The 35-year-old isolated in a Ladakh hospital is mystified. He had no symptoms of Covid-19, no travel history outside his village in the recent past, his friends and family had tested negative for the virus. Besides, when he went to get tested on April 30, no new cases had been reported from his village, Yokma, in the Chuchot area of Ladakh since April 13.
“I thought, since I am from a red-zone, it’s better to get tested, but when the results came, I was puzzled,” the 35-year-old told Scroll.in on the phone from the hospital. “I spoke to other positive cases as well and they say none of them had any [travel] history or were in touch with any [known] positive cases.”
On May 3, he became one of the 18 patients who tested positive for coronavirus in Ladakh. The Union Territory was one of the first places in the country to report cases of the virus. Most of these were traced back to Yokma and Gongma villages in the Chuchot area of Leh district. Much before the national lockdown was declared on March 24, both villages were sealed. Gongma, declared a containment zone on March 8, was unsealed on May 8. Yokma has been sealed since March 17.
When the test results for 74 samples arrived on May 3, not only did they show the highest ever jump in the number of coronavirus cases in Ladakh, they came at a time when it appeared to have beaten back the virus.
Sixteen of the new cases came from Yokma. “It was a shock to all of us – all of these cases from a containment area,” said Tsering Samphel, medical superintendent of the Sonam Nurboo Memorial Hospital in Leh. None of the cases had any recent travel history outside the containment area, officials said, and all were asymptomatic.
“Around seven cases are from the same family,” said Samphel, who also supervises the designated Covid-19 hospital in Leh. There have been no new cases reported since May 3.
A visit to the vegetable vendor?
Theories about the new infections are plentiful in Yokma, where residents have been ordered to stay indoors for nearly two months. The most common theory – a healthcare worker who is from Yokma, but wove in and out of the village, could have been the source of the new infections. She tested positive on April 13, residents say.
“She would sit at a grocery shop whenever she came to the village to collect information about the patient,” said Abbas Abidi, former councillor from Chuchot. “That grocery shop is frequented by many locals in the village and people suspect that they might have got infected from there.”
Officials have not been able to arrive at a definitive conclusion but they cautiously suggest that a ration distribution point might have been the source.
“Most likely a common point in all these cases is some vegetable distribution that took place within the containment zone,” said Motup Dorje, chief medical officer, Leh. “We interviewed the patients and they said that it was the only place where all of them went.”
Testing bias?
According to Dorje, the cases had also surfaced because the administration focused on testing in the containment areas. “The sampling depends,” he explained. “Sometimes we have 50-60 samples daily and on some days, we collect 100-200 samples. It varies. We did a massive sample collection of around 400-500 people there.”
Dorje also said that the “violation of social distancing norms and other protocol” for containment zones might have helped spread the infection. “We had restricted the entry and exit of the people to and from the village,” he said. “But it appears that inside the village they were not observing protocol. We have now made it very strict for them to observe all the guidelines.”
Stranded Ladakhis flown back from other states are not allowed to return to homes in containment zones. They either stay with friends and relatives outside or are put up in hotel accommodation arranged by government. This accommodation does not come cheap, however. Sayeeda Ladakhi, a member of the Ladakh Autonomous Hill District Council has written to the administration complaining of the steep rates – Rs 2,500-3,000 per day. These rates should be reconsidered, Ladakhi wrote, or institutional quarantine should be arranged within the containment zones.
The ‘curve’ in Ladakh
Despite the coronavirus arriving early in Ladakh, the sparsely populated region has managed to keep its caseload low. By March 6, two residents of Gongma village in Chuchot had tested positive for the virus. But new cases were reported days and weeks apart, even though samples were taken daily. As of May 10, 3,538 samples had been collected from Ladakh and a total of 42 had tested positive.
Before the sudden rise on May 3, the sparsely populated region had peaked with 13 positive cases on March 21. In the 11 days from March 22 to April 1, there were no new cases and three recoveries, giving officials hope that the virus had been contained. The authorities had managed to trace the source of all the initial cases.
“Most of these cases were infected by those who had returned from Iran,” Samphel said. “And the rest of the positive cases were largely their relatives.” A large number of pilgrims from Ladakh had been stranded in Iran, which saw a surge in cases in February and March.
Ladakh has not recorded any Covid-19 deaths so far.
Breaking the chain
Ladakh divisional commissioner Saugat Biswas said the early decision to designate containment zones was key to containing the spread of the virus. “The containment zones were identified as soon as the first cases were discovered,” he said. “They were given all the facilities so that people didn’t come out.”
As India reported its first Covid-19 positive case on January 30, authorities in Ladakh decided to screen every passenger entering the Union Territory.
“We had started screening passengers at the airport in late January only,” said Samphel. In winter and early spring, air travel is the only means to enter Ladakh.
According to Samphel, the decision to screen every passenger at the airport was governed by the sheer number of Ladakhi pilgrims to Iran, an early hotspot for the virus. Ladakh’s first two Covid-19 positive cases had travelled back from Iran in late February.
Not that the screening process was watertight. When the first two cases were reported, residents of Leh district had questioned the utility of thermal screening at the airport and why pilgrims returning from Iran in late February had been allowed to go home without being quarantined.
There was also furore when a taxi driver from Gongma, a relative of one of the patients, tested positive for Covid-19 after testing negative twice. By the time the third test results were declared, he had already been sent home from the hospital where he was being quarantined and had mingled freely with relatives.
Ladakh being landlocked restricted the number of people flowing into the region, officials said. “The other factor that complimented our efforts was the close-knit structure of our society,” said one official who did not want to be named. “Everyone knows everyone else in the village. It helped us in tracking the contacts and the source of infection. People were cooperative.”
The absence of tourists also helped, Samphel said. Every year, thousands of tourists from across India and other countries visit Ladakh. In 2018 alone, around 50,000 foreign tourists and more than 2.75 lakh local tourists visited the cold desert region. According to the 2011 census, Ladakh has a population of 2.74 lakh people.
“This thing [Covid-19] started even before the tourist season started,” said Biswas. “That was a boon.”
On March 18, the Ladakh administration also banned the entry of labourers from other parts of the country.
Testing in Delhi
According to Biswas, both government and civil society had coordinated admirably in a “concerted effort” to contain the virus. But there are three problems.
First, Ladakh does not have a lab to test samples for Covid-19. This got more difficult after domestic flights were banned on March 24. “Since the suspension of flights, we have been sending samples to the NCDC [National Centre for Disease Control] in Delhi through army aircrafts,” said Samphel.
Second, the administration is faced with a potential shortage of ventilators. According to the 2011 census, Leh district has a population of 1,33,487, but there are only 17 ventilators for the entire district.
Samphel also rued the shortage of personal protective equipment for health workers. “We are using it with proper care, only in situations where we think there’s no alternative to using PPE,” he said.