COVID-19 Update

Rajasthan: Time lost in tussle

Print edition : September 25, 2020

Sample collection in Ajmer on August 31. Photo: PTI

Chief Minister Ashok Gehlot (left) reviewing the position of COVID-19 infection at a meeting in Jaipur on September 2. Photo: by Special Arragement

Rajasthan prepares for an effective strategy to contain the infection, which has spread to almost every part of the State.

The number of COVID-19 cases has been increasing steadily in Rajasthan, one of the first States to identify coronavirus clusters. The main clusters in the early months of the pandemic were found in Jaipur and Bhilwara. In Bhilwara, the spread was brought under control with strict adherence to lockdown measures and adoption of safety guidelines. Bhilwara’s sparse population was an advantage in containing the spread. But that was not the case with Jaipur. For some peculiar reason, the city has contributed the maximum number of cases to the overall caseload and fatality figures in the State. Jodhpur has now overtaken Jaipur in the total number of cases. The infection, which was initially concentrated in a few districts, gradually spread to all the districts. Jaipur, Jodhpur, Kota, Bikaner and Alwar have contribute close to 68 per cent of the State’s caseload.

On September 2, as many as 1,470 new cases were reported taking the cumulative tally to 84,674 cases. Twelve persons died in the 24-hour period taking the total number of COVID-related deaths to 1,093. Pratap Singh Khachariyawas, State Transport Minister, tested positive in late August. Earlier, Vishwendra Singh and Ramesh Meena, who were dropped from the Cabinet following the rebellion in the ruling Congress, had tested positive. Reports of fresh cases from the tribal-dominated southern districts has caused some concern. Although the overall figures have been low there, fresh cases were reported from Banswara, Udaipur and Dungarpur. Jhalawar, Bundi, Baran, Barmer, Chittorgarh, Churu and Bharatpur districts reported some 100 fresh cases. Jaipur and Jodhpur are the only districts that have consistently reported 100 to 300 cases every day. The daily figures for Kota and Bikaner have ranged between 100 and 200 cases. Overall, the spike in cases in these districts, including densly populated urban districts and those outlying Jaipur, was observed mainly in July and August. The virus had reached almost every part of the State.

On September 2, Chief Minster Ashok Gehlot held prolonged discussions with his Cabinet colleagues on the public health situation.

The State’s case fatality ratio at 1.3 per cent is lower than that of Gujarat and Uttar Pradesh. Its recovery rate, at 81.4 per cent, is comparable to the national average although its average growth rate at close to 2 per cent has been worrisome.

The ruling Congress wasted precious time in factional fight in July and most part of August. Rajasthan continues to occupy the13th position among States in the number of COVID cases but is in the ninth position in the number of deaths. Rajasthan is among the top 10 States that account for a good part of COVID-related deaths in the country though its share (1,008) to the national tally is low compared with that of Uttar Pradesh (3,616), Gujarat (3,046) or Delhi (4,500).

But the steady increase in the number of positive cases has been a matter of concern. On August 1, the State reported 43,243 cases, but a month later, on September 1, the number of cases almost doubled to 83,163. On an average, 1,000 cases were reported daily from all over the State. On some days, the figure went up to 1,400. Jaipur, which had reported 5,547 cases as of August 1, saw the numbers jump up to 11,099 by the end of the month. In contrast, Jodhpur, which had 7,014 cases in the beginning of August, reported an almost 70 per cent increase. On September 1, there were 12,238 cases in the district. Similarly, the number of cases in Bikaner rose to 4,476 on September 1 from 2,031 on August 1.

Gearing up for response

On September 2, the State Health Department, in an order issued to district and block- level officials, acknowledged that the virus, despite being concentrated in urban centres had spread to small towns and rural areas. The order stressed the need for an effective strategy and directed the Community Health Centres to make arrangements for testing and providing oxygen facilities and a functioning outpatient department. The centres were required to dedicate a room for patients suspected of influenza-related illnesses (ILI) and other vulnerable categories. They were told to mobilise trained medical officers and paramedical staff and provide facilities for testing samples, use oximeters and organise referral arrangements such as ambulances. The order also directed that anganwadi and accredited social health activists be mobilised for screening of suspected patients. It was decided that for every group of five panchayats, six health workers would be assigned to conduct screening by using random sampling methods, under the supervision of trained nurses. They would be equipped with monitoring devices such as oximeters and have vehicles at their disposal.

“It is important to screen people in villages and kasbahs the way it has been done in towns and cities,” the order stated. The paramedical staff would have to ensure containment and quarantine facilities, if required. The District Collector and the Chief Medical Officer would conduct training and evaluate the progress made once a fortnight. The preparations that were under way indicated that the government was apprehensive of the spread of the virus in rural areas and small towns. The order permitted District Magistrates to use the COVID emergency response fund for containing the spread.

Although government hospitals in cities such as Jaipur are no longer reserved for COVID testing and treatment, and have been designated as “COVID -free” since June, there has been a decline in the number of elective surgeries conducted in Sawai Man Singh Hospital, one of the largest government hospitals in Jaipur district.

According to published figures, the conducted a little over 13,000 elective surgeries in January, that is, 450 a day on an average. In June and July, when the hospital opened its OPD for non-COVID treatment, the number of surgeries conducted was 5,507 and 7,784 respectively. In August, as COVID cases rose exponentially, the number of surgeries and operations dropped significantly. In January, 13,110 surgeries were conducted, in February 13,902, in March 8,099, in April 1,802, in May 2,603, in June 5,507, in July 7,784 and until August 22, there were 2,752. In March, the hospital stopped routine admissions and converted the medical college into a dedicated COVID treatment centre.

The pressure on health services, which began in March, increased with a surge in COVID cases. As health care facilities in districts and villages are not on a par with those in the cities, crowding at government hospitals is bound to happen when there is a spike in cases, and the State should be prepared for this in the coming weeks.