COVID situation in 11 States/UTs a matter of ‘Serious Concern’

Cabinet Secretary Shri Rajiv Gauba chaired a high-level review meeting with Chief Secretaries, DG Police and Health Secretaries of all States/UTs, with focus on 11 States/UTs that have been reporting very high rise in daily cases and daily mortality because of COVID-19 in the last two weeks. The meeting to review and discuss the COVID management and response strategy was attended by the Chief Secretaries, DGPs, and senior health professionals of all States/UTs along with the Member (Health) NITI Aayog, Union Home Secretary, Union Health Secretary, Union Secretary (I&B), DG ICMR, and Director of NCDC.

Taking note of the present situation due to the continuous deterioration of the COVID scenario over the fortnight, the Cabinet Secretary pointed out that the current COVID case growth rate of 6.8% in March 2021 has surpassed the previous record of 5.5% (June 2020). The country also reported 5.5% growth rate in daily COVID deaths in this period. While the country was reporting about 97,000 daily new COVID cases at the peak of the pandemic in September 2020, the country has now reached the critical figure 81,000 daily new cases of COVID.

Through a detailed and comprehensive presentation, the Union Health Secretary highlighted the current trajectory of COVID in the States/UTs while Union Secretary (I&B) showcased ways of effective Behavioural Change Communication to instill COVID Appropriate Behaviour among the populace. Dr V. K. Paul emphasized on need for States to follow a protocol for sharing clinical and epidemiological data for more detailed study of mutant strain of virus for genome sequencing. The Union Home Secretary pointed out that the 11 States and UTs that are showing a surge in daily COVID cases have not shown commensurate increase in enforcement of containment activities. He urged the Chief Secretaries and DGs (Police) of the States/UTs for taking appropriate strict action in this regard.

11 States/UTs were categorised as “States of grave concern” on account of their high and rising daily case and higher daily deaths. These have contributed 90% of COVID cases (as on 31st March) and 90.5% of deaths (as on 31st March) in last 14 days, and have crossed/or close to crossing their early reported peaks during last year. It was pointed out the situation was particularly worrying in Maharashtra. They were advised to take up immediate and high effective measures to ensure containment of Active Cases and Daily Deaths through adherence of the standard Clinical Management Protocol shared earlier with all States and UTs.

Another worrisome aspect pointed out was that Tier 2 and Tier 3 cities along with peri-urban areas have recorded the recent high ruses in COVID cases; the spread of infection from these areas to the rural areas with weak health infrastructure would overwhelm the local administration was also highlighted.

After detailed and comprehensive review of the measures taken by the States/UTs, the Cabinet Secretary reiterated the necessity of meticulous and hard work regarding stringent enforcement of containment and surveillance measures, in conjunction with ramping up vaccination and strict enforcement of COVID Appropriate Behaviour. The States were specifically asked to:

• Increase testingcontinuously to ensure that positivity comes down to 5% or less than 5%
• Focus on ensuring RT-PCR tests comprise 70% of total tests
• Reduce waiting time of test results with regular review with testing labs
• Use Rapid Antigen Tests (RAT) as screening test in densely populated areas and where fresh clusters are emerging.
• All symptomatic RAT negatives to be mandatorily subjected to RT-PCR tests.
• Ensureeffective and prompt isolation of those infected in institutional facilities (Covid Care Centres). Ensure that patients isolated at home are to be monitored daily. Isolated infected persons to be transferred immediately to health facilities, if required.
• Ensure that 25 to 30 such close contacts to be traced for each infected person. Tracing of close contacts and their isolation to be done in 72 hours. Subsequent testing and follow up of all close contacts to be carried out.
• Setting up of Containment Zones/ Micro Containment Zones to break the chain of transmission.

States were also asked to examine Case Fatality Rate hospital-wise, devise appropriate strategy and mitigate concerns regarding late admission in hospitals and non-adherence to National Clinical Management Protocol. The need to formulate District Action Plans with a focus on mapping of cases, reviewing of ward/block wise indicators, 24*7 Emergency Operations Center, Incident Command System (Area Specific Rapid Response Team and Timely Sharing of information was stressed upon.

In order to minimize the daily fatalities, the States were advised on strengthening of public and private healthcare resources. They were specifically asked to:

• Increase the number of isolation beds, oxygen beds, ventilators/ICU beds as per requirement.
• Plan for adequate oxygen supply.
• Strengthen ambulance service and reduce response time and refusal rate with regular monitoring by local administration.
• Ensure adequate number of contractual staff and optimum rostering of duties.
• Plan regular tele-consultation of ICU doctors at the districts with AIIMS, New Delhi Core Team or State Core Team. Tele-consultation is being conducted by AIIMS, New Delhi twice a week on Tuesdays and Fridays.
• Strict enforcement of COVID Appropriate Behaviour (CAB) was reiterated. The following was underscored for immediate compliance by States/UTs:
• Use of Police Act, Disaster Management Act and other legal/administrative provisions for imposing penalties on defaulters.
• Use of local officials, political, cultural, sports, religious influencers to disseminate information proper wearing of masks and maintaining physical distance.
• Focus on markets, fair/melas, social and religious congregation that could become super spreader events.
• Awareness to be enhanced that CAB is equally important as vaccination, and this needs to be followed even after vaccination.
• The message of ‘Dawai Bhi, Kadai Bhi’ to be effectively and profusely spread through multi-media and multilateral platforms.

In order to saturate vaccination for priority age groups in districting reporting surge in daily COVID cases, the States and UTs were advised for the following:

• Time-bound plan of 100% vaccination of eligible Health Care Workers, Front Line Workers and eligible age groups, to be made.
• Coordination with Union Health Ministry to ensure adequate vaccine doses. It was stressed that there is no shortage of vaccines with States and UTs; the Centre will continually replenish the requirement by the States and UTs.
• Daily review of consumption from each Cold Chain Point at the State level, for required re-appropriation.

The Cabinet Secretary exhorted the Chief Secretaries to galvanize the state administration and to use all resources at their disposal to tackle the recent surge of COVID cases. The need to expand the efforts to departments other than the Health Department through a “Whole of Government” approach was re-stressed at the meeting today. It was emphasised that the Centre continues to provide all resources and support to all States and UTs for public health measures and clinical management for fighting COVID19.