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Monday, April 12, 2021

Centre to Maharashtra amid surge in Covid cases: Plug glaring gaps

On Monday, the state reported a record 16,620 new cases, accounting for 63.21 per cent of the daily new cases reported in the country.

Written by Kaunain Sheriff M | New Delhi |
Updated: March 16, 2021 7:24:00 am
maharashtra covid guidelines, maharashtra lockdown, maharashtra news, maharashtra coronavirus guidelines, uddhav thackerayCrowded Thane Railway station. (Express photo by Deepak Joshi/File)

From limited contact tracing to lack of effort to map cases and contacts, from patients reporting late to hospitals to a bulk of active cases being in home isolation without proper monitoring — these are among the glaring gaps identified by a Central team of experts deployed to Maharashtra to review the surge in Covid-19 cases in the state.

On Monday, the state reported a record 16,620 new cases, accounting for 63.21 per cent of the daily new cases reported in the country. Sources said Prime Minister Narendra Modi will on Wednesday hold a meeting with all chief ministers in the backdrop of the rising cases being reported from several districts.

On Monday, taking cognisance of the expert team’s report, Union Health Secretary Rajesh Bhushan wrote a letter to the state highlighting 14 specific public health measures that required to be implemented by the state. “Measures such as night curfews, weekend lockdowns, etc. have very limited impact on containing or suppressing the transmission. Hence the district administration should focus on strict and effective containment strategy,” Bhushan wrote to the state.

“For every positive case, at least 20 to 30 close contacts (including family contacts, social contacts’ workplace contacts, and other casual contacts) need to be promptly traced and tracked… The health infrastructure though adequate as of now, the State should plan for a worse-case scenario with sufficient lead time,” Bhushan wrote.

The expert team, in its report, has red-flagged five critical areas as the reason behind the surge.

* Contact tracing

The case-contact ratio — or the ratio between a positive case and the number of contacts traced of the person — is more than 1:20. Though it appears high, a deep dive into the methodology of contact tracing revealed that the concept was not clearly understood by field-level staff, who were mainly listing the immediate family and neighbourhood contacts, the Central team’s report said. The report also said high-risk contacts in workplace, social and family settings were not investigated and listed.

* Testing

The report said that in all the districts the team visited, the positivity rate was high — ranging from 5.1 per cent in Mumbai to 30 per cent in Aurangabad — implying high transmission in the community and that a lot of cases were not being tested. In view of limited contact tracing, a large pool of the symptomatic and pre-symptomatic among contacts were not being tracked and tested, the report said.

Besides, the report said, the contacts of those testing positive were found to be tested the very next day and not as per protocol (all asymptomatic direct and high-risk contacts of confirmed cases are to be tested once between Day 5 and Day 10 of coming into contact). In such instances, the negative test report can be misleading, and such contacts roam around freely without any quarantine restriction.

* Containment Zones

Among the districts the team visited, only Jalgaon was found to follow containment planning, that too limited to micro-containment. There was no effort to map the cases and contacts and notify the containment zone with perimeter control, the report said.

* Home isolation

In the districts the team visited, about 80-85% of active cases were under home isolation. Their report said there was no enough monitoring of oxygen saturation of these cases through pulse oximeter. The day-to-day monitoring of these cases through voice calls was also found to be lagging.

* Clinical management

The team found the current case fatality to be very high among patients admitted to Government Medical College in Aurangabad (11 per cent) and Vasant Rao Pawar Medical College, Nashik (18 per cent in January and 31 per cent in February). This, the report said, needed to be investigated in detail, including sending samples for Whole Genome Sequencing.

The report said death audits, which were being done earlier, should again be performed regularly, as most of the hospitals visited said patients were coming in late and in a critical condition.

* Covid management

With the health staff pre-occupied with vaccine administration, the Central team found that there was limited human resource for surveillance and contact-tracing activities.

“We could sense a feeling that enough has been done already. This complacency may take its toll. The Incident Command under the District Collectors should be reinstated with whole of Government approach to contain/ supresss the transmission,” the report said.

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