Though checking at Mumbai airport had been ramped up to include arrivals from 13 countries since January 18, the UAE wasn’t included in the list. Dubai is India’s largest air travel market with 500 weekly flights. Over 11 million passengers flew between India and the UAE in 2019 but it wasn’t viewed as a high risk destination. The UAE reported its first case on January 29. A Chinese family of four had flown in from Wuhan, the epicentre of the outbreak on January 16 for a holiday. They fell ill on January 23 but the case was publicly announced six days later. On February 23, when the tour group from Mumbai reached Dubai, the UAE had reported 13 cases, by the time they returned the number had risen to 27.
COVID-19 travels in clusters and over the next couple of days, more cases emerged from the group of 40. In response, the state organised a surveillance programme spanning multiple districts and cities. Some 300 people who had come in touch with the travellers were under observation. Within a period of eight days, 15 others from the group tested positive, and accounted for 40 per cent of Maharashtra’s 40 positive cases.
There are 200 beds in the civil hospital and 50 in the medical college. The district has 100 testing kits for COVID-19. When a sample is taken, it is rushed to the nearest laboratory in Pune, five hours away.
When the list of names reached the office of Dr Radhakishan Pawar, district health officer in Beed, he shuddered. Two men and a woman from Beed were a part of the tour group. When they were contacted, they reported no symptoms but were placed under home quarantine in the town. “If it gets out of hand here, there is no controlling the virus in the villages,” he says. In a district with limited resources, prevention was the only real option. The doctor put together an outreach programme that monitored villages and tracked the movement of outsiders.
The 11 talukas are each served by one health officer. Shirur, a block with a large population spread across a hilly terrain, has two ambulances for a population of 60,000.
For Dr. Pawar, the first step in the preparedness plan was the creation of an isolation ward in Beed’s civil hospital. There are 200 beds in the civil hospital and 50 in the medical college. The district has 100 testing kits for COVID-19. When a sample is taken, it is rushed to the nearest laboratory in Pune, five hours away.
As she tends to a steady stream of villagers reporting at the Khalapuri Public Health Centre in Shirur, Dr Gavhane fears that the 50 fifty bottles of sanitiser that was delivered to the PHC will soon run out.
When the Coronavirus disease was declared a public health emergency by the World Health Organization (WHO), a WHO consultant from Latur held a workshop in Beed where she explained the difference between high-risk and low-risk profiles, isolation and quarantine. She gave the medical and paramedical staff a talk on Personal Protection Equipment (PPE) that included a mask, an apron and gloves. There are 15 glove manufacturers in the country with an estimated annual capacity of over 2 billion pieces. India does not manufacture examination gloves because of low value and is dependent on imports. On March 25, the Resident Doctors’ Association (RDA) of the All India Institute of Medical Science (AIIMS) wrote a letter to the director expressing concern regarding the shortage of PPE such as surgical masks and gloves. Shortages are leaving doctors, nurses and other frontline workers dangerously ill-equipped. “The risk to healthcare workers around the world is real,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus in a recent media interaction.
“Even in the best of times, PPE hasn’t been paid adequate attention,” says Dr. Sanjivani Gavhane, the medical officer at the Khalapuri Public Health Centre in Beed district. She was surprised to see China and Italy’s hazmat suits and felt a little ashamed to request just a triple layer mask for local health workers. She has been waiting for a dispatch for the past three weeks. As she tends to a steady stream of villagers reporting at the Khalapuri Public Health Centre in Shirur, Dr. Gavhane fears that the 50 bottles of sanitiser that were delivered to the PHC will soon run out. The line of villagers outside the small yellow primary school building that serves as the clinic is long. Dr. Gavhane calmed a group of men and women with draped dupattas and handkerchiefs across their face as news of a deadly virus was broadcast on radio, TV, local newspaper and their mobiles. Each case was logged and for three days, they were monitored by regular phone calls.
“Everyone is scared,” she said.
Team members are briefed about an app called Life 360 that monitors suspected cases by keeping a tab on their travel history, treatment and quarantine status. A map traces the location of the people under quarantine; breaches result in reprimand. The community is the first line of defence, keeping an eye on people with stamped hands.
About 25,000 people came from Mumbai and Pune. The police formed a ring around the district. Any person wishing to enter had to pass one health official, two constables and one education department employee .
The teams aimed to cover three villages a day and covered 40 villages within the first fortnight. The ambulance was freed from immunisation programmes and allocated to the outreach teams. The siren heralds their arrival and a team member speaking from a microphone delivers the message. They pull into temples and the gram panchayat offices and make announcements for the people to stay indoors and to regularly wash their hands. In meetings with village heads, they ask them to alert the team if anybody develops a cough or cold, and keep tabs on arrivals from outside. Dr. Gavhane reports their observations to the district health officer.
Then came news of the Janata Curfew. The first to disperse from different villages in Shirur were the anti-CAA and NRC protestors who had been encouraged by the Shaheen Bagh protests in Delhi. About fifty women and men promised to rekindle their defiance once the virus had been contained. Then came the flood of people from the cities where they had migrated for work.
About 25,000 people came from Mumbai and Pune, according to, Harsh Poddar, SP, Beed. The police formed a ring around the district. Beed has 14 entry points from five districts and each was sealed. Any person wishing to enter had to pass one health official, two constables and one employee from the education department. Each person in each car was checked, their name, number and destination lodged in a book.
“We don’t have an option to fail. We have to contain this,” the SP said.
In most of the villages there was voluntary compliance and where there were errant elements up to mischief, they were arrested under section 505(2) of the Indian Penal Code for spreading rumours. If there was a violation of the curfew, they were charged with section 188 of the IPC.
At each check post, the men and women responsible for carrying out the checks wore the pink face masks that they washed with Dettol each night.
“Nobody wants to talk to us,” Priti Ramesh (name changed), his wife said. A neighbour called Savita Jadhav, the ASHA. She was soon at their door. The next day when she spotted him at the market at 11 a.m., she ordered him home. Over the next three days, she stopped by his house twice to see if his condition deteriorated. ASHA workers are at the frontline in the fight against COVID-19. Since March 21, she has been following up on active cases where returnees have exhibited symptoms of a cold.
By then 32,000 people had returned to their villages in Beed and anyone with symptoms was being monitored by the district health officer, the SP and local medical teams—efforts coordinated by two apps. While one app collates the health and wellness data of people under surveillance, the other monitors their movements to ensure quarantine rules are being followed. Anyone with symptoms is reported to the nearest PHC. With the pressure rising on public health infrastructure, Ashok Geori, the taluka health officer in Beed held a meeting with the general practitioners and enlisted them to cover two villages each under the rules of the Epidemic Diseases Act, 1897.
As migrants continued to return, the district collector issued a circular from the Disaster Management Cell on March 27, prohibiting the entry and exit of people from Beed. Any person outside who failed to return to Beed before 8 a.m. would be denied entry. All district borders were sealed.
Dr. Pawar continued to panic. The stock of testing kits was diminishing, and with only 77 ventilators for a population of 25 lakh, there could only be failure. A total of 350 returnees from Pune and Mumbai showed symptoms and were placed under strict home quarantine.
“There is already a case of community transfer,” said a senior health officer in Maharashtra, even though officially the central government has so far claimed that there are no such cases in India. “We just have to wait and watch and let nobody in,” he said.