COVID-19 in Rajasthan: Congress government finally takes serious COVID-19 management measures

Amid the rising number of infections and deaths in the State, the Ashok Gehlot-led Congress government issues a series of orders and notifications, which indicates that it has finally got down to the serious business of COVID-19 management and control.

Sample collection for a COVID-19 test, in Ajmer on August 31. As of September 15, 27,05,303 people in the State had been tested, and there were 1,06,700 positive cases.

On September 3, Rajasthan’s Directorate of Medical and Health Services sent a letter to the Joint Directors and Chief Medical Officers in the State informing them of an important decision of the Empowered Group-1 (EG-1), which the NITI Aayog had set up for COVID-19 management. The letter, based on the EG-1’s report titled “Health System Preparedness Needs”, stated that hospitals with intensive care units (ICUs) dedicated to COVID-19 had to use them specifically for the treatment of those infected and not for any “wide purpose”.

The EG-1 recommended that COVID-19-specific ICUs should be aligned with the specific and limited needs of COVID-19 patients rather than function as generic/medical ICUs. These directions of the State authorities to district and other block authorities made it clear that the threat of COVID-19 was still very much a challenge and that dedicated ICU facilities were still the need of the hour. It also transpired that many asymptomatic patients were occupying beds in private hospitals, thereby denying critically ill COVID-19 patients the care and treatment they required. To address this anomaly, on September 6, the government further ordered that private hospitals should shift asymptomatic patients to COVID-19 care centres, which could be set up in hotels adjacent to hospitals. The government fixed the maximum rates that could be charged in such centres. Three private hospitals had signed memorandums of understanding with hotels to develop such centres.

On September 6, in another significant decision, the government converted the Jaipuria Hospital it runs in Jaipur into a dedicated COVID-19 hospital. A team of specialists from the government-run Sawai Man Singh (S.M.S.) Hospital, also in Jaipur, was directed to help set up facilities there. The S.M.S. Hospital, which until recently was a dedicated COVID-19 care hospital, was no longer operating as it had to bear the burden of attending to non-COVID diseases and other health issues. It was among the biggest hospitals in the State in which people from neighbouring Uttar Pradesh and Madhya Pradesh converged and were also referred to for treatment. On September 8, in another momentous decision, the Employees’ State Insurance Corporation (ESIC) Hospital for industrial workers and others covered under the ESIC was converted into a dedicated COVID-19 hospital once again. In the initial stages of the outbreak, just like S.M.S. Hospital, it had been made a dedicated COVID centre, a move that deprived people with non-COVID ailments of getting subsidised treatment and care. These two hospitals were the major health facilities in the government sector. The ESIC Hospital was restored to its original status a few weeks ago only for it to be reconverted in September into a dedicated facility once again. As per a government order, pregnant women and others who were availing themselves of treatment there were directed to the S.M.S. Hospital and the Zenana Hospital at Chandpole Bazar in the walled city area.

Maximum caseload in Jaipur and Jodhpur

As of September 15, 27,05,303 people in the State had been tested, and there were 1,06,700 positive cases, which put the positivity rate at 3.94 per cent. This made Rajasthan’s positivity rate lower than the national positivity rate, which was in the range of 8 per cent, but still much higher than the desired yardstick of under 1 per cent. A total of 1,271 people have died, with the maximum number of casualties being reported from Jaipur (302), Jodhpur (125), Bikaner (96), Kota (89), Ajmer, (88), Bharatpur (73), Pali (49) and Nagaur (44). Among the districts, Jaipur (15,788) has consistently been recording the highest number of cases and deaths, with Jodhpur close behind in the number of cases (15,681) but reporting only half the number of deaths. Jaipur and Jodhpur are the only districts with more than 10,000 confirmed cases each. The districts with between 5,000 and 9,000 cases included Ajmer, Bikaner and Kota. There were 18 districts that had between 1,000 and 5,000 cases; two districts, Ganganagar and Banswara, were nearing the 1,000 mark; and seven districts—Tonk, Sawai Madhopur, Pratapgarh, Karauli, Jaisalmer, Hanumangarh and Dausa—had less than 1,000 confirmed cases. Infections were now being reported from all 33 districts in the State, a trend which had become more palpable from June onwards.

Infections nearly double in 30 days

In the one-month period from August 16 to September 16, the number of infections nearly doubled from 59,979 to 1,05,898. The daily number of infections too, which was under 1,000 for much of June and July, saw a sharp increase in August. This has continued for much of September. For the better part of August, the daily spike in cases was in the range of 1,000 to 1,400. With the onset of September, the daily number of confirmed cases crossed 1,500 a day and has been rising ever since. In the one-week period beginning September 8-16, the average daily growth rate of confirmed cases was 1.7 per cent. Compared with States such as Madhya Pradesh, Punjab, Haryana, Delhi, Telangana, West Bengal and Odisha, Rajasthan had tested more number of people even though it was felt that there was a need to do much more considering that fresh cases were being reported from all its districts. The active ratio (proportion of active infections to the total confirmed cases) was 15.8 per cent, which meant that for every 100 confirmed cases, close to 16 people were currently infected.

The government issued a slew of orders in September against the backdrop of the rising number of infections and deaths. On September 11, an order was issued directing District Collectors to acquire private hospitals under Section 4 of the Rajasthan Epidemic Diseases Ordinance, 2020, which allows private hospitals, their material and human resources to be acquired either partially or fully at rates prescribed by the government. If needed, the state could provide equipment such as the necessary medicines, personal protective equipment kits, disinfectants and other essential consumables. The government had issued a similar order in April but later withdrew it after owners of private hospitals protested. The new order makes it incumbent on District Collectors to acquire private hospitals only if enough beds are not available in government hospitals. They were also supposed to get approval for the proposed acquisition from the Chief Secretary and the Health Department. The acquisition was therefore conditional.

On September 15, appointments were made to fill the shortfalls in the number of nursing staff. Directions were also issued for the redeployment of around 110 paramedical and nursing staff who had been superannuated between March and August. On September 14, the rate of the reverse transcription polymerase chain reaction test was reduced from Rs.2,200 to Rs.1,200 in all of the National Accreditation Board for Testing and Calibration Laboratories approved laboratories and in Indian Council of Medical Research designated laboratories.

The series of orders and notifications indicates that the Ashok Gehlot-led Congress government has finally got down to the serious business of COVID-19 management and control after getting unnecessarily entangled in a more than one-month-long factional battle that ended up wasting a lot of precious time. Clearly, the expansion of health care facilities could have been done earlier.