Technological innovation, partnerships, and holistic approach guided the COVID-19 response in Karnataka

Karnataka, located in the south-western region of India, has a population of 69 million. It reported its first case of novel coronavirus on 9 March and two days later, the state became the first in India to invoke Epidemic Disease Act 1897. As of 17 September, the state has reported  494 356 cases with a case fatality rate of 1.5%.

The response strategy of the state, including contact tracing, isolation, and treatment is primarily guided by use of technology and innovative approaches. Data collection and dissemination of information is done through web-applications and telecommunications. Effective partnerships between the public and private sector, community engagement, and the vibrant IT sector in the state has contributed in strengthening the state’s response to COVID-19.

The State Task Force Team, chaired by the Chief Minister, and senior officials and experts as members was set up to coordinate and guide actions in the field. A technical expert committee comprising of public health experts, virology experts, and clinical experts was constituted to guide the state response based on evolving knowledge and evidence. Three other committees for clinical care and management, death audit committee, and telemedicine led by expert intensivists, pulmonologists, and clinicians were formed at the state level to guide the response.

The synergy between the Department of Health and Family Welfare, responsible for primary health care and the Department of Medical Education, looking after the curative aspects of health through tertiary health care centers, education, and training of health workforce of doctors, nurses, and paramedical workers helped in streamlining a quick response to this pandemic. The response strategy to manage COVID-19 outbreak was an all-encompassing integrated approach. The state and district leadership at the helm led from the front with evidence-based guidance from sector-specific experts. “The expert groups were constituted, including the best of minds from public and private sectors and NGOs to render technically sound advice on public health, clinical management, and testing etc.”, shared Mr Jawaid Akhtar, Additional Chief Secretary Health, Karnataka.

The state pioneered many innovative interventions to deal with the pandemic that serves as learning on how the state leveraged its positives to put up a well-planned and a cohesive response to deal with the pandemic.

Tracing not just high-risk contact but also low-risk contacts
The state included both high-risk and low-risk contacts in its tracing strategy. This proved effective as it enabled the authorities to identify, trace, and isolate individuals who could spread the infection. Screening of international and domestic travelers at all the airports in Karnataka and mandatory institutional quarantine helped in curbing the spread. House-to-house visits by health team for screening for ILI and SARI cases, sampling of vulnerable groups (age <60, co-morbidities, pregnant women, etc.) in containment zones for early case detection and to reduce mortality rate was the key strategy.

Learning along the way
Capacity building initiative of the workforce was implemented through a multi-pronged approach. Integrated Disease Surveillance Programme (IDSP) with technical support from WHO India conducted workshops at the state and district level on the basic epidemiology, public health response, clinical management, and infection control practices. This was followed by a detailed training programme focused on clinical aspects of COVID management for secondary and tertiary institutions including teaching hospitals led by Rajiv Gandhi University of Health sciences. More than 2 Lakh frontline workers have been trained so far using this platform. The state was quick to launch a YouTube Channel, Jagruti Karnataka, that has been in use to disseminate training to the field-level health workers, including departments like education, revenue, Panchayati Raj Institutions (PRIs) on risk communications, contact tracing, conducting monitoring surveys, etc.

Fully equipped control room for crisis management
The state-of-art control room was set up in record time of 24 hours in Bruhat Bangalore Mahanagara Palike (BBMP) corporation body in early March, with facilities like 24/7 control and command centre; virtual training and video conferencing facilities; GIS mapping of cases and contacts; heat mapping technology for containment zone and cluster; immersive technology for large data management of contact tracing and quarantine; real-time tracking of ambulance services and disinfection procedures; production and dissemination of IEC; and daily media bulletins. While the BBMP war room focused on the response in Bangalore, similar control rooms were established for crisis management throughout the state.

Public-private partnerships to strengthen the health infrastructure
Work on health infrastructure in government hospitals at district and taluka levels started in early stages, focusing on increasing beds with high flow oxygen, and ICU capacity. Partnering with the private sector helped in streamlining COVID-19 and non-COVID patient care. The state identified rural and urban primary health centres, government and private hospitals including medical colleges that could be repurposed as fever clinics. These clinics were equipped to screen patients for fever, oxygen saturation, and transfer patients to COVID hospitals if required. Later, the state government also made provision for testing for COVID-19 through swab collection at these centres. The state was the first to cap the prices for COVID-19 testing and treatment in these centres that led to the screening of more than 25 lakh people in the fever clinics.

Scaling the lab capacity
National institute of mental health and neurosciences (NIMHANS) virology department trained and ensured quality assurance of the testing in both government and private labs. With just two labs in March to 104 labs now conducting RT-PCR test, the state has made steady progress to reach the unreached and underserved communities by setting up mobile swab collections units. Ramping of testing from 65.9 per million to 61 678 tests per million as on 17 September has continued to detect cases early. So far, the state has conducted more than 4 million tests which include both RT-PCR and rapid antigen testing.

Ramping up bed availability in COVID care centres
The Bangalore International Exhibition centre (BIEC) has been repurposed as a COVID care center to accommodate 10,100 patients. Similarly, the government repurposed large facilities in Bangalore and other districts to function as COVID care centres for treatment of COVID positive symptomatic or asymptomatic cases. The state has got more than 100 000 beds in COVID care centres, 35 859 in Dedicated COVID Health centres and 8 494 in Dedicated COVID hospitals. All the major medical college hospitals, District headquarter hospitals and corporate hospitals have been roped in to provide treatment for COVID cases. The state also developed a centralized bed allocation system in Bengaluru city aided by the war room to streamline the process of testing, triaging, transfer, and treatment of COVID positive patients.

Integrating psychosocial support in response strategies
Karnataka has a vibrant mental health programme both at the state and district level which is supported by specialists from the National Institute of Mental Health and Neuro-Sciences (NIMHANS). Intending to provide mental health and psychosocial support during the pandemic, the state government strengthened the collaboration with NIMHANS with the launch of the e-Mind technology programme. Under the initiative, more than 640 000 counselling sessions have been conducted so far to provide counseling on mental health and psychosocial issues to COVID-19 patients in hospital isolation wards, people in quarantine, contacts and migrants.

Technology for data collection, analysis and response

• Application for contact tracing: This application enabled the sharing of contacts across the state and building a database of primary and secondary contacts – the most critical step to contain the pandemic.
• Corona Watch-Through this application, the location of corona affected patients can be tracked and their movement history of last 14 days can be recorded. A containment watch app has also been developed to undertake survey in containment zones and ensure the provision of essential services.
• Seva Sindhu Portal of Government of Karnataka was used extensively to issue e-Pass for movement of persons into the state during different phases of lockdown and unlock period. The data from the Seva Sindhu app was synced to the Quarantine Watch app to help monitor and implement the isolation and quarantine process. Quarantine Watch application enabled- self-reporting by people in-home quarantine. 
• Karnataka health watch The state-wide household survey was conducted to map high-risk households and vulnerable populations through Karnataka Health Watch, a mobile application to capture real-time data. Out of 1.68 crores households, 1.5 crores have been surveyed through this application and 60 lakh households were identified with  vulnerable population. The survey of older adults with comorbidities and pregnant women was done through teleconsultation from a state-of-the-art tele-ICU facility in Bengaluru, led by the state’s best doctors.
• Apthamitra Helpline
  The state government also activated Apthamitra Helpline, a free tele consultation to assess those having medium to high-risk infection and ensuring timely screening, testing, and treatment. The technological innovations not only tracked vulnerable population but also guided the state to make decisions on graded relaxation of lockdown norms in safer areas and earmarking high-risk containment zones.
  
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• Tele ICU programme: A Tele ICU programme has been launched in Karnataka with support from intensivists working in private hospitals to train and guide the ICU staff working in different medical college and district hospitals. This has been of immense help in providing quality care at the district level and saving lives. This model is getting replicated in other states now.
• Karnataka Private Medical Establishments( KPME) portal: ILI and SARI surveillance strengthening was done with reporting of all hospitals made mandatory through the Karnataka Private Medical Establishments (KPME) portal made by State. Along with this, districts have used various forms of technology like Google forms and Epicollect to make tracking of cases and ensuring swab collection possible. 

Participatory approach
The resident welfare associations (RWAs) were involved through regular video conferencing with the Commissioner, BBMP in the day-to-day monitoring. The Pranavayu initiative was introduced on self-monitoring for oxygen saturation levels by people in the case of ILI symptoms. 1912 call center was set-up to address grievances related to denial of hospital admission of patients requiring emergency services. The state’s strategy focused on immigrants and ensuring supplies of essential food items; health check-ups of all pregnant women and children. This was spearheaded with the involvement of self-help groups, NGOs, and donors. Awareness campaign regarding wearing masks, maintaining physical distancing, and washing hands regularly were conducted involving celebrities from different walks of life to reinforce the safety messages.

Way forward
“The Government of Karnataka adopted WHO’s guidance by tracing, testing, isolating the sick and quarantining as many contacts as possible and added another element i.e. technology to fast track the response. In this fight against the pandemic, WHO has been strong support, and we appreciate the contributions made by the WHO team in strengthening the surveillance and capacity building of the frontline health workers. We look forward to strengthening this collaboration as the battle is far from over. We need to remain vigilant and keep innovating to make sure that Karnataka lives up to the high expectations of our people”, shared Mr Jawaid Akhtar, Additional Chief Secretary Health, Karnataka.

“The WHO team has been part of COVID-19 response in the state since the start of this pandemic. Through participation in various expert committees, we have provided technical guidance to strengthen the public health response and helped develop standard operating procedures and guidelines.  Our teams in the field have built capacity of key health functionaries on public health response, contact tracing and containment as well as infection prevention and control practices in healthcare facilities. We have also supported in carrying out the ICMR Sero prevalence survey and assessment of dedicated COVID hospitals. The commitment of the leadership in Karnataka to fight this pandemic is noteworthy and we stand committed to support them at every step”, shared Dr Asish Satapathy, Regional Team Lead, South Region, WHO Country Office for India.

Acknowledging the role of technology to facilitate COVID-19 preparedness and response in the state, Dr Roderico H Ofrin, WHO Representative to India shared that the innovative approaches for population screening, tracking contacts, judicious allocation of resources, designing targeted interventions based on evidence and use of mobile applications to conduct surveys and data management could serve as great examples for other states to emulate. “With a robust system put in place to manage the pandemic, the state has created a solid foundation and the learnings gathered while managing the pandemic will help in addressing the challenges that remain,” he adds.