How The Four ‘T’s Helped Assam Get Its Covid-Combat Strategy Right   

The northeastern state of Assam shines out as an excellent example of deploying a sound strategy to fight the Covid-19 pandemic.

Much before other states started acting, Assam had already framed its strategy and got into action mode. The strategy was based on four ‘T’s: trace, test, treat and transparency.

By the end of the first week of March, when most states were yet to wake up to the grave dimensions of the pandemic, state health minister Himanta Biswa Sarma started brainstorming on framing a comprehensive Covid-combat strategy with epidemiologists, virologists, public health experts and senior bureaucrats of his own department.

Guidelines issued by the World Health Organization (WHO) and Indian Council of Medical Research (ICMR) were studied and it was decided to follow them closely. Realising that the state could not fight the pandemic on its own, Sarma invited all private hospitals in the state to join hands with the government.

“We decided right at that time to conduct tests extensively. Testing facilities were ramped up, and we started procuring reagents (used for testing), testing kits, laboratory equipment and personal protective equipment (PPEs). We held meetings on a daily basis to finalise all arrangements and all these were attended to by the health minister,” said a senior officer of the state health department.

It helped a lot that health minister Sarma took the personal lead in framing the strategy and even micro-managing all preparations. With Sarma holding the finance portfolio as well, clearances and allocations from the finance department came through very fast.

A dedicated team comprising medical experts and senior bureaucrats to oversee all arrangements was constituted. A few decisions and steps that Assam took in mid-March stand out:

1. It was decided against admitting Covid-infected patients, or those suspected of having been infected by the virus, in various hospitals in order to avoid transmission of the virus to non-Covid patients and hospital staff.
2. All three state-run medical college hospitals in the state were turned into dedicated Covid treatment hospitals and general patients shifted to private hospitals.
3. By end-March, many primary health centres and district hospitals were also readied and earmarked as exclusive Covid treatment facilities. They were supplied with all equipment necessary for treating Covid-positive patients and stocked with adequate PPEs.
4. Health minister Sarma signed MoUs with private hospitals to shift existing patients from government hospitals to the private hospitals. The shifting took place over a short period of just two days and all the patients were covered under the central government’s Ayushman Bharat and state’s own Atal Amrit Abhiyan (a brainchild of Sarma).
5. Realising the need for a large number of frontline healthcare workers, Assam drafted 500 trainee nurses and all final-year MBBS students for the dedicated Covid treatment hospitals.
6. Structures were set up at stadia across the state to serve as quarantine facilities; the Sarusajai stadium in Guwahati is the biggest one till now with 1,000 beds.

All this was done before even a single Covid-positive case was detected in Assam. Health minister Sarma travelled all over the state to personally supervise preparations, talk to doctors and healthcare workers and motivate them to gear up for the battle.

In another exemplary move, Sarma roped in the best hotels of the state to house doctors, nurses, paramedics and other hospital staff who would need to be quarantined.

“We made a rule that after one week of duty at an isolation ward (treating Covid-positive patients), all doctors and other staff on duty there would be tested and those found negative would be quarantined in hotels for two weeks,” Dr Basanta Hazarika, Assam’s nodal officer for combating the pandemic, told Swarajya.

In Guwahati, the Taj Vivanta hotel was earmarked as an exclusive quarantine facility for the frontline healthcare workers.

Similarly, the best hotels in other cities and district headquarters were contracted to serve as quarantine facilities for healthcare workers.

“This helped boost the morale of all frontline healthcare workers. They knew they would be well taken care of,” said Hazarika. Adequate PPEs, masks, gloves, boots, sanitizers and other gear were procured and stocked for the frontline healthcare workers.

Also, a strict safety protocol was put in place. In all private hospitals as well as government hospitals that had not been designated as exclusive Covid treatment facilities, ‘triage booths’ were set up for emergency screening of all patients.

All patients coming to such hospitals wait outside the hospital premises while an attendant accompanying them is allowed inside and interviewed by staff.

The patient’s medical history is obtained and if the patient is found to be suffering from even the mildest symptoms of Covid infection, he is immediately sent to the nearest dedicated Covid treatment facility.

Asymptomatic patients are then allowed into such hospitals and examined by the emergency room resident doctor who is clad in full PPE gear. This has ensured that doctors and healthcare staff in other hospitals don’t get infected by the virus.

Assam now has 5,000 beds dedicated for treatment of Covid-positive patients, and this number is much more than what even neighbouring Bengal has been able to put together.

The total number of beds with ventilators in Assam far surpasses that of Bengal: the Guwahati Medical College Hospital, for instance, has 50 beds with ventilators while Kolkata’s M.R. Bangur Hospital — Bengal’s prime Covid treatment facility — has a mere 12 such beds.

Assam is also setting up mass quarantine centres of 1,000 beds each at the entry points to the state from Bengal.

All those coming into the state from Bengal will be tested and then quarantined at these centres.

State health authorities said that a standard operating procedure (SOP) for tracing primary and secondary contacts of Covid-positive or suspected patients was put in place long before the first positive case was reported in the state.

Thus, once news of the Tablighi Jamaat markaz at Nizamuddin broke out, the SOP kicked in and all returnees and those they had come in to contact with were traced and tested.

Assam also started testing symptomatic persons very aggressively right from the start of the pandemic. For the first few weeks of the pandemic and till just a week ago, Assam was ahead of even Bengal in the number of samples tested.

The aggressive testing and low positives till recently has now allowed the state to now scale down testing.

Assam was also completely transparent in all aspects of dealing with the pandemic. It has been the only state to name Covid-19 positive patients and give out their details like places of residence so as to alert all those who had come in contact with them.

All such contacts could thus come forward and get themselves tested and go into self-quarantine or get admitted to quarantine centres in the state.

This arrested the possible community transmission of the virus.

Apart from all this preparedness and protocols put in place, Assam has also enforced the lockdown very strictly.

The police have ensured complete compliance with lockdown restrictions and adherence with social distancing norms.

Unlike Bengal, which allowed vegetable, fish, meat and even flower markets to open, Assam has kept them firmly shut.

Only grocery shops selling essential items have been allowed to open for designated hours.

The state police have also reached out to lakhs of people all over the state with aid, including food.

Minister Sarma has, through his social media accounts, kept channels of communication open with all.

His twitter timeline is replete with people asking for help, and he personally responds to all of them.

Assam was also the first state to reach out to its residents stranded in other states and offer help to them.

Monetary aid was provided to patients and their families, as well as to students and poor workers, stranded in other states.

Minister Sarma said 1.5 lakh people of Assam who are now stranded in the rest of the country have been provided financial assistance.

All these measures have helped Assam beat the pandemic, at least till now. And in doing so, the northeastern state has become a copybook example of how to prepare and respond to a grave crisis like this pandemic.