Context: Recently, India has prepared a “containment” plan, essentially an updated version of an earlier Health Ministry blueprint that was drawn up when the only COVID-19 cases were those coming from abroad.
Components of India Containment Plan

A strategic approach based on the stage of transmission has been outlined by the Plan. There are 5 stages that have been identified. These includes:

• Travel-related case reported in India
• Local transmission
• Large outbreaks amenable to containment
• Widespread community transmission
• India becoming endemic for COVID-19

Approach recommended for the various stages of transmission

• Containment of Local Transmission: It hinges on extensive contact tracing and search for cases in the containment zone, testing all suspect cases and high-risk contacts, and isolating all suspect or confirmed cases; quarantining contacts; and social distancing.
• For Larger Outbreaks: In addition to the usual measures, there is higher focus on a particular geographic zone and hospitals around the area are prepared for a rise in cases. (Example: This was done in Agra in early March when the area was cordoned off, contact tracing and isolation undertaken at a large scale in Lohamandi area, and S N Hospital became the base of the surveillance team and also the place where suspected cases could be taken if required.)
• In addition, all asymptomatic healthcare workers are to be given hydroxychloroquine as a preventive.

Procedure to deal with confirmed and suspected cases

• According to the Plan, all suspect/confirmed COVID-19 cases will be hospitalized and kept in isolation in dedicated COVID-19 hospitals/hospital blocks.
• Persons testing positive for COVID-19 will remain hospitalized till such time as two of their samples are tested negative as per discharge policy.
• About 15% of the patients are likely to require hospitalization, and an additional 5 % will requires ventilator management.
• There is a plan to temporarily convert hotels/ hostels/ guesthouses/ stadiums near a COVID-19 hospital as care centres where mild cases may be kept to reduce the burden on hospitals.
• Moderate to severe cases, who require monitoring of their clinical status (patients with radiological evidence of pneumonia) will be admitted to COVID hospital.
• For more severe cases requiring respiratory or other support, tertiary care centres both private and government will be included as part of the micro plan.

Differential approach

• The plan has differential approach to different regions of the country, while mounting a strong containment effort in hot spots.
• The Health Ministry has issued directions for categorisation of designated facilities into three groups — COVID care centres, COVID health centres and dedicated COVID hospitals.
• The care centres will be for cases clinically assigned as mild or very mild, or suspected cases.
• The health centres are hospitals that will offer care for all cases that have been clinically assigned as moderate.
• The dedicated hospitals will offer comprehensive care, primarily for those clinically assigned as severe.

About Protection of healthcare personnel

• According to the plan, at all times doctors, nurses and para-medics working in the clinical areas will wear three-layered surgical mask and gloves.
• The medical personnel working in isolation and critical care facilities where aerozolisation is anticipated, will wear full complement of PPE (including N95 masks).
• The support staff engaged in cleaning and disinfection will also wear full complement of PPE.
• Environmental cleaning should be done twice daily and consist of damp dusting and floor mopping with Lysol or other phenolic disinfectants and cleaning of commonly touched surfaces with sodium hypochlorite solution.
• Sodium hypochlorite is already being used extensively, including in the Nizamuddin headquarters of the Tablighi Jamaat.

About ‘Bhilwara model’ to Control Covid-19
1) The strategy of Administration Complete Lockdown

• Under this the first measure taken by the Rajasthan government was to impose a curfew in the district on 20th March .
• Only essential services were allowed to operate
• The district border was sealed off on 19th Only those with a government approved pass were allowed to enter the district.

2) Aggressive Screening

• At the outset itself, the Health Department and the district administration in Bhilwara constituted nearly 850 teams and conducted house-to-house surveys at 56,025 houses and of 2,80,937 people.
• In just 3 days, these extensive screening and house-to-house surveys were conducted across the city to check for possible cases.

3) Efforts of Various Departments

• Health workers, home guards, police personnel, government officials and every other individual related to the screening of covid-19 patients were working without a break.

4) Zero mobility zone

• Two kilometre-area of any person found covid-19 positive was sealed and checks were done.
• These zones were turned into ‘zero mobility’ zones.

5) Use of Technology

• An app to monitor the conditions of those under home quarantine on a daily basis along with keeping a tab on them through geographical information system (GIS).

6) Maha – Curfew

• The curfew was transformed into a ‘Maha- curfew’ on 3 April .This intense version of curfew was far more.Under this new curfew even the essential services were barred.Doorstep delivery of essentials .Control rooms established for taking calls from citizens.