What is Bhilwara Model and How it can be a crucial part of Govt’s containment strategy for COVID-19 after Lockdown?
Bhilwara Model Explained: On 6th April, the Union Health Ministry released a document ‘Containment Plan for Large Outbreaks’, hinting at replication of Bhilwara Model. What is the Bhilwara Model and will the Government use it post 14th April after the lockdown is lifted? Let’s find out!
Bhilwara Model for COVID-19 Containment: With 14th April approaching, the Union Government has begun preliminary preparations for the lifting of the lockdown announced due to the COVID-19 pandemic in the country. PM Modi has called for a staggered lifting of lockdown across the country and also directed Ministries and Departments to chalk out a ‘business continuity’ plan post 14th April. However, with the steady rise in the number of Coronavirus cases in the country, Modi Government needs to put in place a comprehensive strategy to restore normalcy in the country while also containing the spread of COVID-19.
As part of this process, on April 6, 2020, the Union Health Ministry released a document titled ‘Containment Plan for Large Outbreaks’, hinting at replication of Bhilwara Model for aggressive containment of Coronavirus pandemic in COVID-19 hotspots. But what is the Bhilwara Model and will the Government use it post April 14 after the lockdown is lifted? Let’s find out!
How was Bhilwara Model Developed?
Before we dive into the details of Bhilwara Model, it is important to first assess and understand the need for such a model and how did it come into existence in the first place. Located in the Mewar region of Rajasthan, Bhilwara is a textile town that is home to nearly 30 lakh people, approximately. Bhilwara emerged as one of the early COVID-19 hotspots in the country, even before PM Modi called for a Janta Curfew on March 22, 2020.
The first case of COVID-19 in Bhilwara was reported on March 19, 2020, which was of a doctor from a private hospital testing positive for the infection. Following this, the number of COVID-19 cases shot-up in a very short time transforming the district into the epicentre of the outbreak in the state. Soon, the district had reported 27 positive cases and two deaths within the first few days of the Coronavirus outbreak in the country. Following this, the Rajasthan Government launched an aggressive containment drive to curb the spread of the disease which has now transformed into the Bhilwara model.
What is Bhilwara Model?
According to details shared by the state government and the Rohit Kumar Singh, Rajasthan’s additional chief secretary in charge of the medical, health and family welfare department; the simple way to describe the Bhilwara Model is ‘Ruthless Containment’. The Bhilwara Model of Containment is centred around 6 key steps.
Following are the six steps:
Step 1: Isolation of the District
Realizing the gravity of the situation after the COVID-19 cases shot up in the district, the administration decided to isolate the district by imposing a strict curfew under Section 144 of CrPC. In addition to this, the administration also sealed the district borders immediately, with check-posts set up at all entry/exit points. To plug any loopholes, the district administrations of the surrounding districts were also briefed and told to help in the sealing of borders. Following the announcement of all-India lockdown, the district administration also decided to all rail services and movement of public and private vehicles were stopped, and all industries; bringing the district to a stand-still. From 2nd April 2020 onwards, all essential services were also suspended in the district except for police and health.
Step 2: Mapping of the COVID-19 Hotspots
Once the district was completely isolated with no movement of people, the probability of the spread of the disease during this phase came down drastically. Bhilwara comprises of 7 administrative sub-divisions and to keep such a large area under containment is a challenge. To address this, the state administration decided to identify and map COVID-19 hotspots within the district that had registered the highest number of cases. These areas hotspots were identified and strict vigil as kept on them to ensure zero movement of people. These hotspots also had a buffer zone, which acted as a way to deliver essential services including food ration, medical help in a more effective manner.
Step 3: Door to Door Screening
Another important part of the Bhilwara model was ‘Door to Door Screening’ of people to identify the suspects who might be potential carriers of the novel coronavirus. As part of this drive, 22.39 lakh people getting screened, many of them more than once, during which people with Influenza-Like Illness (ILI), were identified and marked for regular screening. According to a report submitted to CMO Rajasthan, a total of 1,937 teams were deployed across the district, which were tasked with surveying 4.41 lakh houses between 22 March and 2 April. Through this drive, over 14000 people were identified as having ILI, and health workers use to visit them twice a day to check on their health and ensure their whereabouts. This also made sure that people followed home quarantine protocols aggressively.
Step 4: Aggressive Contact Tracing
Once the people with ILI were identified through a door-to-door screening process, the district administration also started aggressive contact tracing of the people who might have come in contact with them and may be potentially infected by the virus. The people who had come in contact with the persons having ILI were advised home quarantine with regular checks and visits by health workers.
Step 5: Increasing Quarantine Facilities
After door-to-door screening and aggressive contact tracing, the number of people that needed to be quarantined also rose drastically as the existing government health infrastructure was unable to handle it. To address this, the district administration took over four private hospitals, each having 25 beds, as well as 27 hotels with 1,541 rooms. This helped in isolating the patients with high viral load, which can lead to further spread of the disease among the households and even locality.
Step 6: Monitoring the Rural Areas
During the 2nd step, which is mapping of COVID-19 hotspots, the majority of clusters were detected in urban areas with high population density. However, being a large district, there were large rural areas that could be porous as people can find ways to move around despite. To counter this, the state administration increased monitoring in rural areas and enforced a complete lockdown by taking people into confidence. To drive the operation, six 24×7 control rooms were set up in the city, including at the collectorate, chief medical and health office, nagar parishad and sub-divisional office.
Other Aspects that led to success
In addition to these six steps, the district administration also ramped up the decontamination drive disinfecting every nook and corner of the city — from all containment and buffer zones, to localities where positive cases have been detected. In addition to this, all police vehicles, ambulances, screening centres, quarantine centres and even police stations were disinfected daily, at regular intervals.
Suspension Essential Services
With the complete clampdown on human movement and even suspension of essential services, the district came to a standstill, causing great difficulty to the common people in terms of availing essential services and daily necessities. To answer this, district administration started a door-to-door supply of essential groceries, fruits and vegetables, and milk. The administration also went to great lengths to deliver cooked food to poor and needy people as well as the distribution of fodder to people involved in animal husbandry and even for stray cattle.
Empowered Local Team
One of the key reasons noted by Bhilwara model and how it has emerged as the way ahead for the country, Rohit Kumar Singh – Additional Chief Secretary (Health) was the empowerment of local administration and ground teams to take the necessary action for containment of the disease. There was clear goal-setting and explanation of the expectations from the local teams which helped them perform their duties without any hesitation. Furthermore, there was no direct interference from higher-ups in the operation, which meant an effective and unified response to the outbreak.
Today, Bhilwara has transformed itself from being an early hotspot of COVID-19 to a district where no new case has been reported in the last 7 days (as on 6th April 2020). In fact, as per the latest reports of the 27 cases reported initially, 13 have recovered completely from the disease. But, while many experts have put their faith in Bhilwara model, implementing it in other COVID-19 hotspots might not be that easy.