In the Taj Mahal of the city of India, the resurgence of coronavirus carries warning signs

AGRA, India (Reuters) – On February 25, a day after United States President Donald Trump and his wife Melania posed for photos outside the Taj Mahal on an official visit to India, Sumit Kapoor returned to his Close home from a trip to Italy.

Kapoor, a partner in a shoe manufacturing company, tested positive for the new coronavirus a week later, making it the first confirmed case in the city of Agra, northern India, and the source of the country’s first large group of viruses. .

The city of 1.6 million people, famous for its 17th-century marble-domed Taj Mahal, moved quickly. It established containment zones, examined hundreds of thousands of residents, and extensively followed up on contacts.

In early April, the city thought the virus, containing fewer than 50 cases, had expired, while new infections exploded in other Indian cities. Prime Minister Narendra Modi’s government hailed the “Agra Model” as a model for the country’s battle against COVID-19, the disease caused by the coronavirus.

Now, as the city and its hospitals battle a second wave of infections, Agra is a model of a different kind, illustrating how the coronavirus can roar even after rapid closure and elaborate containment measures.

“If it had not spread in hospitals, we would have been able to contain it,” said Agra’s top local official, District Magistrate Prabhu N. Singh.

As India grapples with around 42,000 coronavirus infections, second only to China in Asia, Agra’s tangle of the virus offers lessons for big cities in India and elsewhere.

It all started with a shoemaker who visited a fair in Italy.

After flying home through Austria, Kapoor, 44, who lives about 10 kilometers from the Taj Mahal, learned that he might be infected on March 1, when his brother-in-law who traveled with him contracted a fever and tested positive. . in New Delhi A state official called Kapoor the next day and told him to have a test done at the Agra District Hospital.

He was positive, as was his father, mother, son, wife, and brother. All six were transferred to a hospital in New Delhi, some 200 kilometers north. “My brother and I had a sore throat and the other four had no symptoms,” Kapoor told Reuters.

Later, the Kapoor accountant in Agra and his wife also tested positive for COVID-19, while other unrelated cases began to appear in the city.

CONTAINMENT ZONES AND SPEAKERS

Singh, the district magistrate, and his team tried to establish containment zones as the virus spread through the city, but came up with a problem: how to quickly detect thousands of homes.

Dr. Brajendra Singh Chandel, a World Health Organization surveillance medical officer in Agra, said he took out WHO-developed vaccination “micro-plans” for polio control, using them in conjunction with Google Maps to map target areas. .

Chandel explained that the detailed plans at the household level, which helped India eradicate polio in 2014, have clearly delimited the starting, middle and end points for inspecting an area, allowing teams to work in any neighborhood efficiently .

“Once we focus on the area, we use the polio microplanes to run,” he said.

Local authorities identified an epicenter for each group of infections and drew containment areas three kilometers wide around them. They surveyed residents in those areas, looking for those who had contact with people who tested positive for coronavirus or showed symptoms. According to a government presentation, about 3,000 workers evaluated 165,000 households.

Meanwhile, epidemiologists from the federal government’s Indian Epidemic Intelligence Service have come to Agra to help with containment, contact tracing and data analysis, said Dr. Anshul Pareek, who leads the coronavirus rapid response team. from the city.

As the number of cases grew, authorities sealed off critical infection points, usually groups of houses or parts of a street, and cordoned off adjacent neighborhoods that housed up to 10,000 people. In a control room used to manage traffic, officials monitored camera images from across the city to ensure the blockade was enforced. Thousands of police were deployed at critical points and checkpoints. The loudspeakers emitted messages telling residents to stay indoors.

According to health authorities, that differed from other Indian cities, many of which failed to isolate patients or trace their contacts, allowing the infection to spread. They added that the weak blockages allowed potential carriers to slip through the restraint cords. More than 1,300 people have died from the virus in India.

REVIVENCE OF CASES

Agra was celebrated for appearing to have contained the virus. On April 11, Lav Agarwal, a senior official in India’s federal health ministry, presented Agra as an example of how India was working “to defeat the pandemic.”

But a revival was already in progress. By the end of March, a meeting of the Islamic mission group Tablighi Jamaat in New Delhi had become a source of hundreds of new infections across the country. Federal authorities sent officials in Agra a list of assistants to track, Singh said.

Agarwal did not respond to Reuters’ requests for comment.

District Police Chief Babloo Kumar said he used police investigative tactics and cell phone data to identify Tablighi Jamaat members and their contacts. Finally, 104 people from this group tested positive in Agra.

The effort was aided by the March 25 national shutdown that halted all public transportation, closed businesses, and kept residents at home.

“Without a block, we could not have done anything,” Singh said.

In early April, a patient linked to the Tablighi group reported to an Agra hospital and later tested positive for COVID-19, authorities said. The disease spread rapidly among patients and staff who infected their families and relatives. New cases also appeared in other Agra health facilities.

The worst hit was the Paras Hospital, the source of at least 92 cases of coronavirus, Singh said. A staff member infected 14 others in a two-bedroom house, he said. In another case, a hospital patient infected 32 other people in a nearby town, he added.

The hospital was closed on April 6. Late last month, a chart tracking center-linked positive patient contacts was still next to Singh’s desk.

Agra now has around 600 coronavirus cases and 14 deaths, according to local authorities. At the end of April, there were 39 critical points of infection and tests had been performed on 6,848 samples, and some people did this multiple times.

Singh says he is confident the city will defeat the virus, thanks in part to its aggressive contact tracking system.

“The good thing is that for all cases, we know the source,” he said.

Still, eradicating COVID-19 in the crowded neighborhoods of Agra will remain difficult, particularly without testing large groups of people, said Dr. Rajib Dasgupta, an epidemiologist who teaches at Jawaharlal Nehru University in New Delhi.

“Even within a containment zone, for a conceivable time, it is not going to go away very quickly,” Dasgupta said.