As Maharashtra's COVID-19 Cases Surge, Nagpur Offers Lessons In Keeping Virus At Bay

Nagpur, MAHARASHTRA — In the first two weeks of March, Maharashtra ’s first cases of COVID-19, the illness caused by the novel coronavirus , were detected in Mumbai, Pune, Nagpur, and Yavatmal.

Now, two and a half months and four lockdowns later, the virus’s aggressive expansion in Pune and Mumbai has meant Maharashtra now accounts for close to 40% of India’s 138,845 cases of COVID-19; yet the city of Nagpur appears to have succeeded in containing the outbreak in thus far.

On Monday, Maharashtra recorded over 50,000 cases of COVID-19, over 30,000 of which are in Mumbai alone. Yet, Nagpur, the state’s winter capital, has recorded only 426 cases thus far, of which 327 patients have recovered from the virus, according to Nagpur District Information Officer Anil Gadekar. Only seven patients have died of COVID-19 in the city thus far.

To be sure, Nagpur is a fraction of Mumbai’s size with a proportionately smaller floating population; yet the city has also witnessed spikes in cases such as in the first week of May when 44 cases were detected in 24 hours. In sum, city officials say the relatively small number of cases is a consequence of a clearly articulated and implemented containment strategy.

As stranded workers return from India’s major metropolises to smaller towns and cities across the country, Nagpur’s experience could offer useful lessons.

The first case of coronavirus in Nagpur was reported on March 11, when a patient tested positive upon his return from the United States. The city reported its first COVID-19 death three weeks later on April 5 in the Satranjipura neighborhood. As cases continued to rise, Nagpur was categorized into the red zone.

The city administration responded by designating two government hospitals Indira Gandhi Medical College (IGMC) and Government Medical College (GMC) as nodal hospitals for testing and treatment

AIIMS Nagpur was also added to the list after a few days. 

“The biggest factor was the proper coordination between GMC and IGMC,” said a doctor from IGMC, “Since the staff at both these hospitals have worked at both these hospitals in the past, there were no glitches in implementations.”

“Another good thing was that  IGMC already had a functional virology lab. The construction of IGMC is such that it already has separate isolation wards which is why IGMC was declared the first COVID center,” the doctor said. 

This decision paid off because now most of the city’s containment zones are within a 3-kilometer radius of the IGMC, the doctor said. 

“AIIMS was an added benefit,” said another doctor. “AIIMS had a lot of funds and gave a boost for testing. Nagpur also got three weeks more compared to other cities because the surge did not happen at the initial stage.” In one of the earliest meetings, the doctor said, it was decided IGMC would treat most coronavirus patients as this hospital was located near densely populated areas of the city.

Tukaram Mundhe, Nagpur’s municipal commissioner, said that the city’s aggressive containment strategy had helped limit the spread of the virus. 

“We started institutional quarantine from March 25 when the fifth case was reported,” Mundhe said. “We stressed on institutional quarantine because we found that home quarantine was not being properly observed.”

Mundhe said municipal teams surveyed the city’s 2,400,000 residents for flu-like symptoms and used the data to identify and isolate possible hotspots. Mumbai by contrast is home to nearly 18,000,000 — making a similar exercise much harder.

But Mundhe conceded there was resistance to the tough quarantine measures.

“There was a lot of resistance to institutional quarantine. In two hotspots, people were not giving information so we started mass quarantine,” Mundhe said. “Around 1400 people from one area were isolated and their swabs were taken out of which more than 100 test results came positive.”

In another hotspot, Mundhe said, 2500 people were quarantined of which more than 200 people have been tested positive for Covid-19.

For perspective, that would be a test-positivity rate of between 7% and 8%. India’s average test positivity rate has largely hovered at 4% since the pandemic first broke out, but has edged upwards to 5% in recent days, largely as a consequence of rising test positivity in Maharashtra.

Mass quarantine, coupled with contact tracing, and instructions to private hospitals to report all COVID-19 like cases, Mundhe said, had helped the city “break the chain” of transmission and contain the number of deaths. 

“If you look at the numbers in Nagpur now, the death rate is also low and our rate of infection is also low and the spread is focal and local which means we have not allowed it to spread to multiple areas,” Mundhe said.

Mundhe conceded that his decision to mass quarantine entire neighborhoods had met with resistance. Some beleaguered citizens even filed petitions in court against the measures. The first such petition has been disposed off by the court.

“Yes, there was a lot of resistance regarding mass quarantine,” he said. “There has been and will be resistance but it mellows down when people see that our steps are proving to be useful. Some may like our decisions and some may not but as of today, we are on the right track.”

As the lockdown eases, Mundhe said, the city administration is prepared for a possible surge in cases.

“A war room has also been set up. Nagpur was categorized as a non-red zone city but I requested the government and made sure it continues to be in the red zone. I fear a spurt if we open up on all fronts immediately,” Mundhe said. 

The city has prepped a 5000-bed capacity COVID care center, and municipal hospitals with 50 ICU beds with oxygen facilities have been readied. Another 2700 private hospital beds have also been kept ready. 

“The chain of corona can never be broken 100%. Isolated cases will always be there, it’s not going to disappear,” Mundhe said. “But you need to contain the hotspots, that’s how you break the chain.”