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COVID-19 | Bhilwara and Kerala offer hope during this pandemic

While Bhilwara in Rajasthan has showed how ruthlessly tackling COVID-19 is effective, Kerala has showed how a disciplined approach can bend the curve. This will be handy while relaxing the lockdown norms in a few weeks’ time

May 10, 2020 / 06:21 PM IST
Representative image

Representative image

When Prime Minister Narendra Modi signalled the continuation of the lockdown for another 19 days, taking the aggregate period to 40 days, there was also a sliver of hope for those advocating a structured, phase-wise weaning off from April 20.

The extended lockdown will help in further delaying the peaking of the COVID-19 curve as is being witnessed in many other countries with better social and economic infrastructure. At the same time, we cannot ignore India’s accelerated timeline: While it took 44 days to go from one case to 100, it took 15 days to go from 100 to 1,000 — and just 17 days to reach 10,000 cases.

Out of the 10,453 cases in India, about 8,990 are active cases — also so far only about 190,000 tests have been carried out. This puts India’s testing ratio at 137 per million (population). Another cause for concern should be that out of every 29 positive cases there is one mortality. The COVID-19 death tally as of April 14 is 339.

The prime minister has left it to individual states to plough their own paths as there cannot be one blanket remedy for all. Yet it is worthwhile to look at what some states are doing to get things right. That the Kerala model is worth emulating is an undeniable fact.

It was the first state in India to record a COVID-19 infection case right in January. Since then, the state has waged a disciplined and inspired war against the deadly virus, aggressively tracking and monitoring individual cases, snuffing out chances of a community spread with the people working hand in glove with the government and cordoning potential clusters.

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COVID-19 Vaccine

Frequently Asked Questions

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How does a vaccine work?

A vaccine works by mimicking a natural infection. A vaccine not only induces immune response to protect people from any future COVID-19 infection, but also helps quickly build herd immunity to put an end to the pandemic. Herd immunity occurs when a sufficient percentage of a population becomes immune to a disease, making the spread of disease from person to person unlikely. The good news is that SARS-CoV-2 virus has been fairly stable, which increases the viability of a vaccine.

How many types of vaccines are there?

There are broadly four types of vaccine — one, a vaccine based on the whole virus (this could be either inactivated, or an attenuated [weakened] virus vaccine); two, a non-replicating viral vector vaccine that uses a benign virus as vector that carries the antigen of SARS-CoV; three, nucleic-acid vaccines that have genetic material like DNA and RNA of antigens like spike protein given to a person, helping human cells decode genetic material and produce the vaccine; and four, protein subunit vaccine wherein the recombinant proteins of SARS-COV-2 along with an adjuvant (booster) is given as a vaccine.

What does it take to develop a vaccine of this kind?

Vaccine development is a long, complex process. Unlike drugs that are given to people with a diseased, vaccines are given to healthy people and also vulnerable sections such as children, pregnant women and the elderly. So rigorous tests are compulsory. History says that the fastest time it took to develop a vaccine is five years, but it usually takes double or sometimes triple that time.

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The picture would be far from complete without a robust state healthcare system that has its base in primary healthcare centres that caters to every citizen at the village level, then the district/general hospitals offering more than what a private hospital does, at far lesser cost, and the medical college hospitals that put the super speciality hospitals to shame both in terms of infrastructure and acclaimed doctors.

In the past also, when first the Zika virus and then the Nipah virus outbreak was handled efficiently, it was Kerala’s government-run hospitals that delivered.

Also, having run relief camps in the last two years during back-to-back floods, setting up camps and community kitchens as well as taking care of the state’s labour force, migrant and otherwise, is not as big a challenge for Kerala as it could be for other states. No surprise then that ever since the lockdown started, there have been stories of compassion and community care, alongside the daily updates of suspected cases, testing, quarantine and recoveries.

On the eve of Modi’s address to the nation, Kerala had tested 15,683 cases, of which 14,829 were negative and of 378 positive cases, 198 (52.4 percent) had been cured and 178 (47.1 percent) were under treatment, with only two deaths (0.5 percent) so far. That would put the Kerala model right at the top.

Against this, there is the much-lauded Bhilwara model that has by now become the case study for ruthlessly tackling COVID-19.

Once it became clear that the infected doctors of Brijesh Bangur Memorial Hospital in Bhilwara, in Rajasthan, may have been in direct and indirect contact with thousands of patients, the fight back by the district collector and his team began on a war footing. Bhilwara, with a population of 2,400,000 was shut down and over the ensuing days, a whopping 92 percent were screened and over 6,000 suspected cases tested for the disease.

The quarantined families were constantly monitored and all support by way of food and amenities were provided round the clock. For an epidemic outbreak that had originated in a hospital, Operation Bhilwara was carried out with clinical precision. The result speaks for itself — from a peak of 21 positive cases on March 31 to no new cases till date!

As time will prove, the Bhilwara model may clearly be the path to follow in places such as Dharavi in Mumbai and other clusters or hotspots, if it gets more rampant in the days to come. Even Kerala may have to take a page from the Bhilwara chapter, in the case of a massive COVID-19 spurt.

Till then there may be wisdom in following the Kerala model, chapter and verse, for many states, including Rajasthan as they begin a graded cooling-off period, post-April 20, initially for the green zones (with no cases), mainly with an eye on reviving various economic sectors. The orange zones (with a few cases) can follow later, though with abundant caution. The red zones (hotspots, etc.) may do well to see through the 40-day period, even extend it if need be. Kerala has done it in Pathanamthitta without any major disruption for the public. Even in Kasargod, Kerala’s hotspot that accounts for 44 percent of its cases, the rate of recovery is three times the national figure.

In the end, flexibility in addressing reality at the grassroots level will hold the key in finding a solution. It can only be a bottom-up approach and not a top-down one.

Vinod Mathew is a senior journalist based in Kochi. Views are personal.
Vinod Mathew
first published: Apr 14, 2020 02:11 pm

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