With a surge in COVID-19 cases in Bihar, West Bengal, Assam and Odisha, the Union health ministry has asked these states to make renewed efforts to contain transmission of the virus and keep case fatality rate below one per cent. With these states imposing lockdown anew, the health ministry emphasised that the restrictions should be utilised to focus on containment, surveillance and testing in containment and buffer zones as the key strategy for early detection of cases and fatality management.
In a letter to Principal Secretaries (Health) and Secretary (Health) of these states, Joint Secretary in the Ministry of Health Lav Agarwal asked them to ensure that at least 80 per cent of the new cases have their close contacts traced and are in quarantine within 72 hours of case confirmation. The letter underlined that containment and buffer zones should be suitably delineated based on the mapping of cases and contacts, and a list of NCC volunteers along with other workforce is available on COVID warriors' portal which can be optimally utilised in containment and surveillance effort.
"In terms of testing the state should aim to achieve a minimum of 14 tests per one lakh (140 tests per million) per day, while ensuring a positivity rate of less than 10 per cent," the letter to the states read. The Centre has also decided to depute a multi-disciplinary team to Bihar to review and coordinate with the state in managing the pandemic there, according to an office memorandum issued by the health ministry.
The team, comprising Agarwal, Dr S K Singh, Director, National Centre for Disease Control, and Dr Neeraj Nischal, Associate Professor, Medicine at AIIMS New Delhi, will undertake the visit immediately and coordinate with state health authorities to review the existing situation and provide necessary support and guidance. According to the letter to the Principal Secretary (Health & Family Welfare), Bihar, cases in the state are rising with almost 450-500 cases being reported daily and 80 per cent of the total active cases in the state were reported in the last seven days.
Districts like Patna, Bhagalpur, Muzaffarpur, Nalanda, Begusarai and Munger are reporting higher number of cases while Saharsa, Gaya, Paschim Champaran, Jamui, Arwal, Saran and Khagaria are the emerging hotspots. The overall testing is very low in the state vis-a-vis national average and an increasing trend in case positivity rate on weekly basis is also a cause of concern, the letter said.
In the letter to the Secretary (Health and Family Welfare), West Bengal, Agarwal said the state is reporting almost 1,600 cases daily and 93 per cent of the total active cases in state were reported in the last four days. "Kolkata, Howrah, North 24 Parganas and South 24 Parganas as well as emerging hotspots in Jhargram, Purulia, Nadia, Midnapur East, Hooghly and Nadia need immediate attention."
Further, Odisha is reporting an average of more than 500 cases everyday since the past four weeks, the letter to the state's Principal Secretary (Health and Family Welfare) said. "According to active case load, Odisha is the tenth most-affected state in the country with Ganjam reporting approximately 37 per cent of the state's active caseload," the letter said, adding, there is need to focus on emerging hotspots such as Nabarangpur, Sambalpur and Kendujhar.
"The increase in weekly fatality trend with almost 29 pc of cases above 45 years, is also a cause of concern," the letter said. In the letter to the Principal Secretary (Health and Family Welfare) Assam, Agarwal said the state is reporting approximately 600 cases everyday. About 80 pc of current active case load is reported in last 14 days, with Kamrup metro reporting more than 50 per cent of state's active caseload.
Nine districts including Nagaon, Goalpara, Karbi Anglong, Nalbari, Sivasagar are testing lower than India's average. High case of positivity is noted in Dima Hasao and Kamrup Metro, the letter highlighted. To keep cases fatality rate less than one per cent, weekly case fatality needs to be monitored and the state should conduct rapid audit of hospitals and create dashboards to monitor real time status of bed utilisation, the letter sent to the four states mentioned.
It also asked them to ensure adequate human resources, revamping ambulance system and helplines to ensure resolution of problems of patients experiencing symptoms or undergoing home isolation. "The Centre of Excellence for Clinical Management should undertake hospital wise/facility-wise fatality analysis and guide facilities with high CFR through regular VC on appropriate clinical management. Required support from 24x7 team set up by AIIMS Delhi for clinical management consultation may also be taken in this context," the letters said.
Necessarily testing all asymptomatic high-risk contacts and mild symptomatic as per ICMR protocol should be undertaken, it said. The states have also been asked to use the forecasting tools made available by the health ministry to ascertain the number of COVID beds required and accordingly calculate the oxygen requirement.
"A nodal officer to keep a track of oxygen requirements and for relevant communication with the centre is to be appointed," the letter said. "State should also focus on ensuring availability of non-COVID services such as immunisation, maternal and child health services including other emergency and critical care services," it stated.