Review report of containment strategy in Bapu Dham Colony by Dr. Srinivasan.Selvamani, WHO
Review of Containment Strategy InBapuDhamColony, Sector 26 Chandigarh UT
On 31st December 2019, the World Health Organization (WHO) China Country Office wasinformed of cases of pneumonia of unknown etiology detected in Wuhan city, Hubei Province of China. On 7th January 2020, Chinese authorities identified a newstrain of Coronavirus as the causative agent for the disease. The virus has been renamed byWHO as SARS-CoV-2 and the disease caused by it as COVID-19. WHO has declared this outbreak a “Public Health Emergency Of International Concern” (PHEIC) on 30th January 2020, subsequently WHOdeclared COVID 19 a pandemic on 11th March 2020.
As of 15th July 2020,>13 million confirmed cases have been reported globally from 214 Countries/Territories/Areas. A total of 576000 deaths have beenreported globally so far.
As of 15th July 2020, all states/UT have been affected, a total of 9,70,169 confirmed cases have been reported with a total of 24,929 deaths.
1.4 Chandigarh UT Scenario
As of July 15th, 2020, a total of 619 positive cases have been reported, currently, 149 are active, 459 have recovered and 11 deaths have been reported.
1.5BapuDham, Sector 26
BapuDham colony is named after Mahatma Gandhi and located in sector 26 of Chandigarh UT.It was developed in the 1970s to rehabilitate 900 slum dwellers. Eventually, the colony saw 3 phases of growth, housing approximately 30000 people who live in multi-story houses.The people living in BapuDham belong to migrant groups from the states of Uttar Pradesh, Bihar, Tamil Nadu,J&K,Jharkhand, Uttarakhand, and Rajasthan.Some are the original inhabitants who were rehabilitated under resettlement by Chandigarh Administration. The allotted people either currently live in the houses or have rented them leading to a large migratory population staying in the Colony.People who live on rent are allotted house blocks where more than 30 people live in a single settlement unit.The colony comprises people of various religions including Hinduism, Sikhism, Christianity, and Islam.
BapuDham reported its first COVID 19 case on 24th April 2020, a total of 250 cases (40% of the total cases of Chandigarh UT) were reported as of 6th of July 2020 along with 2 reported death.
To review of containment strategies at BapuDham,on the request of the administration.
- Key informant interview
- Review of records
- Field visit
- The first case was reported on 24th April, the EPI curve shows a gradual increase in the cases with two peaks at 15 days interval since reporting of the first case.
- There was a gradual decrease and a plateau was achieved starting from 30th of May onwards
- Since 16th of June sporadic cases are being reported
The above table indicates the age-wise distribution of cases
- >75% of the cases were reported in the age group 0 to 39 years
- Only 13 % of cases reported in elderly > 50 years of age
The above table is the gender-wise distribution of cases
The above table indicates the point of collection of samples from BapuDham
The above table indicates the type of facilities the cases were referred and managed
The Chandigarh administration promptly responded on the 25th of April 2020, BapuDham was declared an affected area and as per the disaster management act (2005), containment plan was initiated.
The plan was named as “MeraBapudhamMeraKartavya”
5.1Map of BapuDham:
The administration started using a hand-drawn map of the BapuDham colony, the layout of which was provided by the department of architecture. One of the good practices was the use of a map of BapuDhamin deciding the containment zone. The map was used to spot positive cases as well as contacts since day 1, which helped in understanding the chain of transmission, planning of the containment, and de containment strategies.
The entire BapuDham colony was part of the containment zone. For administrative reasons and better management,the entire BapuDham was further divided into 20 pockets each containing 1500 -2000 population.
5.2.1Effectiveness of Geographic Quarantine:
The perimeter of the containment zone was well defined,around 40 police personnel were deployed in 3 shifts. They were strategically deployed around the entire perimeter.The containment zone had one clear entry and exit point. There was a strict restriction on the movement of people or goods, except for medical,essential goods and services. Supervisory rounds were conducted every day to ensure compliance with strict perimeter control.CCTV was used around the perimeter of pocket 15 ( the most affected pocket of BapuDham)
5.3Establishment of Control Room :
A Control Room was established for communication between the Public and Administration. Initially, the control room was at the SDM office, from the 2nd of May onwards a dedicated control room forBapuDham was established at the community center (Good practices).A central helpline number - 112 was made available to the population contained. In the Control Room, the unitanalyzed data and bifurcated it into different categories which mainly consisted of:-Fruits and Vegetables (24X7),Groceries,Sanitation Work,Employment,Medicines,Police,Electricity,Sewerage,Books and stationery,Health,Daily needs,Milk,Gas and,Migrants.
5.4RRT Team ( RapidResponse Team) :
The administration deployed two key personal, one was nodal officer disaster management in charge of civil defense, anothera liaison officer ( special incident commander), both these members were part of the RRT deployed to support in mitigation, under the overall guidance of SDM East.
Further BapuDham was divided into 4 Sectors each containing 5 pockets. Four RRT teams were formed for each sector This team included– Sector Incharge, Superintendent, Assistant Superintendent, Clerks, and Volunteer.
5.4.1 Civil Defence :
One of the good practices was the use of Civil defense as part of the containment strategy. DC Chandigarh deployed nodal officer of disaster management ( senior civil defense inspector ) along with a 20 member team in the BapuDham colony. The Civil defense personnel were strategically placed around each pocket. Their role was to ensure no movement or mingling of residents withinthe pocket, door to door supply of essentials, support to screening teams, and ensuring social distancing norms while moving for purchase of essentials services.
5.5Public Health Response :
House to house screening of all residents was conducted by the health department on multiple occasions at regular intervals. Those with symptoms were then referred to the dispensary for further management.
5.5.2AggressiveContact Tracing And Quarantine Of Contacts
One of the good practices was a dual system of contact tracing being followed in Chandigarh UT, the same continued in BapuDham. One team from the Municipal Corporation and one team from IDSP did independent contact tracing. Findings of both the teams complemented and gave comprehensive data.
All high-risk contacts identified were sent for testing to dedicated testing facilities through a dedicated ambulance. Those turning out positive were sent to an isolation facility, while those testing negative were sent to the quarantine facility and not allowed to return to the containment zone. Many of the low-risk contacts especially those with comorbid conditions were shifted to quarantine facilities for better management.Quarantine facility one at Hostel no 8 Punjab university and the other at government school at Raipur Kalan was set up and exclusively used for residents of BapuDham.
5.5.3EstablishmentOf The Dispensary:
A dispensary was established by the department of health at the perimeter of the containment zone. The services were available 24*7and all essential medicines were made available. During screening all symptomatic were sent to the dispensary for further management, also those in need of care would approach the dispensary at any point in time. As all clinics/practitioners/medical stores were completed shut in the containment zone, providing this essential service to the community ensured continuity of care, and brought confidence.
Was carried out by the administration twice daily on lanes/roads and public places. Indoor sanitizationdrives were conducted through periodic communication with the community through loudspeakers and volunteers.
5.6UseOf Volunteers :
One of the best practices noticed was the effective and strategic use of volunteers in containment zones. With the help of a counselor, from each pocket, 4 to 5 self-motivated young adults were selected as volunteers, they belonged to the same community.
These volunteers working round the clock became the link between the community and the administration. All requirements or needs of the particular block were informed to these volunteers who in turn shared with the administration.
The Volunteers were effectively used in IPC and dissemination of risk communication strategies. Confidence and compliance among the community through these volunteers have worked in the successful containment of the disease.
5.7.1Vegetables And Daily Needs :
One of the challenges was ensuring a regular supply of essential commodities. A preliminary daily requirement for milk and vegetables was conducted. Subsequently, the administration collaborated with milk and vegetable vendors from inside the colony,vendorswere designated for each pocket and was provided with a PPE Kit.
Milk was supplied by 12 vendors from 5:30 to 6:30 am. Vegetables were made available from 9:00 am to 12 noon by 35 vendors maintaining the norm of social distancing and taking all universal precautions. All supplies were first offloaded at a transport area just outside the perimeter. They were crosschecked and subsequently transported in batches inside the containment zone.
Shops and Essential Stores were open from 10 to 1 pm in the Buffer Zone. Inter pocket movement was restricted and only the volunteers were allowed to supply the essentials.
5.7.2Banking AndMobile ATM Vans:
For the community to purchase essential services money was needed, since there were no ATM’s within the containment zone, Mobile ATM vans were effectively deployed.
Migrant laborers who felt the need to send money home were facilitated by setting up a banking correspondent at PNB bank outlet inside the containment zone.
5.7.3Supply Of Medicines:
Those needing medicines and unable to purchase them were provided free of cost by the administration either through the free drug supplies of the department of health or through the RogiKalyanSamiti(RKS).
Paying residents were supplied medicine through a private supplier identified by the administration.
5.7.4Garbage Collection:the daily collection was done house to house by the municipal corporation.
5.8Community Engagement And Psychosocial Support (Good Practice)
Proactive community engagement, through a well-crafted community outreach program for BapuDham, was implemented. Some of the activities as part of the program is listed.
- Daily practice of Pranayam by public address system.
- Counseling sessions were conducted by the department of social welfare and experts from GMSH-32 hospital.
- Resident messages and songs were played daily for 1 hour via Radio Mirchi.
- Distribution of books and stationery by schools of Chandigarh such as Carmel Convent School
- Whatsapp group with students of Bapudham and NSS PO was formed. Several Zoom Meetings were conducted to understand their problems and to show and convince them that everyone is with them in this pandemic.
- Various online competitions on Environment were also organized for children by the NSS Volunteers of Carmel Convent School
- Environment Day and Yoga Day were celebrated
- Careeopedia classes were held to guide the children about several courses they could enroll in after class12
- Few state-level online competitions were held with children wherein they received certificates from the southern railway.
- Online training was also provided to class 10 students by the Bulls Eye institution.
Psychosocial support: through VC
- Robust communication and awareness campaigns helped to encourage and engage people to fight COVID-19. Loudspeakers and Public Address Systems were installed across the entire containment zone. These systems provided services like important administrative announcements and awareness about COVID 19.
- Field functioning was active 24X7 and announcements were made by health experts and public representatives in the form of audios and videos.
- The good practice was not to use pamphlets etc as part of IEC strategy
5.10 Continuation Of Employment: The administration ensured that all the residents who were contained received a continuation of employment. Initially, a survey was conducted, government employees were issued letters or communication, were as the private employers were contacted and requested to ensure the continuation of employment.
5.11CapacityBuilding Of Staff/Briefings :
- A crucial component in the fight against the pandemic is the capacity building of the front line workers and officials. The department of health provided the knowledge and skills concerning the disease.
- SDM East ensured the teams are well briefed on their roles and responsibilities, he held a daily briefing and debriefing meetings with his team. This is an example of good practice were all senior officials converge, regularly supervise, and provide support to the frontline workers.
5.12FinancingOf Containment Operations:
- Funding of the operations was done mostly through SDRF funds
- Large material donations were received which was directly distributed in the welfare of the community
5.13StayArrangements For The Field Staff:
The administration ensured all front line workers were taken care of, residential facilities were provided for them at Sanik guest house and panchayat Bhavan.
6.0ScalingDown Of Operations
As the outbreak was controlled and a plateau was achieved starting 30th of may onwards the administration adapted a well crafted and careful strategy to scale down operations in BapuDham.
Anaffected area committee was formed (Good practice) which looked into pocket wise data and other critical indicators and based on risk assessment scaling down was recommended. First, such an order was issued on the 2nd of Junewith the removal of perimeter control in the buffer zone,. Weekly committee meetings henceforth saw the BapuDham open up in a phasic manner.
Containment zone and buffer zone demarcation: not done as per GoI guidelines, hence no delineation of activities conducted in these zones
Active case search: daily screening of population( part or complete ) not conducted
Sampling: No provision for on-site sampling
Data analysis for action and feedback: stratification of data of the positive cases and contacts was not done for better understanding the chain of transmission and guiding decision.
As pockets of BapuDham continue to open and life returns to normal, the threat of reemergence continues as globally, nationally and in Chandigarh UT the cases continue to rise.
8.1Strengthening Of Surveillance AndPassive Reporting Of ILI Cases
Surveillance will play an important role in identifying the early re-emergence of cases in the community. Since the active house to house screening is not a feasible option, there is a need to strengthen passive surveillance and reporting.
Using the polio eradication experience, all local practitioners /RMP/Qucaks,etc of BapuDham should be sensitized and motivated to report all cases of ILI visiting their facilities. These cases should be mapped and any clustering should be a trigger for testing and further management. In this manner, we will be able to detect an ongoing transmission and mount response promptly.
We need to protect, detect early, and provide supportive care to the aged and those with co-morbid conditions. Mapping and daily surveillance can be done using the community volunteers and throughthe health department.
8.3Continue Proactive Community Engagement
- One of the strengths of the containment strategy in BapuDham has been the proactive engagement of the community. We need to continue this engagement and ensure the community are empowered and become an equal stakeholder in our fight against this disease
- Continue using the community volunteers in effective risk communication and also as surveillance agents
- Continue effective behavior change strategies in the community.