Surveillance is defined as “systematic and continuous collection, analysis & interpretation of data; added with timely dissemination of results and assessment so that action can be taken”. It is an essential feature of epidemiological and public health practice.
Red zone/containment zone: once one or more cases of covid-19 are diagnosed in a locality or area, it is designated as red zone/ containment zone by the district administration and a containment plan is followed which includes demarcation and sealing of boundaries of the containment zone, fumigation of the area, contact tracing and risk assessment activities, sampling for covid-19, maintenance of essential services, health education to people and surveillance.
Our team includes five ISM Medical officer’s who are assisted by two ISM Pharmacists in the collection of data from the districts & one MBBS Medical Officer who assists one MD Community Medicine Doctor (Public Health Specialist) in data analysis and surveillance, all working under the leadership of Mr Vikas Kundal (IAS, In-charge Red Zones Kashmir) with an overall supervision of Divisional Commissioner Kashmir P.K. Pole. The main role of this Red Zone Surveillance cell is to act as a centre to collect the data of Red Zones from all the districts of Kashmir, analyze this data, pick up the deficiencies and communicate them to the concerned districts directing them for appropriate activities in their Red Zones. The role is not to go to the field which is the domain of respective districts.
Our team has been looking after the surveillance of all the red zones of Kashmir Division. It has been now around 2 months for our team to be associated with surveillance and we have been doing many actives to improve the outcome of fight against Covid-19 in Kashmir. We devised a two page semi-structured questionnaire for every household and designated it as Form 1. It contains 14 closE ended questions on page number 1 for each household which covers assessment of broad areas of containment plan including fumigation frequency, awareness among people, sealing of checkpoint disinfection of vehicles, physical activity and diet adequacy of family members, Aarogya Setu app installation, frequent hand washing face mask usage and social distancing during outdoors, availability of medication for chronic diseases and awareness about birth plan for pregnant ladies. It also looks for any missed contacts or returnees from outside Jammu & Kashmir and co-ordinates their Covid-19 testing. This form 1 also has a table on page 2 where in the details of all family members are to be entered in addition to their history of visit outside the UT of JK/India and any symptoms of ILI or fever .
The composition of surveillance teams, who do house to house survey, is usually a basic health worker /MPHW, an ICDS worker/Teacher, a Pharmacist /Nursing orderly, ASHA of the area and at occasions, a Medical Officer. All these surveillance teams along with all red zone in-charges and district nodal officers for covid-19 were added to a WhatsApp group in which couple of videos and audios, (recorded by the Public Health Specialist Dr Rouf Hussain Rather) were circulated. These videos and audios were aimed at training these surveillance teams as well as others regarding this house to house survey and filling up of the forms. This Form1 is for house to house survey to be filled in by surveillance teams with one form for each house hold.
Another form known as Form-2 was formulated, covering all the questions of Form 1 on a single page, it is being filled up by Red zone in-charge and counter signed by District Nodal Officer after analyzing form 1 of whole Red zone. Videos and audios of how to fill this Form 2 were also circulated in WhatsApp group. Thus one form for one Red Zone, duly signed, was asked to be send to the surveillance team where the public health specialist analyses the data and interprets about the deficiencies in containment plan. Same are compared with other Red zones and subsequently communicated to the concerned district administration. The district administration is asked to work on these deficiencies and hence improve the containment plan activities.
The 3rd form (Form 3) is a daily based surveillance form which each district sends us after being duly signed by CMO and Additional Deputy Commissioner. It includes the details of red zones, red zone in-charges, number of households and population of red zones, status of screening of ILIs and fever, status of disinfection of red zones, number of samples collected, number of pregnant ladies in red zone, number of total positive cases, active positive cases, deceased and recovered cases. All this information is analyzed on daily basis and feedback is given to the districts regarding any deficiencies and the measures to improve up on it.
All the districts were asked to do Covid-19 testing of pregnant women within red zones on priority basis initially for those whose EDD is nearer and latter on for all pregnant women. This testing of pregnant women revealed many positive cases who were shifted to designated Covid hospitals for management. This activity prevented fear among medical professional regarding the Covid status of pregnant women at the time of conducting delivery thereby avoiding any untoward outcome. It also prevents spread of Covid-19 infection from pregnant women to medical staff as well as to other admitted patients, hence protecting many human lives.
The districts were further asked to conduct the Covid-19 testing of all the goods & service providers within the red zones as these can act as central points in the spread of Covid-19 infection and constitute a high risk group. When the testing of these goods & service providers was done, many came positive and were shifted to designated Covid hospitals and Covid wellness centers. Their close contacts are being traced and tested for Covid-19 infection. This activity supplemented the contact tracing team in picking up positive cases from the Red zones and further delineating their contacts.
The data of testing of pregnant women and goods & services care providers is being reviewed and analyzed regularly and low performing districts are given feedback to improve the testing. Till date more than 60% pregnant ladies & 75% goods & services care providers within the Red zones have been tested out of whom 67 pregnant women & 21 goods & service care providers have been tested positive.
Surveillance is an important and significant component of every control program which not only informs us about the status of the ongoing control program but also guides us to make appropriate changes in the program based on the needs and requirements, so that we can achieve the objectives and targets of control program in a time-bound manner.
Dr Rouf Hussain Rather, Senior Resident at Department of Community Medicine, GMC Srinagar, presently working at Red Zone Surveillance Divisional Covid-19 Control Room Kashmir.