Honest communication and mutual trust between communities and local government authorities hold key to fighting this battle
by SHAHID CHOUDHARY
It is that time of the year when plane-loads of tourists would land in Kashmir. With heat and humidity spiking in the rest of the country, Kashmir would become the most loved summer destination and this has gone on for centuries. Its beauty and rich culture of hospitality of the locals as well as the state-of-the-art facilities both in public and private sectors has offered Kashmir as a preferred alternative to other destinations for both foreigners and Indian nationals. Srinagar, with the airport on its margins, the majestic lakes in its middle, rich history and heritage spread across its width, has been a major beneficiary of tourism. Sadly, it hasn't been the same since early last year because of a series of special circumstances, the latest being the outbreak of the COVID-19 pandemic.
As a public servant tasked to deal with this pandemic, I know of the difficulties the Srinagar residents have been facing and braving since March this year when the disease was first reported in the district.
Yes it's been challenging but there's never been a day when greater efforts weren't made to try and reduce these difficulties. Our entire team of hundreds of dedicated officials and volunteers have stood firm to the challenge — they have never given in.
Every morning we wake up to new questions – asked in social and mainstream media and in person – and every day's work ends with more questions. We put in our best efforts to try and answer these and redress the grievances and complaints raised through them appreciating the genuineness of the concern therein.
These questions and concerns are not unique — people across the world have them and government administrations are confronted with them. It's just the way things has been — unpredictable and uncertain. We have in fact recognised it as an important part of our job to appreciate these concerns in our efforts to alleviate the worries that COVID-19 has given to people.
It has been about five months now — of unpredictability and uncertainty and of trying to deal with it in the best possible manner with the resources that we have in Jammu & Kashmir. It was as early as the first week of March, – way ahead of most other states and UTs in the country – that the J&K came up with a comprehensive response to the situation as it was known then. Under monitoring of the honourable Lieutenant Governor's office, daily action planning and review by the Chief Secretary and guidance of the national-level response system, the government has been able to deal with the challenge as the situation evolves.
With the overall UT-level combat and relief strategies in place, monitored and reviewed on daily basis, a range of measures are left to the district disaster management authorities or DDMAs, a response system co-terminus with the role of district administrations. Here is a brief account of how we have managed affairs in Srinagar district over the last five months, what exactly is our current status and what should we look ahead to in view of this unique situation.
Our early response goes back to February when not many had heard of what was happening in Wuhan province of China where the coronavirus emerged. Questions were raised on tracking passengers returning from China but that helped us learn how to trace the potential carriers of virus. Also in February, a meeting of the DDMA Srinagar with Municipal officials and Panchayat representatives was seen by many as false alarm but in a few weeks people started getting to understand the challenge all of us were about to face. People on social media now started asking pressing questions like availability of ventilators and hospital beds. These questions, howsoever harsh and rude, are always a reflection of a participatory approach and certainly helpful in making administration more responsive and sensitive.
Talash – Story of contact tracing
Around March, COVID-19 advisories and guidelines were an evolving process. All entry points, by air and road, were plugged in to check origin of every incoming person, travel history and current health status. Many people were getting furious with anger but for us it was time to be on the right side, on the side of being over-cautious as the situation demanded. Cases of hiding travel history started coming to fore, making us more vigilant. Public response at this stage was reaching its peak.
Many people with travel history to Italy, USA, Bangladesh, China, African countries, Iran and Gulf countries, to mention a few, reported wrong travel history to avoid mandatory quarantine of international travelers. A prominent COVID-19 expert recently said that the coronavirus pandemic spread in developing countries could be controlled to the extent of 90 percent merely by right information management. We tried to dig right from the beginning. With help of some of the best available IT experts, we developed a mobile application by the name of Talash, probably the first such initiative in the entire country. This was a game-changing intervention, helping hundreds of people to self-report and hundreds more to tip off discreetly. This exercise yielded a list of 889 people with hidden or misrepresented travel history.
By the time the first case of COVID-19 was reported in Srinagar on March 18, more than 3000 persons returning from abroad were already in quarantine, and nearly 10,000 local residents returning from various states had also undergone screening and sent to home quarantine under surveillance. Next one week saw thousands of more guests at quarantine centres as soon as the Government of India announced suspension of flights from March 25 with people made last minute efforts to reach home. Thousands of people landing every day were to be accommodated at quarantine centres, at possibly the shortest notice. The local hotel industry, barring few instances of reluctance requiring force, and government properties came up as help. Many good Samaritans offered their plush properties for quarantine for nominal or no charges. Things were still settling down.
Srinagar started with graded measures towards a lockdown early, beginning with closure of primary schools, then followed by senior level schools, colleges, universities, public transport, commercial establishments — before a total lockdown was ordered in due course of time, which was a week before the nationwide lockdown.
But lockdown of such a scale needed a backup plan of the same scale in order to ensure medical and essential supplies and essential services remained uninterrupted. The plan included as a major part taking care of non-COVID healthcare issues and emergencies which existed before the disease came to J&K.
Flights carrying medicines, protective gear, medical equipment and other supplies landed regularly to maintain supplies. Along with this, a mechanism was put in place to ensure stocks are replenished on regular basis at both the wholesalers and retailers ends. Stocking of essential and life-saving drugs has remained a priority since day one.
Managing a city of 1.2 million population under a lockdown of this kind was no easy task — delivery of medicines, ration, LPG, handling healthcare emergencies, running essential services like power, water, sanitation, managing movement, minimising footprint and so on were serious challenges. But a team effort of remarkable kind made this possible. Remember this whole gamut of tasks had to be managed by just a quarter of the total staff strength.
Other than the hectic efforts to trace and tear COVID-19 affected persons, we tried to build an advance database of regular patients who needed special attention because of the nature of their illness.
Efforts in this regard brought to fore thousands of such patients who needed support. Nearly 10 thousand patients suffering from cancer, diabetes, kidney, cardiovascular among other major ailments registered themselves with the district administration for support.
Without wasting time the administration immediately set up a network of 30 dedicated vehicles and a support team of tens of officials and volunteers which worked round-the-clock to help such patients at the first call and free of cost. More than a dozen dialysis centres in the city were hired for providing dialysis services which were funded by the district administration. Delivery of movement passes, provision of vehicles, fixing appointment with medical practitioners and other hosts of services in assistance to those requiring them were provided to each such case. Patients not covered under any regular scheme or insurance were also provided financial assistance – worth and aggregate of over 53 lakh rupees – for emergent treatment during the lockdown.
A dedicated line for expecting women established by DDMA assisted more than 700 women – medical care, counselling, Covid testing, ambulance service, delivering kits for mother and child.
Getting back home in a pandemic
I think response to a pandemic can't be entirely clinical. The distress calls and repeated demands of evacuation from aboard and several states within the country was another challenge which could not be ignored. Notwithstanding administrative and jurisdictional constraints, more than 12 flights were organised from different countries with at least half of them assisted with bulk purchase of tickets and clearances. This was difficult but some innovative thinking with support and trust from the J&K and central governments made this possible.
Students stranded in several cities in Rajasthan, Punjab, Himachal, Uttarakhand and New Delhi were provided buses for evacuation while the fight against COVID-19 back home in Srinagar was still at a critical stage and becoming more challenging. In just three weeks after the government allowed and enabled return of stranded J&K residents from different parts of India in the first week of May, more than 26,000 people were found quarantined in Srinagar. All these thousands were tested for COVID-19 on their arrival and quarantined until testing negative. Those testing positive which were a few hundred were shifted for treatment.
All through that period, especially during the holy month of Ramzan, our team of officers and officials worked round-the-clock in efforts to minimise the inconvenience that mandatory procedures like quarantine upon arrival involved. We understood the reluctance and difficulties in going into quarantine upon return to home but we knew it was for the well-being of the personal and collective health of our people. The risks of thousands of people returning home and mixing with the locals could just be imagined.
Just weeks later, when services were resumed at the Srinagar airport, a 60-member health team and a 120-member team from administrative and managerial staff were stationed at the airport for management of arrivals, sampling, facilitating quarantine and taking care of a host of other logistical requirements. So far more than 42,000 Srinagar residents have gone through the process. The effort that it might have taken can just be imagined. Each single traveller testing positive is in fact a testimony to this effort — to the efforts helping contain spread of COVID-19 to families and localities saved.
Testing — greater the number clearer the picture
We have always known that things are clear when tests are done in plenty and so testing has been amongst our main focus areas. Till August 10, over 80,000 residents have been sampled in Srinagar — these include 39,787 on arrival, 36,215 in various zones, 3200 at railway station and more than 5000 in various city hospitals.
This number is expected to cross 1 lac mark this by next week. For a 1.2 million population as it is in Srinagar it's a sign of reassurance. Government's initiative of strengthening the laboratories is clearly paying dividends. Round-the-clock efforts of microbiologists, designing of sampling kiosks and mobile testing vans by engineers, supply of material by concerned organisations, management of arrivals and local target groups by management and administrative teams are just a few visible parts of this vast process at play. It is notable that Srinagar ranks among the country's highest per million testing cities.
It is also counted one amongst those which lent more focus to qualitative aspects than to mere numbers. This is evident from the COVID-19 related health audit which was held in Srinagar as in other parts across J&K. The health survey to determine the spread of COVID-19 involved more than 700 teams comprising officials from Health, ICDS, SMC and Election departments in the district. The survey, which was to determine the course of action that needed to be taken to deal with the situation as it were, was started in red zones and then held across the district. The data generated as part of this survey was collected using a mobile application. More than 10 lakh Srinagar residents have been surveyed during the process of this health audit.
Preventions and precautions — a sustained and varied awareness campaign
Globally it has been an accepted norm that 90% of the containment revolves around efficient public information management. Working on this principal we developed a multidimensional Information, Education & Communication model in Srinagar to spread awareness about the COVID-10 disease and preventions and precaution that need following in our day-to-day lives.
It involved association of health and medical experts and professionals from the media to ensure that right kinds of message were conveyed at appropriate times and in a manner that attracted attention. It's been disseminated through all forms of media including print, electronic and social media to ensure maximum reach.
Public response to this campaign has also been great — our awareness videos run on the social media has millions of viewers around J&K. Discussions and shows on TV and radio by experts have also remained a regular feature. In addition to it, streets and markets were flooded with hoardings and posters on guidance surrounding COVID-19 prevention and containment.
The campaign was started in February, earlier than anywhere in the country, and continues in its six month now. I should acknowledge that Srinagar residents have lived up to the expectations. We are now at a stage where these precautions need to be carried forward as a way of life.
Lockdown put to use
The lockdown period aimed to achieve two major objectives among others — one to reduce the chances of a large outbreak by minimising human movement and two to build capacities and response system for a worst-case scenario in which there is sharp spike in COVID-19 affected cases. The later also included strategies to minimise load on the already-burdened hospitals. While appealing to the public to stay indoors at the outset of the lockdown, we usually referred to examples of the world’s most advanced medical health infrastructure in countries like the USA and Italy crumbling within days. We made a case for prevention being the only cure till we have a proven treatment or vaccine.
Our health infrastructure
With the healthcare infrastructure found falling short globally, including in some of the richest and most advanced countries, concerns and questions surrounding the “ailing” health infrastructure of Kashmir started springing up in people. Being aware of the situation and keeping a close eye on the way things were unfolding around the globe, the government in J&K knew that lockdown had a dual purpose — it wasn't just about containing spread of the disease but also as much about enhancing capabilities.
In Srinagar, in just about six weeks from the date lockdown was enforced, several COVID Care Centres or CCCs with over 3000 beds aggregate were put in place, all of them equipped with required medical infrastructure for care of asymptomatic positive patients.
With the crisis we were testing our capabilities; our engineers lived up to the occasion, putting the best foot forward. The establishment of these care centres, at different places using open and closed including spaces at indoor sports stadia, hostels, government and private buildings, has proved instrumental, looking at the current situation with a rise in COVID-19 positive cases.
More than 2055 COVID positive patients under medical care there at CCCs have recovered and been discharged from these centres. Doctors and paramedics went beyond routine duty to provide the best possible care at these centres. These facilities have lent a great support to our hospitals taking the extra load off the shoulders of our healthcare infrastructure. Presently the CCC bed-capacity in Srinagar has been enhanced to 4000, and another 1200 beds are being added this month.
I should give credit to many private organisations which volunteered to provide their spaces for development as per laid down standards. Now, the focus is on further upgradation of medical infrastructure in these CCCs for handling the symptomatic COVID-19 patients.
Given the questions raised in public about preparedness, J&K's response and performance has been outstanding. Our premier health institutions in Kashmir, including the Sher-e-Kashmir Institute of Medical Sciences, the Government Medical College Srinagar, the SKIMS Medical College Bemina, have presented the best possible clinical response system to COVID-19 pandemic. All these hospitals nearly doubled their bed capacity, doctors worked overtime, paramedical and supporting staff was seen putting in their best.
These institutions being autonomous have been working for building their manpower and infrastructure capacities with funding directly from the Government. However, the district administration in Srinagar made all possible efforts to extend all required assistance to them during this ongoing emergency. To enable smooth working the district administration facilitated provision of over 350 hotel rooms in Srinagar which continue to be home to doctors and paramedics on COVID-19 duty since March.
The state drug suppler, JKMSCL, entrusted with equipping the hospitals to achieve the required infrastructure, has also made a good beginning and a lot more is expected to happen soon. By the end of July, 200 ventilators, 1 lakh PPEs, 1 lakh N95 Masks, 14 lakh triple layer masks, 2 lakh hand sanitisers, 2 lakh VTMs, 2.5 lakh RTPCR Kits, 20 lakh gloves, 300 oxygen concentrators, 1700 oxygen cylinders, 1200 nebulisers, 1200 semi fowler beds, medical supplies, oximeters and so on were added by the corporation and the process continues. Meanwhile the managements of respective hospitals have been and are continuously making all-out efforts of capacity building on both human resource and infrastructure fronts. With new challenges unfolding every day, J&K strategy has to be sharp, effective and prompt.
Just a call away
Less than a month into the pandemic response, the Srinagar administration established an IVRS-based Call Centre, which responded to thousands of calls every day from stranded residents, those in need of food, patients requiring support for health issues like dialysis, diabetes, cancer, persons requiring quarantine and testing, ambulance services, financial assistance, and thousands of more calls about essential supplies and so on.
More than 76,000 complaints or issues have been redressed by the Call Centre so far and a dedicated team of professionals continues the socio-psychological support to COVID patients which was started soon after the COVID-19 situation arose in the district. Even to this day this 24x7 service attends an average of 1800 calls a day and continues to extend the required support.
More than 50,000 ration kits delivered on Ramzaan eve, 10,000 on Eid and equivalent later, were coordinated by dedicated and professional executives of Call Centre – based on requests received from individuals, organisations and ofcourse field teams.
Living with the virus
In Srinagar we put a major emphasis on preparing the community for living with COVID-19 post-unlock. We recognised that the virus was not going away too soon and we as a community needed to learn to live with it — not letting it hurt us as we go about our routine life affairs.
As part of this realisation, we focused on training service providers, businesses and trade establishment members for adoption of COVID-19 containment protocols. Also, religious leaders were roped in for community engagement. This massive community engagement campaign lasted around a month before unlock was announced.
More than 10,000 service providers were trained, some 2500 religious institutions reached out to, NGOs and Civil Society Organisations roped in, volunteers trained and deployed as part of this effort. Also, COVID-19 testing of service providers and certification of trainees in service sector was held. Experts from the social and preventive medicines were also roped in as key resource persons. Workshops were organised across the city for COVID-19 SOPs to be adopted for containment and precautions. In this backdrop, a cascading effect of preparedness in service sector vis-a vis adoption of safety protocols is expected.
What do the numbers say
We often find discussion on number of reported cases being referred to in public discourse surrounding our preparedness and response in Srinagar. But I must stress that numbers are easier but details are complex. In a pandemic of this nature the epidemiology of the disease's spread is more important than numbers. Few cases with unknown travel or contact history can pose a more serious challenge than more than a hundred contacts reported positive on any random day. Srinagar’s 6200 cases reported as of 10th August also include nearly 1800 non-residents, such cases which include travellers, those from other districts or states, medical referrals and from establishments. More than 3900 have already recovered and moved home.
In the last two weeks the number of recovered cases has exceeded the new cases reported. Also the pace of testing has gone up and diversified. The DDMA-assisted sero- prevalence study being conducted by experts from the Social and Preventive Medicine department has covered more than 4000 persons under the study and the Rapid Antigen Testing is also on the tracks, with more than 6500 sampled and continuing. Altogether a range of measures are underway to further strengthen the COVID-19 response mechanism.
Where do we go from here
Five months into it, each one of us is now sufficiently aware of what we are dealing with. Honest communication and mutual trust between communities and local government authorities hold a key to fighting this battle. In some places, the relations between people and the government authorities could be difficult for some entirely other reasons. This could lead to lack of trust and pose a serious challenge to our battle which has to be fought together in any case.
In light of this fact, I would like to make a fervent appeal to everyone to follow all COVID-19 protocols religiously, keep faith in the administration, and keep us informed of your concerns. If concerns are not addressed, hold us accountable through any number of ways available to citizens.
It’s time for all of us to reorient our outlook and know how to live with the novel coronavirus. The administration and the general public need to join hands and fight this common enemy together. At the level of administration we are determined to further enhance our capacity to deal with it while enabling a revival of socio-economic activities and developments. At the level of the community we will need to take precautions and extend support to sincere efforts to defeat this enemy.
(Shahid Chaudhary is DC Srinagar)