COVID-19: How did Gujarat become second worst-affected state?

Gujarat has fast emerged as the second Indian city to be the most affected with the novel coronavirus disease (COVID-19) pandemic. Till April 24, it recorded 2,624 cases and 112 deaths.

At least 34,409 people were under quarantine and around 258 had recovered as on April 24. About 33,316 samples had been tested. Ahmedabad, Surat and Vadodara had most districts reporting maximum tests as well as positive cases.

The state witnessed a spurt in the last two weeks. What led to the sudden surge?

India's first case reported in Kerala in January should have kicked off some preparations. There were delays in screening passengers on international arrival. To top it all, the United States President Donald Trump visit to Ahmedabad in late February saw thousands of people in attendance.

But there were many other developments that the administration overlooked.

Let’s take a look at Ahmedabad first. The city has reported the maximum number of positive cases as well as deaths. Highly congested localities such as Khadia, Raikhad, Jamalpur, Shahpur, Dariapur, Dani Limda and Behrampura have emerged as major hotspots.

A huge chunk of the city’s Muslim and Dalit population resides in these localities. Residents said social distancing was nearly impossible to practice. Micro-surveillance did not work either. However, as part of cluster containment strategy, these areas have been sealed and are managed by police and municipal corporation authorities.

“How can you carry out surveillance in housing clusters home to several families of different backgrounds?” said a resident.

Locals were also quick to press on the events that preceded the lockdown.

“People came back home after attending the Tablighi Jamaat congregation in New Delhi. Then there were those who returned after performing Umrah, a pilgrimage to Mecca. There were celebratory gatherings to welcome them. Nobody bothered to check the heavy footfall in temples,” pointed a local resident.

He added that while the authorities largely focused on people returning from abroad, Ahmedabad was experiencing routine flow of visitors from Mumbai and Indore.

“The authorities failed to gauge the threat posed by inter-state visitors. They later shifted their focus on Tablighis,” he added.

Some voices pointed to alleged ‘vilification of Muslims’ which eventually prompted the community to ‘refrain from getting tested’.

“Rumours that the National Registration of Citizens exercise was being carried out in the garb of COVID-19 testing and surveys in Muslim localities led to some resistance. Then the vilification of the entire community in the name of Tablighis followed. They started refraining from going to hospitals for tests fearing quarantine,” said a resident of Dani Limda.

As cases continued to rise, several flouted quarantine rules with impunity. Reports from hospitals unable to accommodate potential suspects or COVID-19 patients started doing the rounds.

A video shared by Vadgam MLA Jignesh Mevani reportedly showed 25 patients standing outside the Civil Hospital in Ahmedabad for several hours.

Observers said that authorities are now working on a war footing, but could have beefed up preparations before the situation spiraled out of control. There were several complaints that private hospitals fleeced patients.

Talking about the spurt in the number of deaths, the state’s principal secretary (health) Jayanti Ravi in her briefing on April 20 said: “Almost 90 per cent of those who died had risk factors or co-morbidities. The risk factors included people aged above 60 or below five years, along with pregnant women. The co-morbidities included blood pressure, heart and kidney problems.”

Eminent genetic scientist Jayesh Sheth, who has been keeping a keen watch over the developments, told DTE, “The deaths are not because of people not getting proper treatment. They are not coming forward for tests. They are not taking cough and cold seriously. It is only when they experience breathlessness that they approach the authorities.”

Among other concerns, Sheth added, is people under treatment showing blood clots. This, he said, is restricting blood flow to kidneys and lungs.

“I have suggested health authorities to include aspirin in their line of treatment as it is not only inflammatory, but also a blood thinner,” he said.

Many pointed out that the Ahmedabad Municipal Corporation (AMC) needed to include a column on asthma along with the routine queries about blood pressure, diabetes, cold, cough and fever in its survey.

AMC commissioner Vijay Nehra on April 24 tweeted, "Earlier #Ahmedabad was having a case doubling rate of 3-4 days. 

Now we have already slowed it down to 7-8 days. At this rate, we expect about ten thousand cumulative cases by 15th May. With people’s support we can further slow it down to about 10 days."

Surat, a model

On a positive note, Surat has come out as a showcase model for its ability to contain COVID-19 spread. This, when the city is much closer to Maharashtra and has a high percentage of migrant labour.

The city reported 456 positive cases and 13 deaths so far.

Authorities said they took lessons from the Plague outbreak of 1994 in the south-central and western India.

“Our strategy of consistent active surveillance was put in place after the 1994 Plague outbreak. Just like in the Plague, COVID-19 cases were found to be confined to a couple of zones,” Ashish Naik, health officer with Surat Municipal Corporation, said.

He added that the city has a system that ensures their primary health workers visit every household once in 15 days to keep a tab on malaria cases. They simply added COVID-19 to the exercise as well.

Sources said that instilling confidence in people to come out and get tested instead of allowing panic to take also worked.

“The moment a patient was tested positive for SARS-CoV-2 virus, fire brigade vehicles along with adequate staff took the patients in an ambulance. This was followed by immediate sanitisation of the locality and the ambulance,” pointed an observer.

Sources said the lockdown has worked effectively in areas like Udhna, Katargam, Pandesara, etc where there is a very high density of labourers from Odisha, Andhra Pradesh, Maharashtra, Uttar Pradesh and Bihar.

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