NEW DELHI—Rajasthan Health Minister Dr. Raghu Sharma opposed the immediate lifting of the national lockdown after April 14 and backed a more careful approach towards easing restrictions while speaking with HuffPost India.
“I don’t agree with immediate lifting. It is not advisable to immediately lift the lockdown,” Dr. Sharma said categorically in the interview.
Sharma felt prior verification about whether coronavirus transmission had been eliminated from a given area should be the key factor while making a decision about lifting the lockdown or curfew, as the case may be.
“Wherever the situation is under our control, then the lockdown should be lifted. In states where this virus has not spread at all, their boundaries should be sealed and lockdowns lifted. Don’t allow anyone to enter or exit those states,” he said.
He had a similar suggestion for districts as well. “In districts where the transmission of this virus is intensified, their boundaries should be sealed so that no one can exit or enter them. In districts where there is no existence of infections, you can remove them from lockdown. This is how you will have to go about it,” he said.
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In districts where the transmission of this virus is intensified, their boundaries should be sealed so that no one can exit or enter them. In districts where there is no existence of infections, you can remove them from lockdown. This is how you will have to go about it.Dr. Raghu Sharma, Health Minister, Rajasthan
In one sense, Dr. Sharma is well suited to talk about the imposition of lockdowns and curfews for containing the spread of the novel coronavirus. He is the minister overseeing the Congress-led government’s unique attempts at resisting coronavirus transmission in the Bhilwara district of Rajasthan, which has been receiving national attention for aggressively containing the spread of coronavirus.
These attempts have been labelled the ‘Bhilwara Model’ in the press and they deploy a mixed bag of measures including imposition of curfew and large scale screening of local population to check how many people have been infected. This has yielded results, Rajasthan government officials say, as hardly any new cases of virus transmission have been detected.
Importantly, Dr Sharma’s comments come at a time when there is national curiosity about whether the lockdown will be lifted or extended. With barely four days to go for the Narendra Modi government’s 21-day-long lockdown to end, there is keen interest to know if it will be further extended. Recently, PM Modi held a video conference with Chief Ministers to sound them out about the possible future course of action. He hinted at the possibility of not fully withdrawing the lockdown and prolonging a return to normalcy.
The Rajasthan health minister said a decision about lifting the lockdown must be taken after careful planning and with an eye on reaching a desired conclusion.
“I am of the same opinion that there should be a logical conclusion for making a decision to lift the lockdown. In that as well, your planning and thinking should be such that when the lockdown is lifted, virus transmission does not flare up. Both these things will have to be considered,” he said.
Dr Sharma also said that, “after reviewing the situation, if the cases are growing, you are not advised to lift the lockdown.”
He expressed concerns about the economic impact of the lockdown and curfews on the states and said the impact on the economy must be a consideration for lifting lockdown or curfews in specific areas.
The Congress MLA hinted at a lingering disappointment about the Modi government not quite heeding Rajasthan Chief Minister Ashok Gehlot’s appeal for central assistance of Rs 1 lakh crore to states. “There are issues other than the health sector which are also important during lockdowns and curfews, right?” he asked.
Speaking about the ‘Bhilwara Model’, the health minister explained how measures for containing the spread of the virus were imposed aggressively.
When asked what prompted the state to adopt such aggressive measures, first in Bhilwara and then in several other districts, when the total number of cases were significantly lesser than many other states and a national lockdown had not yet been announced, Dr Sharma explained, “Details of this alarming situation were in front of us. Though there was just one case in the state, our conscious decision to formulate an action plan after anticipating the gravity of the future problem saved our people.”
Edited excerpts from the interview:
Let’s start with something that’s being discussed across the country by many. Please explain to me what is the ‘Bhilwara model’?
There is a private hospital, the brajesh bangar memorial hospital, where a doctor got infected. Some guests had arrived from the middle east who transmitted the virus to the doctor, who in turn transmitted it to other doctors and patients who were present there for undergoing surgeries or had come to the OPD for treatment. This was a large number. Suddenly the number of people infected there became 26 and we were worried. Immediately, measures were taken under the Chief Minister’s monitoring.
Let’s go chronologically. When did you find out about this and since when did you start taking measures?
From March 20, we found out about it and our teams left for Bhilwara. The boundary of the entire district was sealed, no one was permitted to enter or exit the district. Even the boundaries in rural areas were sealed and curfew was imposed.
After that, through a team of 3000 health workers, we conducted active surveillance. The containment plan for this is applicable till one, three and five kilometers from the hotspot. So the screening process that we started initially was around the one kilometer radius of the locality in which the hospital is located. Then we did it in three kilometers radius followed by five kilometers and then in the entire district.Nearly 28 lakh people were screened. Teams went to each household and screened every person.
Those who were found to be symptomatic cases; people who had influenza-like illnesses, cough and cold mainly, were also identified and monitored properly to see if their numbers are increasing or decreasing everyday.
First we took samples of those who were found to be symptomatic and these were sent for testing to Jaipur, which has this facility. Those found positive were isolated. Contact tracing was done to find out the people they came in contact with.
So as I said to you before, the first thing to be imposed was a lockdown then curfew followed by active and passive surveillance. Then screening, testing those found symptomatic followed by contact tracing, and people were quarantined on a large scale in hotels and other facilities earmarked specifically for the purpose. Some were also isolated in isolation wards. Nearly four lakh people were kept in isolation wards.
the first thing to be imposed was a lockdown then curfew followed by active and passive surveillance. Then screening, testing those found symptomatic followed by contact tracing, and people were quarantined on a large scale in hotels and other facilities earmarked specifically for the purpose. Some were also isolated in isolation wards. Nearly four lakh people were kept in isolation wards.Dr Raghu Sharma, Health Minister, Rajasthan
Because of all these steps we could convert all the positive cases found in the initial stage into negative ones. Most cases have been converted into negative ones. One new case has been found but the situation there is in control. When the initial 14 day curfew period ended, we imposed a further intense curfew. It is not as if now we are relaxing things over there.
Most importantly, we are making sure that no one feels inconvenienced due to their inability to access food rations, vegetables, medicines and milk. All of that has been planned to see to it that our delivery system is strong and the supply chain does not become dysfunctional. Otherwise people get worried. So every major thing has been dealt with and that is why this is successful.
When you implemented this, it was several days before the national lockdown came to be announced by the Prime Minister Narendra Modi. So what specific information or input made you act so swiftly and strongly?
Yes, it was four days before the national lockdown. Chief Minister sahab was regularly monitoring this, I was monitoring it, the Bhilwara district administration was alert. Deployment of the police department officials happened in an effective way to ensure there was no public movement.
And most significant work was done by our medical department team of doctors, paramedical staff, nursing staff, ambulance drivers and peons—all of them comprised the 3000 member strong team of the health department. In city areas, we have done door-to-door surveys two-three times.
So what I want some clarity on is that, at a time when most other states and the central government as well were not resorting to any drastic measures to tackle this virus, what prompted you to go in for such aggressive measures in one district?
Rajasthan had its first positive case on second March. It was a couple from Italy who flew down to Delhi and then arrived in Rajasthan by road but we did not know their travel plan. We didn’t get information about whether they were screened at the Delhi airport. In Rajasthan, ever since we got the first positive case, teams of doctors and nursing staff were deployed at the Jaipur international airport round the clock where eight foreign flights would arrive everyday. Every traveller who had arrived from a foreign country—whether a local resident or one visiting us—was screened.
We were alert about the conditions developing across the world. We were getting reports from China, the Indians living there were calling us. Chief Minister sahab was receiving calls. I was also getting reports.
And when the WHO declared this a pandemic, it was but natural for us to take this seriously. We got reports from South Korea that one lady infected five thousand people.
Details of this alarming situation were in front of us. Though there was just one case in the state, our conscious decision to formulate an action plan after anticipating the gravity of the future problem saved our people.
So acting promptly and on time brought these positive results.
Now you can see that across the state we have provided for separate COVID-19 hospitals.
How many are they?
Every district has a COVID hospital. In hospitals aligned with medical colleges, at least 500 beds are only for corona patients. ICUs, ventilators and separate OPDs—only for corona patients.
If you can go into some specifics about this to help me understand better. You are saying each one of the 33 districts in the state has a COVID hospital?
Yes, a dedicated hospital for treating corona patients.
How many private hospitals have you taken over?
Those are as per requirement.
We also have government hospitals. For instance, the SMS Hospital in Jaipur has all the required infrastructure so we brought together beds in four-five departments and converted into a COVID facility. So where government facilities were available...across the state, we knew from the beginning, we could quarantine 1 lakh people at the same time. We have developed those facilities. They are available presently.
Further, if isolation is required for 20,000 people at the same time, those facilities are also ready. Ventilators, PPE kits, N95 masks, paper layer masks, everything is monitored by the Chief Minister, me and my department everyday.
We have 27,000 teams of health workers. Rajasthan’s work of active surveillance has not been seen anywhere else in the country. We brought about 12.5 lakh families across the state in active surveillance, screened them. Nearly 5 crore 37 lakh people have been brought under our scope of screening. Work to screen people on a large scale is being done even now. It is being monitored on a daily basis. We have given a helpline number. Nine senior IAS officers led by the Additional Chief Secretary (Health) constitute a war room. Our state service RAS officers are also part of this team. Through all these officers, daily monitoring about what is happening across the state is being done.
After Bhilwara, we found positive cases in Jhunjhunu district. Immediately, our rapid response team went there.
Apart from Bhilwara, how many such districts in the state are under curfew now?
Curfew is in Bhilwara, Jaipur, Tonk, Jhunjhunu, Ajmer, now even Kota was brought under it. Wherever it is required, immediate decision of imposing the curfew is taken. First, it is imposed around one kilometer radius of the place where a positive case is found. If such cases spread then the area under curfew is expanded.
So right now, curfew was imposed in Jaipur’s Ramganj, a locality in the walled city area. But now we realised that there are some cases in the outer city as well. So the scope of the curfew has been expanded.
So right now all of Jaipur is under curfew?
No. There is a lockdown in all of Jaipur. In the Ramgaj locality of the walled city, there is curfew and now wherever positive cases have been found, they have been brought under curfew.
Some days ago you gave a statement that every resident of the state will be tested for coronavirus. How will you make that happen?
When we got the first test on the second of March, we didn’t have any testing facility in Rajasthan. Samples of the Italian tourists I mentioned before had to be sent to the Virology lab in Pune. It took two days for the report to arrive.
So after that, on the direction of the Chief Minister, we developed a testing facility here, initially planning for eight places but now, in Jaipur alone, we can do 1500 tests per day. All of this work has happened in the past one month. Now what has happened is that the ICMR has approved 12 companies to conduct rapid testing through kits. Just as diabetes testing is done by taking one drop of blood on a strip, we are moving forward to implement that by procuring rapid testing kits. We can’t take any decision without approval from the ICMR. When they approved, I had said that we will do mass scale testing since testing facilities are increasing. I had said random sampling. Especially those places where tourists keep visiting and people who they meet in those places.
After all, no one here was infected. This has probably come from China or tourists from foreign countries or Indians who visited those countries and returned. That is why I said we will conduct random sampling. We will provide rapid test kits to our health workers, train them and sampling will happen on a large scale.
But random sampling is selective, so how is that the same as testing everyone?
We know which part of Rajasthan still has large transmission of the virus presently. There our perspective towards testing will be different and districts which are safe now, there our perspective will be different.
If testing is not done on a mass scale, how can we tell how many have been infected by the virus?
In the active surveillance that we conducted, the Influenza Like Illnesses are being identified. But this new virus is affecting even those who are not symptomatic when we test them. So the difficulty has increased. That is why we will have to emphasise on sampling and a decision has been taken yesterday to conduct intensive sampling.
So how will this decision be implemented in practise?
We will take more samples. Thus far, all those who were quarantined were not being tested. But now we will test all of them.
This is also the season of harvest in which migrant workers travel in and out of Rajasthan to harvest crops in farms. So will their movements be regulated in your state?
Both are necessary—harvesting the crops as well as the migrant workers’ safety. Our health workers in rural areas will monitor them. We need the crops to be harvested otherwise there could be a crisis of the availability of foodgrain.
By maintaining social distancing, we will have to open mandis. Farmers have to visit mandis and the government has to procure as per the support prices.
This is how the process may be done. A date will be given to the farmers and their harvest will be bought from them on the same day and same place in the mandi. The government can get a two or four member team. The payment system has been put in place. Thus harvesting will also happen and so will procurement of foodgrain. This will have to be done.
How much has the central government supported states in terms of finances as well as health related assistance to deal with the coronavirus pandemic? Is it adequate or more is needed?
See, at this point, I do not wish to indulge in any politics. If I say we have received less or haven’t received anything, then it will seem political.
I am just asking for the facts.
Listen, when the Prime Minister held a video conference with all Chief Ministers, our CM clearly said that the condition of the states is bad and they are going through financial problems. This was endorsed by the CMs of BJP-ruled states as well. So our CM asked for assistance of Rs 1 lakh crore for the states from the centre.
Lakhs of NREGA workers whose livelihoods are dependent upon works they do under the scheme should receive financial assistance directly in their bank accounts for the 21 day lockdown that you have announced. These were the two things which the CM said that day at the video conference.
So what is the status right now: have you received the financial assistance or not?
The CM has again written a letter about it to the centre. Now you can guess whether we have received it or not.
Has the ICMR as an institution provided the required assistance to the states in capacity building or to address concerns about health infrastructure?
They are sending testing kits, I am not denying that. They are giving us N95 masks as well. But is this enough? Tell me. This is something even we could procure on our level. It doesn’t involve much cost.
You spoke of economic support. In that, there are issues other than the health sector which are also important during lockdowns and curfews, right?
So broad based financial support is still expected from the centre?
Yes, that is expected till date.
People have been speaking about how Kerala has dealt with the pandemic. What is your opinion?
Kerala has done good work. See, it is a 100% literate state and relatively small. We are the largest state area wise in the country. And in desert areas, there is one house per kilometer and in forested regions inhabited by adivasis, one family can sometimes be found on one hill. Our geographical terrain is very difficult. Population is also seven and a half crore.
How can what you did in Bhilwara be replicated on a national level?
This is getting appreciation on a national level and the cabinet secretary has said it should be adopted nationally. That is because of the visionary leadership of our Chief Minister.
This is about crisis management. It happens more through the heart than the mind. If you are planning to implement a lockdown or curfew, you will have to identify the difficulties people will face by not venturing out and maintaining social distancing. And you will have to take decisions accordingly.
We are towards the end of the national lockdown. What do you think about lifting the lockdown?
I don’t agree with immediate lifting. It is not advisable to immediately lift the lockdown. It should be slowly, slowly and after reviewing the situation, if the cases are growing, you are not advised to lift the lockdown.
So it should be lifted stage-wise after careful assessment is what you are saying.
Take for instance if cases are increasing in Jaipur, will it be advisable to lift the lockdown?
Wherever the situation is under our control, then the lockdown should be lifted. In states where this virus has not spread at all, their boundaries should be sealed and lockdowns lifted. Don’t allow anyone to enter or exit those states. In districts where the transmission of this virus is intensified, their boundaries should be sealed so that no one can exit or enter them. In districts where there is no existence of infections, you can remove them from lockdown. This is how you will have to go about it.
You will also have focus on things which are adversely affecting the economy.
Do you think this national lockdown could have been better planned?
If I have to implement a lockdown or curfew, before this thought comes to my mind, I will think what are its after effects and implications? What is the preparation that I will have to do so that when I impose this decision on the people, they have minimum inconvenience?
This depends on the vision of whoever takes the decision.
So do you think that has not happened here?
No. I am not saying that. Leave it to the people’s judgement. Why do you want me to criticise anybody?
No, no, the facts are in front of everyone. I am only asking for your opinion.
It is a fact that, if you want to inconvenience someone for a good reason—saving their life—that’s fine. Your intention is fine. But if you plan it well, there will be least inconvenience. After all, you are reducing one kind of inconvenience and increasing the other kind.
So this logic applies to lifting the lockdown as well? That it should be planned well.
I am of the same opinion that there should be a logical conclusion for making a decision of lifting the lockdown. In that as well, your planning and thinking should be such that when the lockdown is lifted, virus transmission does not flare up. Both these things will have to be considered.