders, and door-to-door screening of people began only on March 20.

Perhaps now is not the time to assign blame. But it is also too soon to offer a pat on the back. Either way, one thing is clear. The virus came from outside India, and had stricter measures been put in place and had those entering India complied seriously with those measures, perhaps the disease would not have spread so far and so fast.  

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