Mysuru district in Karnataka made headlines when an employee of a pharmaceutical company, Jubilant Life Sciences, tested positive on March 26. It has been nearly two months since the man, christened Patient 52, tested positive and the district has not reported a single death due to COVID-19. The number of active cases has now come down to zero. Of the 88 people who contracted COVID-19 in Mysuru, 74 were from the cluster related to the pharmaceutical company. With the cluster of cases gaining traction, district officials were under pressure to find the root cause of the spread. To this day, officials are in the dark about the source of infection. This, however, has not stopped them from effectively containing the spread of the virus. TNM spoke to Abhiram G Shankar, Deputy Commissioner of Mysuru, about the challenges of working with a mysterious cluster and the coordination among various departments to curb the spread of COVID-19. Excerpts from the interview: There were 88 cases in Mysuru with zero casualties. Did demography play a part in this? There were a lot of challenges but we had six to seven patients who were critical. In two cases, they were less than 40-years-old. There were four senior citizens and of them, three were very critical and not in great condition. These three patients were in the ICU. Our doctors took care of these patients quite well. We had an ‘e-rounds’ facility by the state government, where expert doctors in Bengaluru would discuss critical cases via video-conferencing and guide the doctors here. One patient had severe comorbidities. This was Patient 273. For five to six days, we really did not think he would make it. He recovered from COVID-19 and died of cardiac arrest. After he recovered from COVID-19, we kept testing him everyday and his results were negative each time. However, he died of cardiac arrest on Friday. We declared this as a non-COVID-19 death. While the cause of infection of patient-zero is yet to be found, what was the strategy implemented to counter the rise in cases? In early March, when the foreign arrivals started, we had a contingency plan. We equipped the government hospital in a short period of time to handle the situation. It was a learning experience for all of us. It was not like we had seen this. We never knew the concepts of containment, quarantine, and contact tracing. Until the virus struck, these were alien concepts. No one had seen a pandemic or an epidemic here and handling it was an alien concept. By the time we had the first case on March 26, when we had Patient 52, we decided to make all employees of the company as contacts. Initially, going by the definition, there were less than 100 people who were his contacts. Despite requests from other employees (who said) they had not seen him or met him and so there was no need for quarantine, we took a call that all employees have to be quarantined. Almost 1,500 people were quarantined in a day. Most were in Nanjangud, some in Mysuru and a very small number in other districts. Subsequently, on March 28, we got five cases from Nanjangud. That was the first cluster outbreak that we had. Immediately, we went ahead and sealed off the entire Nanjangud and adjoining residential areas. Almost 65,000 people living here were cut off from other parts of the district and state. We blocked it from all sides and no entry was permitted except for essentials— groceries, milk and medicines. A 35 km radius was marked around Nanjangud and traffic was diverted away. No vehicle was allowed to pass despite it being a National Highway. All shops were (open only for) three to four hours: morning 6 to 10 or evening 7 to 10. Everything was shut. It became like a small ghost town for some time. People were not permitted to go out and move around. We had formed squads to enforce this. Another challenge was that on the first day, when Patient 52 tested positive, we were not able to find all the employees as many were on leave. We had to trace and find over 800 people. We did house-to-house surveys and quarantined them after taking the employees list. Nanjangud was like a litmus test. It could have gone very bad and into severe community transmission but we managed it quite well under the circumstances we were in. What worked according to the initial plan and what did not? Thankfully, for good or for bad, the contingency plan was not put to use. We had planned for more than 500 cases at any time and had identified facilities to house these patients. Now these facilities have been converted to quarantine (centres for) primary contacts, or people from other states. We have changed the guidelines of use. In March, the guidelines were different and simple. We were not too far into it. We had made arrangements for 500 COVID-19 patients. We had purchased blankets, bedsheets, beds, and other ancillary things they would need while in isolation. We had kept it ready. Once Nanjangud went into lock down, health workers began surveillance activities. They would cover every house every day. They would go door-to-door and see if people had symptoms, whether they were healthy, and keep track of them. We had a robust calling system. The call centre would call each person once or twice a day to check on them. Each person at the call centre would call the same 50 people that he or she had called on day one. Health workers developed a rapport with those who were in home quarantine. In terms of testing, what was the restriction you had to face in terms of shortage of resources and what did you decide? In March, there was a shortage of N-95 masks, PPE (and) general shortages. It took two to three weeks to stabilise. Now we have no shortage of anything and are flush with materials. We have multiple quality of materials and also those of multiple price ranges. Testing there was a severe limitation. The testing protocol was also different initially. Only the symptomatic patients with travel history were being tested. In the Nanjangud case, we took special permission from the government to test all the employees. Because we did not know to what extent it had spread. In Nanjangud, over 2,000 people were tested. The employees and their families were all tested. We were testing 400 people per day. What was the public asked to do and how did they respond? Surprisingly, people were cooperative. We had imposed a lot of restrictions in opening shops and movement. People did cooperate. Local elected representatives also took over the task of creating awareness and asking people to cooperate. Local bodies were distributing groceries to people in need. The MLAs also did a lot of work in distributing food and ration in their respective constituencies. The government had given ration two months in advance. The district administration was dealing with core activities like tracing contacts and management of hospitals. The peripheral activities like distributing food, ration etc. was taken care of by local bodies and the MLAs. The police were doing their job well. One thing which stood out here was that there was nothing to complain about coordinating with different wings like the local bodies or police. Everyone came together to work and the coordination was very smooth. The credit goes to everyone involved including officers, NGO, activists. In terms of influx of migrants coming back to the district, what has been your plan and how do you plan to deal with it? That is the next challenge. As of now, the influx of daily wage labourers is very less. Mysuru is at a relatively advantageous position. We do not have a big population of daily wage labour force that is coming in. People come here for work, unlike in districts like Yadgir, Kalaburagi and north Karnataka districts. Here, the labour force is migrating outside the district. We have less than 3,000 requests to come into Mysuru and around 13,000 people have applied to go to other states. People who are coming in are lower and upper middle class. We are calling each and every one who has registered to come in. We are telling them that they will be quarantined. We are doing this to ensure that only those with absolute need can come in.
