While most of India was reeling under the huge surge of the second wave of the pandemic the district of Cooch Behar which serves as a gateway to northeast India had only 30-40 percent hospital bed occupancy at its peak.
Cooch Behar has emerged as the champion district in West Bengal in this pandemic. Kudos to the district administration along with the teamwork and efforts of the District Health Administration and MJN Medical College and Hospital for being deftly proactive in ensuring that citizens are the least impacted in this health crisis.
The Optimist News got in touch with the District Magistrate of Cooch Behar, Pawan Kadyan, a 2012 batch IAS officer who is a graduate from IIT Kanpur, to understand how the district achieved this remarkable feat.
Q: How is the Covid situation at Cooch Behar?
A: Cooch Behar as a district has always been on the better side of things in the pandemic. We took many preemptive measures to control the spread of the virus. Many of our initiatives were later found to be in line with subsequent instructions given by the state and the center for districts which gave us the confidence that our thinking was on the right track and that our understanding of how to control this novel virus and the lockdown was going in the right direction.
Cooch Behar does not have the same level of medical paraphernalia as Kolkata or Siliguri, still we were able to tide over the crisis rather smoothly. In 2020, Cooch Behar was the last district in West Bengal to be affected by Covid. We did not report any cases till the 30th of May 2020. The positivity rate has always been below the state average and one of the lowest in the state. During the first wave the district’s death rate had also been among the lowest in West Bengal. Now that the second wave is subsiding we might achieve a similar feat.
Q: How did you manage the lockdown?
A: The lockdown posed a unique experience for all, particularly Cooch Behar. We were able to manage all public services during the lockdown by using the available resources and channelising new strategies and interventions within what was permissible as per the orders issued by Government under Disaster Management and its Regulations.
From the very beginning we had planned about the incoming migrants. We took steps to ensure they face least difficulties. Around 20 cells were formed in which psychological counseling was also included other than isolation, quarantine, transport, availability of essential commodities and cooked food supply. We used the experience we had from holding elections and disaster management we did before.
The district faced an influx of 1.4 lakh migrants last year. It was possibly the highest among all districts in West Bengal. However, we were able to isolate and quarantine everyone. The migrant returnees kept coming to the district till mid-June, 2020. At its peak in June 2020, the district recorded around 400 active cases. However, by July 4, we were back to zero active cases implying that the isolation and quarantine measures had been effective and successful. Thereafter the cases again saw a gradual rise due to opening up of the economy in subsequent phases of unlock, however, the situation in the district remained under control overall.
Q: In the second wave the challenges were more on clinical management. Many cities faced shortage of essential medical supplies. How did you avert the crisis on that front?
A: In the first wave we had one Covid hospital with a capacity of a little over 100 beds, but we never witnessed that much bed occupancy. We were able to treat patients with our resources and were never in want of medical equipment or doctors. This time the spread was more generic, and our focus was primarily on early testing, isolation, containment and clinical management. The number of COVID beds in the district had to be increased manifold at war footing and we successfully created a capacity of over 1000 beds. Overall, we have managed to create the required capacity on time and were never constrained on the availability of hospital beds, oxygen or medical supplies.
Cooch Behar shares a 550 km long border with Bangladesh and 85 km border with Assam. We have a huge responsibility to prevent the spread of the virus to and from the northeast and from public and cargo interactions and movements on the borders to the extent possible. It is a grave concern; however, so far the situation has been under control.
As a part of Covid Management, Covid control rooms were set up even in gram panchayats of Cooch Behar and were monitored at the district level, everyday. Since the first wave, all patients in home isolation were followed up on call and intermittently through home visits, all were dedicatedly provided with COVID medical Kits, FAQs about COVID, different Contact numbers for COVID Care, Government Services and so on. Moreover, even before the state government started the Safe Home initiative, isolation centers were made available in the district for Covid positive patients who could not be isolated at home.
It was easier for people to understand the importance of COVID appropriate behaviour during the second wave. However, it was the availability of particular medical equipment in time which posed a concern, but after clearance from the state government we were able to arrange quite a handsome amount of equipment on our own. I used my personal network to a large extent to get such supplies. I happen to be a graduate from IIT Kanpur. My friends from IIT Kanpur who are well placed in various top positions across the country and abroad came forward under a banner called ‘Help Indian Hospitals’ which created a way of getting donations and partnering with NGOs and manufacturers or retailers to arrange medical supplies for government hospitals across the country.
I used the same network to get donations directly to Cooch Behar either through Help Indian Hospitals or organizations like Give India, Commercial Banks, PSUs and others. Many organizations and businessmen from Cooch Behar also came forward. This supplemented what we were getting from the state and allowed us to create sufficient capacity for appropriate clinical management.
Q. Community engagement forms the bedrock of good governance. Did you plan anything on that front?
A: Community participation has always been important for us. People have come forward which enabled us to manage the pandemic well. We found many natural leaders among them, who with hand holding from the administrative side for guidance helped keep the district safe. Responding to our call to the public in the first wave, people in their private capacities set up community quarantine centers which helped Cooch Behar to quarantine the migrant population. The Panchayat bodies also played a crucial role in this regard. Similarly, in the second wave people came forward and set up community isolation centers and oxygen booths for Covid positive people.
Since post Covid complications have been reported among patients from other parts of the country and the world, follow-up OPDs have been initiated across all Block Primary Health Centers, Sub-Divisional Hospitals and MJN Medical College Hospital. ASHA workers are talking to patients in home isolation to help them avail preventive health check-ups to screen them for any such complications like Mucormycosis, a week after COVID recovery.
We also initiated a drive in which data was collected from all Blocks and Subdivisions about people who had recovered from Covid and could share resources like pulse oximeters, oxygen concentrators or oxygen cylinders with the district to be used by other patients or directly with the local people in need.
During last year’s Durga Puja we held local competitions between various Puja associations, Byabasayi Samitis, Self Help Groups and others to spread awareness on Covid. Based on the rare black softshell turtle found at Baneshwar Shiva Dighi Mandir at Cooch Behar which has a sentimental value for the locals, we created a mascot named ‘Mohan’ for the district. The mascot wore a mask and had a hand wash with the tagline “Amar Mask-i amar Vaccine”, meaning, ‘My Mask is My Vaccine’. The local puja associations, market committees and others made huge cut outs of the mascot and used it for community sensitization.
Q: India aims to vaccinate all adults by the end of this year. What has been your strategy for vaccination?
A: Making the vaccines accessible and reducing hesitancy has been challenging for Cooch Behar. We have launched a ‘Duare vaccine’ program in which the district administration is reaching in different local areas to senior citizens and people residing at far off places. WhatsApp chatbot is also being used to book vaccination slots for the municipal area of Cooch Behar.
We are vaccinating on a daily basis and mapping the population that is uncovered. Since there is high demand for the vaccine now, appropriate availability of vaccines called for regular monitoring and interventions on a daily basis.
Our strategy is to be able to contain the virus through vaccination, apart from implementing other containment measures. We did a detailed Gram Panchayat-wise and Municipal Ward-wise data analysis of the number of active cases in both the waves. Also, we have tried to cover the most vulnerable population in areas with higher positive cases, for instance the municipal pockets which have shown higher positivity. Hence, we vaccinated people living in the municipal areas faster than those in the rural areas. The idea is to create localized bubbles of herd immunity in small pockets where positivity has been higher than the overall population.
In some municipalities more than 90 percent of the people have got vaccinated while in others at least 50-60 percent have got their jabs. We hope that in some manner general herd immunity may get created faster in the municipal areas through faster vaccination to help slow down the spread and counter mortality.
Q: Vaccine hesitancy usually poses a hindrance for vaccination drives. How have you tackled the situation?
A: We studied trends of vaccine hesitancy in other states and reached our conclusion that it is mostly about the psyche of the people and the way information was reaching them.
To counter vaccine hesitancy we vaccinated the local influencers first and ensured that the message gets duly propagated. Besides, there were active attempts to counter media based apprehensions through video testimonials in social media. These were done through individual posts. If it had been done through official channels it would not have received the kind of acceptability that was achieved from posts made by somebody from within the community.
I personally used to take a lot of time in explaining the science behind vaccination. We used to study the situation minutely to stay ahead of the curve, explain things to locals in simple language and meet group of stakeholders with real life examples of people from Cooch Behar.
To strengthen the process further we ensured that various officials who were in leadership positions take their shots as soon as they become eligible thus leading from the front and acting as role models for others. This made it easier for many to follow suit and quell any rumour or misapprehension even before they could run wild. These active interventions from the district administration thwarted vaccine hesitancy from reaching critical levels which might have affected the vaccination drive.
Q: There are apprehensions from different quarters about the third wave. How are you preparing for it?
A: In the first wave we had 110 beds for Covid patients in the district, in the second there were more than 1000 beds of which only 30-40 percent were utilized and no oxygen crisis was reported. We have set up an Oxygen Monitoring Committee and taken active interventions in all COVID Care Facilities with prompt planning and daily follow-up reporting regarding the status of oxygen availability and patient-wise oxygen usage summaries. By now, one PSA plant has been set up and two more are planned. Other than sufficient oxygen cylinders and oxygen concentrators, we have a new state of the art Critical Care Unit ambulance with voluntary donations received from a group of local businessmen in the District. Armed with these ample supplies Cooch Behar is advantageously placed to combat the third wave.
Since the third wave might affect rural areas and children more, we have identified areas where health infrastructure including bed capacity need to be augmented. We are also looking into how many new beds for neonatal and pediatric care can be arranged. Every rural hospital in Cooch Behar today has some oxygen based hospital beds at each of the units. Similarly, neonatal and pediatric based ICUs have also been arranged.