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Wednesday, September 29, 2021

Contact tracing: How Mumbai lost the momentum

BMC staffers, overworked, fatigued and fearful of the virus, struggled to cope with the tough rigour of the process – combing congested localities, interviewing people, testing and isolating them.

Written by Laxman Singh , Tabassum Barnagarwala | Mumbai |
Updated: May 28, 2020 10:41:09 pm
A new strategy is needed to rejuvenate India's healthcare sector A new strategy is needed to rejuvenate India’s healthcare sector

When the first two Covid-19 cases showed up together in Mumbai on March 11, the BMC had reached the patients, an elderly couple, within the first hour, and interviewed them for half an hour asking who all they met in the 10 days since their return from Dubai.

Five persons – their domestic help, driver, neighbour and two friends – were quarantined. Six civic officials visited five neighbouring buildings in Andheri West within a day. A 3-km radius around the couple’s building was chosen to conduct door-to-door survey for Covid-19 symptoms.

Contact tracing is perhaps the most crucial measure in preventing the spread of Covid-19. But the initial aggressiveness was shortlived.

BMC staffers, overworked, fatigued and fearful of the virus, struggled to cope with the tough rigour of the process – combing congested localities, interviewing people, testing and isolating them. As a result, in most cases, while BMC quarantines the immediate family, it has little time to make a list of people the infected persons had met in the days before they tested positive.

For instance, mid-May in Bandra, four neighbours were involved in getting a Christian man – a Covid-19 patient – treated at a hospital and his eventual burial. But when a BMC team came after two days of his death, they only took away his family for quarantine. The rest were not even asked if they had interacted with him or had any symptoms.

As on Tuesday, Mumbai had reported 32,900 cases. The same day, Municipal Commissioner Iqbal Singh Chahal had offered a catchy new slogan – ‘chase the virus’ – and said that he had asked ward officers to trace 15 people per new infected person in every slum.

At present, for each new Covid-19 patient, BMC traces 4.65 high-risk contacts. To meet the target, it needs to triple the coverage.

The worst performers is T (Mulund) ward, where only one contact per new patient is traced. In H East (Bandra East), M East (Govandi), K West (Andheri) and B (Dongri) wards, two contacts per patient are traced. Bhandup, at 11, has the maximum number of contacts traced per patient.

Delay in testing, lack of staff:

When a person tests positive, a community health volunteer (CHV) has to immediately reach the locality and trace high and low-risk contacts by asking who all had met the patient in the last few days – from grocery store owners to a security guard. As per BMC guidelines, each CHV has to screen 100 families, but resources are stretched. Currently, one CHV has to screen 250 families.

“There are so many new cases in a day that we hardly find time to reach out to all patients the same day. The backlog keeps increasing,” a medical officer said. The delays are costly because if the contacts remain unchecked, they could be spreading the infection they might have caught from the patient.

Once high-risk contacts are found, they are either quarantined at home – if they have personal toilet – or a team of three BMC officials (coordinator and two CHVs) move them to institutional quarantine. Those under home quarantine are stamped on the hand.

Alpa Jadhav, corporator of K West ward – reporting the fifth highest number of cases in Mumbai – said once a person tests positive, it takes two to three days for BMC to receive their report from private laboratories. “Residents don’t inform BMC. They take different types of transport. They visit multiple hospitals. They come in touch with several people. By the time BMC gets their report and reaches them, the patient has already met many people. How will they be traced?” Jadhav added.

There is a delay in swab collection and results coming from laboratories as well, as several are working beyond their capacity. Once a person tests positive, a laboratory usually takes 48 hours to test and another 24 hours to inform the local ward office. Only then patient details are put on a “line list”, armed with which civic officials visit the locality of the infected. By then, three days are lost. Commissioner Chahal has now asked all private laboratories to hand over test reports within 24 hours, and instructed ward officers to start contact tracing immediately.

An assistant municipal commissioner said while a high-risk contact must be moved to quarantine centre within 24 hours of a person testing positive, in reality it takes them three to four days.

“When our teams try to take high-risk contacts to quarantine facilities, they oppose. They start fighting. We have to convince them why it is necessary to be quarantined,” said Manish Valunj, Assistant Municipal Commissioner, L (Kurla) ward. A shortage of ambulances has also delayed transportation to quarantine centres.

Stigma continues.

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