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Door to door screening
Door to door screening
Image source: The New Indian Express

Health

The Effectiveness of Door-to-Door Screening for COVID-19

Two months into the lockdown, Tamil Nadu’s COVID-19 case count touched 13,000, making it the second most affected state after Maharashtra. The state has launched a micro plan to test people in 33 containment areas, according to health minister C Vijayabaskar.

The program, called Namma Chennai Corona Thaduppu Thittam will see nearly 500 newly appointed health inspectors fan out to screen patients with influenza-like symptoms. It will begin in Royapuram, where the maximum number of health inspectors will be posted. Poor living conditions in the area have contributed to the spike in the number of cases, such as the sharing of drinking water and toilet facilities. There has also been a spillover from the Koyambedu cluster.

“If they have flu, a mobile unit will also do a chest X-ray to see if they have chest congestion, a symptom of respiratory infection. We have deployed 14 mobile X-ray machines for this. Tests will be done on people with fever or congestion,” said Vijayabaskar. 

A “robot” rickshaw has also been launched to spray disinfectants in the area built from locally sourced materials by Tarun Bhalla, the founder of Avishkaar.

Out of the 688 fresh cases confirmed on May 19, 87 are returnees from other states and from abroad. 23 are passengers from Dubai and one from the Maldives. 13 other passengers from Dubai, Kuwait and Malaysia, who had initially tested negative, have tested positive on the Covid-19 ‘exit test’ yesterday, after their airport quarantine. 

49 people from Maharashtra and one person from Kerala have also tested positive yesterday. This has led to rising concerns regarding the unpredictable trend in the hot-beds of the infection in the state.

Door-to-door testing will be used to detect and home quarantine people who show symptoms in vulnerable areas, aside from the measures being taken for those arriving newly to the state. People with symptoms that need hospitalization will be admitted. Fire tenders and municipal workers have also deployed drones to spray disinfectants in local areas such as bus stands, temples, markets, etc. 

Door-to-door screening in India

The Chandigarh government had started door-to-door testing early in April to curb the spread of the virus. 

“We are conducting screening of people in the city and it is doable,” said UT Chandigarh Adviser Manoj Parida. 

Chandigarh was the first city in the country to conduct testing on 100 percent of its citizens, covering a population of 12 lakh. They screened people in the city who had fever and cough and those who had a travel history.

From April 16, Bihar began door-to-door screening in four affected districts covering Siwan, Begusarai, Nalanda, and Nawada. The locations where the COVID-19 positive patients were found was treated as the centre, from which a three-kilometer radius of area saw door-to-door screening with a focus on the elderly. Protective equipment such as masks and gloves, along with special training was given to the deployed healthcare workers. 

Sanjay Kumar, Bihar’s principal health secretary had said, “The state government also decided to tap retail drug stores, formal and informal service providers, including MBBS doctors, Ayurveda, Unani and homoeopathy practitioners and quacks to collate data on people with influenza-like illness (ILI) and severe acute respiratory illness (SARI) who had consulted them.”

Concerns on screening

One of the biggest concerns that some people have regarding the door-to-door screening is that its harm could outweigh its benefits.

The door to door screening in Bihar has left people concerned. The lack of adherence to guidelines regarding data collection has been reported. There have also been instances of healthcare workers skipping households and conducting incomplete and perfunctory interviews. 

“There are around 100 households in my village but not a single one of these has been screened, including mine,” said Pratap Singh, a farmer in Bariarpur village in Pachrukhi block of Siwan district according to a report published in IndiaSpend. 

Another resident of Bariarpur complained of the same. There have been complaints of incomplete questioning on the part of the healthcare workers. “They just noted down names and ages of my family members and asked if anyone in my family came from outside the state or country,” said Brahmdev Ram, a marginal farmer, from Sahibganj panchayat in Forbesganj block of Araria district. 

“They did not ask if my family members have cough, fever or other symptoms,” he added.

Some of the healthcare workers have complained of not receiving masks while on duty, let alone masks for the people who are found to have the symptoms. 

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One in four migrant workers returning to Bihar have tested positive for COVID-19 as of May 19th. This is higher than the positivity rates of workers returning to other states. This has significantly raised the number of cases in Bihar. More people have tested positive in the 10 days around the aforementioned date than they have in the previous two months. As of May 15, Bihar has had over 1000 COVID-19 cases and 43,371 samples have been tested in all the seven labs, which is 417 tests per million population. The population of Bihar, as per 2011 census, is 104 million. An IndiaSpend analysis showed that this is the lowest rate of testing in India for which testing data was available.

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