RAJASTHAN COMES OUT WITH SHINING COLOURS IN COVID-19 MANAGEMENT; GEARING UP TO MEET THE CHALLENGE OF OMICRON VARIANT – EXTENSIVE OUTREACH HELPS STATE TRIUMPH SECOND WAVE OF PANDEMIC
Kalyan Singh Kothari
Coming out with flying colours in the onerous task of COVID-19 management, Rajasthan as the largest state in the country has had an enduring journey in overcoming the second wave of the pandemic that soared across India. The community spread could no longer be prevented through contact tracing and the COVID treatment facilities would be saturated soon if remedial measures were not taken without delay.
While the first wave of the pandemic was mainly contained in urban areas in 2020, the second wave was sweeping through the distant villages in early 2021. The committed and dedicated health officials of the State Government set on a journey to reach out to the remotest villages and detect and give relief to the patients at the earliest. In this conquest, the health officials reached villages amid shifting dunes in the west, ravines in the east and even island settlements in the southern districts of the state.
The strategy was to prevent the hospitalisation situation by early detection and treatment of COVID patients. The door-to-door survey helped in the detection and initiation of symptomatic treatment for 18 lakh people and help them cure at home. Those with serious symptoms were taken to the nearest health facilities. However, most of them revived at the temporary COVID care facilities developed locally.
The mega campaign involved 2,725 doctors, 4,454 nurses, 19,970 auxiliary nurses midwives (ANMs), 51,423 accredited social health activists (ASHAs) and 7,031 multipurpose health workers (MPWs), along with 65,399 village health committee members, including school principals, Gramsewaks and Patwaris, constituted in more than 25,077 teams. The drive continued for 70 days, covering several areas more than once. The total sample reach thus went over 16 crores, more than twice the total state population.
Along with the survey, symptomatic treatment kits were also distributed by the Medical and Health Department. These kits along with preventive and symptomatic treatment medicines also had zinc and vitamin supplements. Before the drive commenced, many people had the fear that being suspected of infection they may be sent to isolation and thus were hesitant to visit health facilities until complications emerged. Ensuring home treatment, the teams were successful in gaining the confidence of the masses and convincing them to take treatment at the earliest.
The strategy helped in saving numerous lives. While many were saved from unnecessary complications, the drive also helped control the demand for hospitalisation. The drive ensured that the beds were continuously available in hospitals for needy patients, as a large number of persons were treated at home.
The Health Department simultaneously was also working on the expansion of services and a large number of patients from the National Capital Region and other neighbouring states too were getting treatment at different places in Rajasthan.
However, the service expansion had other infrastructure challenges, such as the availability of oxygen. The door-to-door drive helped in delivering respite in the oxygen scenario. Since the most important aspect during the second wave was oxygen, proning training was also given during the door-to-door campaign. While the supply of oxygen was regulated by the Union Government, this proning campaign helped in controlling demand as well as ensuring patients near 90 saturation got cured at home.
Thus, prevention once again testified as best medicine and the State Government’s campaign such as “No Mask, No Entry” and the door-to-door survey gradually helped to control the situation that once seemed invincible. The door-to-door campaign was another achievement of the State Government. While the survey provided the Health Department with a more realistic picture of the state scenario amid the second COVID wave, the lessons were also found useful in planning for an anticipated third wave of the pandemic.
Rajasthan has been at the forefront of providing relief to the common man during the pandemic. The State Government took up expenditure of Rs. 1,866 crore by giving Rs. 5,500 each to 33 lakh families. The Government issued a special package for the children orphaned and women widowed because of the COVID infection.
As part of the assistance package, Rs. 1 lakh was given to orphaned children immediately and Rs. 5 lakh rupees will be paid to them on attaining 18 years of age, in addition to Rs. 2,500 per month till the age of 18 years and Rs. 2,000 per year for school uniforms and books. Widows were given Rs. 1 lakh and as immediate assistance and Rs. 1,500 per month as pension and Rs. 1,000 per month for their children.
Under the special package announced for children orphaned by COVID and widowed women, financial assistance has been released to 167 orphan children, 8,049 widowed women and children of 5,485 widowed women, involving the release of Rs. 96 crore. On the other hand, no such immediate assistance has been given in the package released by the Union Government.
The issue of the release of ventilators from the PM CARES Fund has generated enough controversy, to which the Chief Minister, Mr. Ashok Gehlot, has responded by asking from whom did the Centre purchase these bad ventilators playing with the lives of patients. Several states, including Rajasthan, Madhya Pradesh, Punjab and Uttar Pradesh, had complained about the malfunction of ventilators.
The State Government has geared up to deal with the spread of the Omicron variant of coronavirus after the detection of nine infection cases in Jaipur. Four members of a family, who had returned from South Africa, and five of their acquaintances, who all tested positive for Omicron, were admitted to the Rajasthan University of Health Sciences (RUHS) Hospital in Jaipur in early December.
The RUHS Hospital’s fifth floor has been dedicated to quarantining the Omicron-positive cases, while a backup plan has been formulated for the immediate availability of oxygen concentrators and cylinders. Besides, the beds with ventilators and oxygen support have been reserved in the hospital to meet an emergency situation. According to RUHS Hospital’s Superintendent, Dr. Ajit Singh, 300 of the 1,200 beds in the hospital are equipped with intensive care facilities and the number of oxygen-supported beds could be increased from 900 to 1,000, if needed.
The State Medical & Health Secretary, Mr. Vaibhav Galriya, gave necessary directions for increasing the alertness and vigilance to look for the Omicron variant, besides getting more samples and doing random sampling. The genome sequencing of all the patients who are tested COVID positive will also be carried out.
An effective tracking and tracing are being done with regard to the people coming from abroad as per the Union Government’s protocol. On December 4, the health personnel by working tirelessly set an example of vaccinating more than 11 lakh people and took a pledge to continue the drive vigorously to deal with a possible third wave and control the pandemic.
Mr. Galriya has not ruled out the possibility of a third-wave of COVID-19 and has given instructions for the timely installation of the necessary equipment including oxygen plants and Intensive Care Unit (ICU) beds in hospitals. The doctors and nursing staff have also been asked to get training in ICU management, oxygen therapy treatment protocol.
“Test, track, treatment, vaccination and appropriate behaviour” is the new five-fold strategy adopted by the State Government to meet the challenge posed by the spread of the Omicron variant of the virus. This is accompanied by contact tracing and RT-PCR tests of all primary and secondary contacts coming in contact with suspicious travellers, a compilation of information of each Omicron-positive case in the prescribed format, daily review and testing of samples of all influenza-like illness (ILI) and pneumonia patients coming to OPD and IPD of the hospitals.
The newly appointed Medical and Health Minister, Mr. Parsadi Lal Meena, took charge of his office on November 24, while affirming that providing better medical facilities to the general public is the top priority of the State Government. Mr. Meena said that more than 83% of people have been administered the first dose of the corona vaccine and more than 53% of people have been administered the second dose. The war against corona will remain incomplete without administering both doses. In such a situation, officers will be directed to make a time-bound programme and vaccinate the people deprived of the second dose at the earliest.
Mr. Meena has pointed out that while utilising the corona period, the State Government has worked to strengthen the infrastructure of medical facilities. As part of these efforts, free tests and medicines are being made available at Primary Health Centres and Community Health Centres. In the coming days, all necessary medical facilities will be made available at all CHCs and PHCs, so that the villagers do not have to come to cities for treatment.
In Mr. Meena’s own Assembly constituency, Lalsot in Dausa district, the PHCs and CHCs are being strengthened at the local level by providing medical equipment and other facilities from the MLA quota. An appeal will also be made to all the MLAs in the State to adopt this model. If the health services are strengthened at the local level with the budget from the MLA quota, then it can prove to be a better option, according to Mr. Meena.
In another four-hour-long marathon meeting with the Department’s officers shortly after taking over as the Minister, Mr. Meena directed for increasing the corona testing in the State and administering the first dose to 100% people by the year-end, besides intensifying the efforts for administering the second dose and to taking care of the cases related to giving compensation following the deaths caused by COVID-19 at the earliest.
The Health Minister directed for random sampling in crowded places such as markets, mandis, bus stands, railway stations and tourist places and schools to control the spread of corona infection. He said at present more than 28,000 samples are being taken daily. He instructed them to take up to 1 lakh samples daily. He also directed to take samples of suspected ILI patients, while emphasising that the infection could be controlled sooner by taking more samples.
Mr. Meena pointed out that Rajasthan has been on top in corona management. In corona vaccination too, Rajasthan is performing better than the national average. About 84% of people in the State have been administered the first dose of the vaccine and 54% of the people have been administered the second dose. The Minister also instructed for setting a target of administering 10 lakh doses per day in the State. Significantly, the Department has the capacity to administer 15 lakh doses per day.
Mr. Meena has also directed to speed up the genome sampling of the samples of corona positive patients and to start genome sampling in all the medical colleges. He has discussed in detail many subjects including sero-surveillance, the progress of oxygen generation plants, ICUs and the status of children’s hospitals. Reviewing the seasonal diseases, he directed for taking up preventive activities, fogging in affected areas and other activities while doing the micro-planning in dengue affected areas.
Deaths due to corona are a very sensitive issue, according to the Health Minister. The officers getting self-motivated should help in getting compensation to the affected by carrying the cases of compensation to the competition level in the next seven days. Mr. Meena has directed all the Chief Medical and Health Officers and higher officials to work in the field. He said if the officers remain in the field, then the arrangements in the medical institutions will start improving.
While reviewing the Budget announcements from 2019 to 2021, Mr. Meena has given instructions to fulfil the announcements at the earliest. He has also reviewed the flagship schemes of the Department. Taking detailed information about Chief Minister’s Chiranjeevi Insurance Scheme, Chief Minister’s Free Medicine Scheme, Chief Minister Free Diagnostics Scheme, Janata Clinics and Chief Minister’s Nirogi Health Camps, Mr. Meena was informed about 332 Community Health Centres selected for prevention from the possible third wave of the corona.
The comprehensive efforts made by the State Government for the prevention of corona have won praise across the country. After a very low number of corona cases for several months, once again the number of these cases is increasing. To ensure that the corona infection does not increase, the officials have been directed by the Medical Department for special vigilance and strict adherence to the corona guidelines.
Mr. Galriya informed that during the past festive season and the ongoing marriage season, the Corona rules are being largely ignored. As a result, the number of corona infected has increased. But to ensure that its spread is not high, instructions have been given to the officials to ensure that the five-fold strategy is followed.
According to the Health Secretary, the infection can be stopped if the persons coming in contact with the COVID patients are immediately investigated. The officials have been instructed to take intensive active and passive surveillance action in the areas inhabited by the infected patients. Issuing the advisory, Mr. Galriya has directed that the first dose of vaccine should be completed by identifying the eligible persons who did not take the second dose.
It goes to the credit of the State Government that Rajasthan is performing much better than the national average regarding COVID vaccination. About 83% of people have been administered the first dose and 48.9% of people have been administered the second dose in the State. The efforts will be made for full vaccination by making a special action plan and increasing the number of vaccination camps in the less vaccinated districts.
Rajasthan has topped in every regard from corona management to vaccination. Vaccination is being done on a large scale in the ongoing “Prashashan Shahron and Gaon ke Sang” campaigns. The people who were earlier deprived of the vaccine, were vaccinated on a large scale through 12,000 camps in Chiranjeevi Health Camps starting from November 14.
The beneficiaries deprived of the first and second doses of vaccine are also identified by conducting a door-to-door survey under the “Har Ghar Dastak” campaign carried out from November 3. Full vaccination has been done in more than 3,000 villages in the State under this campaign, whereas the teams of the Health Department are visiting and vaccinating the general public in 22,000 villages.
Till November 10, against the targeted population of the State, more than 6.36 lakh people were administered the first dose and more than 2.08 crore people were administered both doses of the vaccine. The State is also ready for vaccination of children aged less than 17 years. The targeted group of children up to 17 years comprises about 1.10 crore in terms of numbers and full preparation is in place for their vaccination.
The Medical and Health Department has sufficient storage, cold chain and trained manpower for children’s vaccination. With getting the vaccine doses for children, information, education and communication (IEC) activities will be carried out on a large scale and publicity will be done so that the children feel that will be completely safe with the vaccine.
Significantly, the vaccination of children is a common process, as it is done from their birth. As soon as the vaccine dose for children is received, the vaccination will be done effectively in the State.
The State faced the maximum problem of medical oxygen during the second wave of COVID-19. In this regard, the State is on the path of self-reliance. As many as 545 oxygen generation plants have been sanctioned in the State, of which 285 have been installed and the remaining ones will be established shortly. More than 47,000 oxygen concentrators have also been supplied to the State, and with them, 1,000-litre metric tonne medical liquid oxygen will be available.
The nine cases of Omicron infection were detected in the State by genome sequencing of a family from South Africa, after which the Health Department got the family admitted to RUHS Hospital. Five other people who came in contact with them were also found infected and they were lated to shifted to the same hospital.
The Department has been fully active since the arrival of the family from South Africa in Jaipur and their monitoring was being done continuously. An intensive contract tracing was also done and the treatment was started after identifying all the people who came in contact. Mr. Galriya has appealed to the general public to strictly follow the COVID-appropriate behaviour. He said that everyone should wear masks while leaving the house, follow social distancing, keep washing their hands with soap not forget to take the doses of vaccine.
It is quite evident that the Rajasthan Government is preparing all the officials for any new spurt in cases during the second wave of COVID or a potential third wave, even as the number of cases and fatalities in the State have shown a decline in both urban and rural areas. The Chief Minister, Mr. Ashok Gehlot has pointed out that the State has set an example across the country by managing the COVID situation well during the first and the second waves of the pandemic.
Mr. Gehlot has said that the State Government would provide adequate financial resources to strengthen the health facilities and directed the officials to prepare an effective strategy to counter the third wave, as there were reports about different variants and the third wave is likely to be more deadly. “A strategy should be chalked out keeping in mind the research and study going on in the country and the world,” Mr. Gehlot has said.