India’s daily new coronavirus infections shot past the 81,000 mark on Friday, prompting the Centre to urge greater testing, tracing and isolation in states, strengthening healthcare resources, and using police and disaster management rules to enforce covid-appropriate behaviour.

Daily infection levels are rapidly approaching last year’s peak of 97,000 cases seen in September, at a time the government has expanded vaccination to all Indians above 45 years.

Comparison of vaccination drive in different nations

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Comparison of vaccination drive in different nations

A meeting called by the Union government on Friday tagged 11 states—Maharashtra, Punjab, Karnataka, Kerala, Chhattisgarh, Chandigarh, Gujarat, Madhya Pradesh, Tamil Nadu, Delhi and Haryana—as “states of grave concern”, adding new cases and deaths at a frenetic pace. At the meeting attended by chief secretaries, police chiefs and health secretaries of all states and Union territories, cabinet secretary Rajiv Gauba noted that these states added 90% of new cases and deaths in the second half of March, crossing or nearing their 2020 peaks.

Infections also swelled at a record pace of 6.8% in March, crossing last year’s record of 5.5% set in June 2020. The country reported a 5.5% growth in daily covid-19 deaths in March.

At the meeting, states were advised to strengthen public and private healthcare resources to reduce deaths, and increase the number of isolation beds, oxygen beds, ventilators/ICU beds, plan for adequate oxygen supply, strengthen ambulance services and reduce response time and refusal rate with regular monitoring by the local administration.

The meeting also discussed rising infections in tier-2 and 3 cities and peri-urban areas and the possibility of infections from these areas overwhelming rural areas with weak health infrastructure.

The cabinet secretary termed the situation in Maharashtra particularly worrying, advising the state to take up immediate and effective measures to ensure containment of active cases and daily deaths by adhering to standard clinical management protocol.

Union health secretary Rajesh Bhushan made a presentation tracking the advance of covid-19, while the information and broadcasting secretary presented ways for effective behavioural change communication to instil covid-appropriate behaviour. Member (health) NITI Aayog Dr V.K. Paul emphasized the need for states to follow a protocol to share clinical and epidemiological data for a more detailed study of mutant strains for genome sequencing.

States were specifically asked to increase testing continuously to ensure positivity comes down to 5% or less, focus on ensuring RT-PCR tests comprise 70% of total tests, reduce waiting time of test results with regular reviews with testing labs, use rapid antigen tests (RAT) as a screening test in densely populated areas and where fresh clusters are emerging, and all symptomatic RAT negatives to be mandatorily subjected to RT-PCR tests. The central government also said states should ensure tracing and isolation of 25-30 close contacts of each infected person in 72 hours and later test all of them. The states were asked to set up containment zones/micro containment zones to break the chain of transmission.

At the meeting, top government officials stressed on the strict enforcement of covid-appropriate behaviour. The central government said states should use Police Act, Disaster Management Act and other legal/administrative provisions for imposing penalties on defaulters, focus on markets, fair/melas, social and religious congregation that could become super-spreader events.

States were also asked to examine case fatality rate hospital-wise, devise appropriate strategies and mitigate concerns regarding late hospital admissions 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, 24X7 emergency operations centres, incident command system, area-specific rapid response team and timely sharing of information was also emphasized.

States were further asked to ensure an adequate number of contractual staff and optimum rostering of duties, plan regular teleconsultation 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.

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