Mumbai / New Delhi: May 21, 2020 

With everyday spike in cases across the country and the world, already there is a requirement for a new normal, with change in perspectives in every field, industry and individual.

Cities that are densely populated are the most affected, with Mumbai having the maximum cases in comparison to other cities. The main reason is its densely populated settlements which have been a thriving ground for the spread of corona virus. In order to fight the Pandemic in densely populated urban settlements, Health Ministry lists down the focus areas to be addressed in order to fight COVID-19 in these settlements.

 

What are these settlements and how are they crucial in the fight against COVID-19?

They are mostly informal settlements within cities that may have mushroomed due to rural-urban migration, with inadequate housing and poor living conditions, poor structural quality of housing, inadequate access to safe water, insecure residential status and poor sanitation. One can witness these areas suffer from gaps in health and healthcare services. 

 
Hence physical distancing, isolation, quarantine, surveillance, and communicating risk to the dwellers could be challenging in such areas.

How to implement containment plans in these areas

Urban Local Bodies (Municipal Corporations or Municipalities) should plan for preparedness and response to COVID-19, considering the challenges unique to such populations. Health Ministry states that an Incident Response System would be set up.

An Incident Commander of appropriate seniority is to be identified who will be reporting to the Municipal Commissioner. Incident Commander will identify the area’s planning, operation, logistics and finance teams, so as to implement the measures to respond to a COVID outbreak.

A coordination mechanism will be evolved under the leadership of Incident Commander and will comprise of representatives from Health, Women & Child Development, Integrated Child Development Services, Housing & Urban Affairs, Public Health Engineering Wing, Swachh Bharat Mission, elected representatives, prominent NGOs already serving the area, community leaders, etc.

He/she will daily review the implementation of containment plans in the settlements. All information will be shared on a daily basis with the District and State Control rooms, which will provide necessary guidance to the teams at field level.

Surveillance:

The surveillance system shall be strengthened for surveillance and contact tracing mechanism.

The District Integrated Disease Surveillance Project IDSP unit can map field workers/ health workers who can be used for surveillance - in the health posts/dispensaries, ANMs, ASHAs, Anganwadi Workers, Municipal health staff, sanitation staff and other volunteers (NSS/NYK/IRCS/NCC and NGOs) etc. The trained manpower available on www.covidwarriors.gov.in can also be tapped if necessary.

The plan will clearly delineate the allocation of households for the surveillance staff for house to house survey for case detection & contact tracing, coordinating sample collection, case management, data collection and reporting. The existing routine surveillance would be strengthened through dispensaries/health posts/urban health centres and private health facilities for ILI/SARI surveillance.

Training of the surveillance team:

Orientation training will be organized by the Chief Medical Officer/Executive Health Officer to train the surveillance workers. Their trainings will focus on surveillance, contact tracing, home quarantine, IPC, managing quarantine and isolation centres, supply of ration to homes etc.

What are the key activities for a surveillance worker during house to house visits?

1. Active case search, listing and tracking of contacts, coordinating sample collection, recording temperature, identification of high-risk individuals
2. They will inform the inhabitants about common signs and symptoms, preventive measures to be adopted, need for prompt reporting of symptoms and also address stigma and fake news.
3. It must be stressed at all times that hiding of cases will affect both their health and their family

The surveillance teams in the containment as well as buffer zones must submit their daily reports on suspect case detected and referred, contacts traced etc. Adequate provisions for appropriate PPEs must be made for field level surveillance teams.

Besides these volunteers, surveillance of specific areas can be made possible with the help of Community Volunteers as well. Use of local (political, religious and opinion) leaders for communicating all aspects of the COVID prevention and control is vital as dwellers are more inclined to trust them. In addition to government health facilities, surveillance network linkages need to be established with private medical practitioners in such localities.

Identifying COVID Care Centres / Quarantine facility in a nearby area:

The next issue is availability of community level structures in these areas, that can be transformed into designated COVID Care Centres / Quarantine areas. The urban local body shall be assigned with identifying existing facilities near to these settlements which shall be earmarked as COVID Care Centres/Hospitals. The civil dispensaries, health posts, health & family welfare centres and private health facilities within these settlements will act as nodal points for the wards/sub-wards/zones for detecting and reporting ILI/SARI cases through their OPDs. Such facilities will also be used as depot holder for Hydroxychloroquine, masks, household disinfectants etc. In order to avoid crowding in hospitals or health centres, non-COVID services especially immunization, management of communicable and non-communicable diseases, maternal and child health services should continue to be provided in these areas.

Similarly Quarantine facility (school, stadium, etc.) in a nearby area also need to be identified. Shifting of high-risk contacts (elderly and those with co-morbid conditions) is a crucial intervention to minimize the spread of disease in such persons, thereby limiting morbidity and mortality among them. The high-risk population can be shifted to institutional quarantine so as to have focused management of such cases as it may have an impact on mortality.

Ambulances need to be stationed at the perimeter of these localities.

What are the behaviour changes need to be addressed?

Practice frequent hand washing, Follow respiratory etiquettes, Ban spitting in public places, Following physical distancing Use masks/face covers Avoid consumption of gutkha, paan, cigarettes/bidis etc.

 

Challenges:

• Physical distancing will be a major challenge at such places. However, it should be promoted at all formal and informal gatherings, particularly in community water points, public toilets, PDS distribution points, health centres etc. While sleeping, the distancing can be achieved to an extent by sleeping in opposite direction i.e. head end of one person faces the leg of the other
• Community cleaning and disinfection drive needs to be undertaken on daily basis.
• Adequate arrangement for soaps/disinfectants should be ensured at the health & family welfare centres
• Face covers should be made mandatory. It can be manufactured locally within the area as self-help group activity or through NGOs.

Communication:
Community participation is very crucial to overcome this pandemic. Hence measures should be taken to create awareness on:

• Common signs and symptoms of COVID-19
• High risk population particularly elderlies
• Risk involved for persons with co-morbidities like hypertension, cardiovascular diseases, renal disease etc
• Helpline/Toll free numbers should be widely publicized for reporting cases.

How to communicate?

• Need to address psycho-social issues and spread stigma removal messages particularly in local languages
• Psycho-social teams should be deployed to the area to address mental health needs
• Posters should be put up outside in the community area, toilets, water points
• Local cable TV channels may be utilized to create community awareness
• Social media should be used to target this population and for refuting fake news

Community groups should also popularize adoption of Aarogya Setu application.

 

How to respond to COVID-19 outbreak in Urban settlements

The trigger for action would be reporting of a suspect/confirmed case from routine surveillance observed by the health practitioners.

Once a case is reported, the Incident Command System and Control room will be activated. Coordination meetings will be held at the incident command level and at sub-ward/ward/zone level with ward officer/assistant commissioner/local CBOs/NGOs.

The first and foremost action upon reporting of a suspect/confirmed case of COVID19, is identification of the containment and buffer zones by the District Surveillance Unit, based on rapid identification of other cases and contacts. For small clusters, the containment zone can be mapped as the administrative boundaries of residential colony / mohalla, surrounded by a buffer zone. In case of a large outbreak, the entire population of municipal ward/zone/police station area, towns etc may be taken as containment zone with all its neighbouring areas in the buffer zone.

Strict perimeter control must be enforced to regulate entry and exit from the containment zone. Section 144 under CrPC will be enforced to ensure people remain indoors. The local administration however must make every effort to maintain supply of essential commodities in such area. The routine medical needs of the population other than COVID19 must also be catered to. If feasible, the relief centres in the containment zone may be geo-tagged and information may be made available through mobile applications. All containment activities should be implemented in line with the Health Ministry’s plans on COVID19 containment for small clusters and large outbreaks.

The management of the suspect and confirmed cases should be institutional, and no COVID-19 case can be managed at home. It has to be ensured that there are no delays in transferring patients from one facility to another including availability of sufficient ambulances. Strict adherence to Infection, Prevention and Control practices shall be followed in all COVID and Non-COVID health facilities. In case of occurrence of a death, management of the dead body shall be in accordance with the guidelines of Health Ministry.

The complete guidelines can be read here.

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DL

 

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