India’s first COVID-19 containment cluster in AGRA

In India's first COVID-19 cluster Agra, containment strategy included identifying the area within 3 km of the epicentre as containment zone. Over 1,200 teams conducted door-to-door survey of 9.3 lakh people. The strategy, now known as 'Agra Model', also saw Smart City Control Room being converted into 'war room', where a central helpline was established.

A proactive approach in identifying cases, intensive testing, door-to-door surveys and strict quarantine measures helped Agra successfully arrest the spread of Covid-19, officials said on Sunday, after the central government instructed states to learn from the containment model followed by the Uttar Pradesh city.

The “Agra model” kicked in early in the Covid-19 outbreak cycle when six patients tested positive on March 3. At the time, the whole country had only 30-odd cases. “We at once started door-to-door surveys and identification of infected cases and placing them in quarantine. The outcome is that the cases testing positive now are mostly those already in quarantine,” said Prabhu N Singh, Agra district magistrate.

The city administration followed the strategy of drawing up a list of those back from foreign travel and identifying their family and other close contacts. The neighbourhood where patients lived were declared hotspots, with a three-km radius around them acting like a containment zone and a five-km radius area as the buffer zone.

“Beside this, 10 patients were cured, including the three who were treated at SN Medical College in Agra . Another aspect of the success was in getting the hotspot areas delisted after extensive door-to-door surveys and sanitising the area, with strict measures to avoid movement within hot spot areas,” said Singh.

The Union health ministry was directly involved in drafting and monitoring the measures taken to contain the rising clusters in Agra. The central integrated disease surveillance programme team came to know of the first positive case in the middle of the night, and, soon after, they started drafting a containment strategy.

“People at all levels, from the higher authorities to field staff, were involved in containment measures as it was confirmed that we were dealing with India’s first big Covid-19 cluster. The success of containment can solely be attributed to the team effort that went in it,” said a senior health ministry official, requesting anonymity.

A war room was established in the Agra Smart City office in mid-March, where 7,000 complaints have been heard till date. The identification and sealing of hotspots under a micro plan was removed after all patients from the area tested negative signifying that all patients of that area were cured. Initially, 38 hotspots were identified by Agra administration, of which 10 have been sanitised. Currently, there are 28 hot spots in the city.

“At least 2,000 of health workers are working 24×7 and we have included around 3,000 Asha workers (village volunteers) to improve outreach when door-to-door surveying for identifying suspected cases reached 1.6 lakh houses. We reached one million city residents with 1,248 two-member teams,” said Dr Mukesh Kumar Vats, chief medical officer.

About 2,500 people who were symptomatic, including 36 with a travel history, were tested.

“For adequately follow up, we developed a foolproof quarantine approach. Those found asymptomatic were placed in home quarantine while those who were symptomatic were placed in isolation ward, so we were mostly testing those already in quarantine,” said Dr Vats.

“We worked on getting clusters contained, sanitized and removed from list of hotspots, which allowed us to focus on new clusters,” said Dr Vats.

By the end of March, Agra had only 12 cases, of which 8 had recovered. But the arrival of 28 people in Agra linked to the Tablighi Jamaat event in Delhi, which is India’s biggest hot spot, led to a surge in numbers in April, with half of new cases linked to the Nizamuddin congregation.

In all, 143 people from the Jamaat and their contacts were tested. “We had to search for these Jamaat members and their contacts and extensive work was done in tracing them. This increased the number drastically,” said Dr Vats.

“Agra has already tested 2,144 samples, of which 104 were positive as on Sunday, the day when 12 more cases were found positive, and mainly comprised of staff at a private hospital and their contacts. This hospital alone had 16 cases testing positive of Covid-19 and has turned into major hot spots, our team is planning to take drastic measures,” said the district magistrate.

Despite the success, the challenges are not over. The city now has 104 cases and authorities are struggling to contain the spread at one of the city’s main private hospitals. Moreover, doctors warn that the virus may have spread in the rural areas of the district, cases being reported from Saiyyan, Fatehpur Sikri, Khandoli and Iradat Nagar. “A plan has been created for rural areas where cases have been identified in two categories, migrants who arrived infected, and those living in villages but working in the city, mainly in hospitals, where they got infected,” Vats said.