Wider testing, perhaps through pooled tests that are reportedly being considered for the zero-case districts, would help identify cases.
Lockdowns help enforce social distancing, but identifying and then quarantining Covid-19 patients efficiently is what will make a lockdown meaningful. A study by researchers at the Armed Forces Medical College says ensuring even 50% efficacy in quarantining/isolation during the lockdown could drastically bring down the peak incidence and the demand for hospitalisation—which is what India’s corona strategy has to be, given, even in a ‘1% of the population infected’ scenario, the hospitalisation demand (as estimated by the Center for Disease Dynamics, Economics and Policy) overshoots the total number of beds in government medical facilities.
Wider testing, perhaps through pooled tests that are reportedly being considered for the zero-case districts, would help identify cases. But the challenge thereon would be to ensure that quarantining is strictly followed, especially with the government mulling over not hospitalising mild and moderate cases, and doing contact-tracing. States can learn from Andhra Pradesh (AP) and Kerala on village-level mobilisation to ensure diligent reporting on Covid-19.
AP had started a village/ward volunteer system, with 2.6 lakh volunteers, to check and report on the last-mile delivery of government services. With the Covid-19 outbreak, the state has repurposed this cadre to carry out household-level reporting of Covid-19 symptoms and quarantine compliance. Each village volunteer is assigned 50 households, while each ward volunteer is in charge of a cluster of 50-70 households. The volunteers have visited close to 1.5 crore households since February 10, as per the state government’s health department, and helped identify 10,000 people who have returned from abroad. Early identification helps undertake timely hospital/home isolation measures. The visits by the volunteers have also been geared towards identifying individuals who may be showing Covid-19 symptoms, which has helped in expanding testing, though, given infected individuals may sometimes not show symptoms in the viral incubation period. The village/ward level surveillance has also resulted in a more effective contact combing operation. Kerala, which adopted local surveillance and reporting quite early, has used its local government and village level government workers to implement local monitoring—the surveillance is decentralised and the response protocol standardised at the state level, while the district administrations mount containment efforts. Along with the high initial testing that the state did to capture infection early, these efforts have ensured that cases don’t go undetected, which shows in the fact that state’s curve is beginning to flatten while it has reported a very low mortality (as a proportion of its overall incidence), and the highest recovery rate so far. Indeed, the success of the state’s surveillance system is visible from the fact that the Pattanamthita administration was able to trace 98% of the people who had come into contact with five members of a family, all of whom were reported as positive on March 9—this helped limit positive cases in the district to 15 (April 8).
Decentralising the surveillance and reporting, with proper training for ground level personnel (whether volunteers or part of the local administration), could help India get some degree of control—utilising the remainder of the lockdown, and extensions, if there are any, could help beat down the peak, perhaps even the eventual spread.