BMC officials stretched to the limit tracing patients’ contacts
Corporation connects everyone from relatives to vegetable vendors the patient may have come in contact with
Ever since Mumbai reported its first confirmed case of the novel coronavirus on March 11, the Brihanmumbai Municipal Corporation (BMC) has taken on the mammoth task of contact-tracing.
The BMC is supposed to trace every person the patient came in contact with from the time they developed symptoms, but the civic staff has been finding it extremely tedious to track low-risk contacts that may include local vendors or even taxi drivers. The number of low-risk contacts may run into hundreds. As a result, the BMC’s health department is stretched to the limit.
Contact tracing is the process of identifying, assessing and managing people who have been exposed to a disease to prevent transmission. Any person who has had contact with the patient under investigation for suspected, probable or confirmed cases should be monitored for appearance of symptoms. Health workers, family members, anyone who had physical contact, or those who stayed at the same place are all considered high-risk contacts. Others who may have come in contact with the patient briefly, socially, are low-risk contacts.
As on Wednesday, Mumbai has 43 confirmed coronavirus cases (people living in the city), including two people who died. Of these, while most have a travel history, the others were in close contact with confirmed patients.
South Mumbai’s D ward, which consists of Malabar Hill and Tardeo, has had four confirmed cases so far, including one death. Of the four, three are from the same family. An officer from D ward’s health department said, “The first challenge is to get the patient to share his details with us. When the patient sees that a team of people wearing protective gear has come to his house and is asking for his whereabouts, he feels extremely intimidated. That is why, we start by interacting with other society members so that the patient does not feel targeted.”
However, the officer also mentioned that a few patients are forthcoming as they are worried about their contacts. In the four confirmed cases, D ward traced 36 high-risk close contacts.
“We conduct an influenza-like survey wherein we speak to a lot of people from the community. We also speak to private practitioners from the area, ask if there has been a spike in patients with these symptoms. But since it is impossible to trace everyone, this lockdown is important,” the officer said.
Vinayak Vispute, Assistant Municipal Commissioner of H West ward (Bandra, Khar) that saw one confirmed case, said, “In the case of this patient, he had 10 to 15 close contacts. Our team sat with him for five hours and determined 70 to 80 other contacts. Now, we call all these people every day and check if they have symptoms.”
Ajitkumar Ambi, Assistant Municipal Commissioner of N ward (Ghatkopar) is swamped with work as the ward has seen five confirmed cases so far, one of them in a slum.
“In the case of housing societies, the patient may be forthcoming but the society may not cooperate while in a slum, the neighbours are encouraging but the patient is typically scared,” said Mr. Ambi.
On the challenge this entails, Mr. Ambi said, “In many cases, people do not remember the exact details of what they did over the past several days. It is impossible to trace what vendor they bought vegetables from or what surfaces they touched at a railway station. After April 1, we will see the effects of these people mingling in public, if at all, but we are trying our best to track everyone.”
The officers from T ward (Mulund) were luckier, as they only had one confirmed case and the same family lived in that housing society. They had also asked the house help to stop coming.
Vishwas Mote, assistant municipal commissioner of K West ward (Andheri West) that has seen two cases so far, said, “In many cases, people don’t remember. We first focus on families, neighbours and colleagues. But in case of low-risk contacts, the numbers increase exponentially. It is very difficult.”
This ward has 10 medical teams at health posts for contact tracing, and they have been meeting contacts to look for symptoms.
Recently, a Class X student who appeared for his SSC exam tested positive. BMC tracked down all the students from the class as well as the invigilators and is testing them for coronavirus.
Apart from these, the teams are tasked with tracking home-quarantined patients.
Dr. Amol Mankar, the State epidemiologist, said, “Apart from high-risk contacts, we are supposed to find maximum low-risk contacts and they are supposed to be home-quarantined for 14 days with monitoring for symptoms. If they develop the slightest of symptoms, they have to be admitted immediately.”
This is not a big issue, he said, because the general observation is that the longer a patient spends with another person, the higher the possibility of transmission. “The maximum number of close contacts who later got the coronavirus were among high-risk ones, like family clusters. Domestic help is also part of a family cluster.”
Dr. Mankar said in one case in Aurangabad, there were more than 700 low-risk contacts.
While the city lauds the efforts of its healthcare workers, it can perhaps spare a thought to its civic staff as well.