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Assam’s war against COVID-19, ‘Ruthless quarantine but effective care’

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The state of Assam has adopted a multi-pronged strategy to fight COVID-19 under the guidance of the health minister of Assam, Dr Himanta Biswa Sarma. This indeed has proved highly effective in managing cases. Dr Lakshmanan S, Mission Director, National Health Mission (NHM), Assam, Dr Dipjyoti Deka, State Programme Manager, NHM, Assam and Dr Biraj Kanti Shome, Consultant (Health Systems), WHO-India, give an overview of how the state of Assam is tackling the COVID-19 pandemic in an exclusive interaction with Sanjiv Das

Dr Dipjyoti Deka, State Programme Manager, NHM, Assam

How has the state of Assam fared when it comes to handling the COVID-19 pandemic?

So far, Assam has been effectively managing cases of COVID-19 with a low death rate of 0.32 per cent (as on 01.06.2020). The state has been able to successfully manage cases because of the following reasons.

The state made an estimation about the number of people, who will return to Assam once lockdown is relaxed and a likely spike will be seen in COVID cases. Accordingly, the Health Department with the support of other allied departments (Police, Transport, District Administration) has made adequate planning on the management of the influx in Assam. The major decision was to keep the influx population at quarantine centres, to test them and based on the test report, either discharge or admitting patients at hospitals. The state’s quarantine policy is “Ruthless quarantine with a human heart”. 

You will be glad to know that more than 95 per cent of the cases came from different quarantine centres. Once a person is tested positive from a quarantine centre then s/he is taken to the appropriate hospital. Before taking the patient to the hospital triaging is done. All critical patients are sent to the medical college and patients with NCD and other comorbid conditions are sent to the district hospital and asymptomatic positive cases are kept at the model hospital. 

Check posts with medical teams are put on duty at all entry points and from entry points, people are brought at quarantine centres to carry out procedures.   

To have the maximum quarantine centres, the same has made five regional quarantine centres functional at Kokrajhar, Guwahati, Jorhat, Silchar, Tezpur and these centres are made responsible for a number of districts, attached to each one of them (zone-wise). Over and above, each district has made its own quarantine centres functional to accommodate positive cases at the district level. 

Of late, the state is moving towards block-wise, legislative constituency-wise quarantine centres, so that a person, who is at the quarantine centre feels s/he is at home (as the quarantine centre is close to his/her home). 

Along with an increasing number of quarantine centres, the number of facilities treating COVID has increased manifold. All the district hospitals as well as identified 50 model hospitals of the state have been made functional to treat COVID patients. Training is being given to the staff on the treatment protocol.

The lab testing facility has been ramped up considerably in May 2020. In the month of May itself, the state could test more than 90000 samples and thus the total number of tests have crossed more than one lakh till 31.05.2020. You will be glad to know that Assam has surpassed Kerala in total testing done so far, though Kerala’s health infrastructure is known by the country. 

With the operationalisation of more labs, a load of testing at earlier labs has come down and thus reports are fast getting generated. Based on the test report, people who are found negative are being released after three to four days and rest of the residual period (out of total 14 days quarantine period), s/he is sent for strict home quarantine. Community members have been urged to be vigilant, alert to ensure that all the family members of the person, who is sent for home quarantine, adheres to the norms of home quarantine strictly so that community members do not get affected COVID-19. 

Finally, to ensure smooth implementation of all the above plans, the war room staff take updates from all stakeholders and accordingly gap-filling measures in terms of human resource engagement, a supply of logistics are done on an urgent basis. 

So, with planned readiness, the state is able to successfully manage the surge in the number of cases, with quality care and very less case fatality rate. 

Source: Department of Health, Govt of Assam

Tell us more about the quarantine facilities and how are they taking care of the patients?

The state took a conscious decision that anyone entering Assam by any means (air/railway/road) will be quarantined at identified quarantine centres and samples will be collected for all of them. Based on the swab test report, either giving discharge or sending him/her at the hospital for COVID treatment is taken. Even if one is discharged from quarantine, then the person is sent for strict home quarantine for the residual number of total quarantine period of 14 days. It is heartening to inform that more than 95 per cent of the cases, came only from different quarantine centres, hardly any case from the community has come so far. 

Of late, the state has decided to further decentralise the quarantining process by creation of quarantine centres at the block level, legislative constituency-wise so that person, who is at the quarantine centre feels s/he is at home (as the quarantine centre is close to his/her home). 

Along with an increasing number of quarantine centres, the number of facilities treating COVID has increased manifold. All the district hospitals as well as identified 50 model hospitals of the state have been made functional to treat COVID patients. Training is being given to the staff on treatment protocol.

To enhance the numbers of COVID treatment facilities, recently, Guwahati Medical College and Hospital (GMCH) has been made functional with 200-bedded exclusive COVID treatment centre with 50 ventilators and the COVID establishment of GMCH is fully sanitized, which is done using ultra-violet ray (imported from Canada). The two (02) annexe hospitals of GMCH, namely MMCH and Kalapahar Hospital have been made fully dedicated COVID hospitals. 

Other than these hospitals, each district hospital has dedicated COVID beds for COVID treatment and recently, 50 identified model hospitals have also been added to the lists of COVID treatment centres. 

The state has 411 quarantine centres at different levels and more are being identified, to keep them as stand by. Hostels of colleges, universities, lodges have been requisitioned by the district administration and these are kept ready and used as and when extremely necessary. The idea is to test each person, before s/he goes for home quarantine.

You have recently launched a super speciality hospital in Guwahati Medical College and Hospital. How is it going to help the people of the state?

The functioning of a super-speciality hospital in GMCH is seen as a big leap in delivering quality healthcare in Assam. This will not only help the citizens of Assam only but will also cater to the needs of the entire northeastern states.

Since COVID has emerged all of a sudden, so the state has decided to make the super speciality hospital functional exclusively for treatment COVID patients. Once the COVID situation normalises, the hospital will start entertaining all other critical non-COVID cases, which might happen in the next few months. 

The super-speciality hospital is centrally sanitised by using ultra-violet ray (a technology imported from Canada by the state government and the system has been made operational). 

The hospital will provide all specialities, supported by experienced senior specialists of each discipline.

Critical patients, henceforth, need not go outside Assam for treatment and will be able to seek treatment here at the super speciality hospital in GMCH.  

How is the state helping the health staff/ doctors during the pandemic?

In COVID-19 management, the safety and security of COVID-19 warriors are very important. As a step towards this, the Health Department, Assam is taking all possible steps to extend them the best support in terms of logistics and also psychological support. It has ensured that there is no shortage of PPEs, N-95 masks, triple-layer masks, hand sanitizers, gloves etc. so that staff remains safe. 

Further, the state has decided that each team of COVID healthcare providers (of all cadres) work for seven days and after seven days of work, the team is quarantined for seven days in identified quarantine centres (mostly in hotels, lodges), where health department takes care of food, accommodation of the members. 

After the mandatory seven days quarantine period, each team again joins back to their duties. During their duty, none of the members can go home as a safety measure. 

What kind of technologies are being used to help patients and doctors alike during the pandemic?

In certain facilities, at the screening area, PAS (Public Address System) is introduced to get the patient details. Healthcare providers sit inside an insulated room and the patient’s history is collected using PAS. Decisions are taken about the next step to be taken. 

To address the loneliness/boredom of patients, android mobile is given among few patients and each one of them can call their family members as and when s/he feels like so that s/he remains mentally fit and family members also know that the patient is doing fine and improving.  

Proper training is the critical component to achieve success as proper training equips manpower to follow the proper protocol of clinical management, which results in a high survival rate. Assam formed different training teams with the support of WHO, UNICEF, Jhpiego (An international non-profit health organisation affiliated with Johns Hopkins University). Members finalise the training contents for different levels of cadres (doctors, para-medical staff, nursing, cleaning staff etc.) and imparted training. 

Due to the lockdown, the state via video conferencing trained the district level trainers from different medical colleges, who in turn trained the hospital staff and managerial staff of each district.

In order to ensure a strong backup of trained human resources, Assam trained 700 final year MBBS students and 2000 final year nursing students and they are kept ready as back up human resources.

The healthcare providers are equipped with all latest guidelines, advisories, SoP, as published by Ministry of Health and Family Welfare (MoH&FW), National Centre for Disease Control (NCDC), IDSP, India Council of Medical Research (ICMR), World Health Organization (WHO) are being closely looked at on a daily basis and relevant guidelines are adapted in the state context. 

What is the scenario in the districts? How are Asha workers helping in this endeavour?

As on June 2, all the 33 districts of Assam have COVID cases and figures ranging from 177 cases (Hojai district) and one case in Majuli district. All the cases, which are identified at the district level, are being managed at the district level and the critical cases (mainly aged person with comorbidity status) are sent to medical colleges for better treatment. The districts are ready to treat patients. 

ASHAs have been helping to fight back this pandemic in a big way. In fact, the first suspected case from Jorhat district, who got tested negative in the second test, was identified by ASHA, which proves that ASHAs are highly active in the field. Health Minister, Assam on record appreciated the role being played by these frontline workers. The active support of all frontline workers (ASHA, ANM, MPW) has been found very useful in reaching the last household of the community with the COVID-19 messages, mainly DOs and DON’Ts of COVID-19.

With an aim to ramp up testing, Health Department, Assam has started ‘Assam Community Surveillance Program (ACSP)’ from May 7, 2020 in around 28000 villages/wards of Assam to look for SARI (Severe Acute Respiratory Infections) and ILI (Influenza-like Illness) and fever cases. Testing of all such cases is done to take necessary steps, as per the test report (be it COVID, JE, Dengue, malaria) and to take follow up actions (including isolating a person followed by treatment and contact tracing). 

Under this ACSP, ASHA workers visit each household in her area and look for if anyone has any signs and symptoms of COVID-19 and people with signs and symptoms are listed. They  are screened by the medical team, headed by a medical officer. If necessary, the lab technician collects samples (blood/swab, as the case may be) and tests. Based on the test report, treatment is given as necessary. If COVID is confirmed, the patient will immediately be shifted at the appropriate facility. So far, no one has been found COVID positive from the community visit. 

ASHA workers generate awareness among the community to ensure that community members keep a strict vigil of the movement of the quarantined family members and if anyone is found roaming outside then the nearest health facility has to be informed so that necessary actions, as per norms can be initiated against him/her. 

How are you engaging the primary health centres during the pandemic?

The state has taken a conscious decision not to admit COVID cases at Primary Health Centres (PHC). The reason behind this is that when  one gets admitted at PHCs, it adversely affects the essential healthcare services, like maternal health, child health, immunisation, Non-Communicable Diseases (NCD), other primary health activities, community outreach activities, IEC-BCC campaign etc.

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