Covid-19 norms flouted in 50 worst districts: Centre

New Delhi The Centre on Sunday warned the three worst affected states — Maharashtra, Chhattisgarh and Punjab — that Covid-appropriate behaviour was not being followed in 50 of their districts, necessitating greater enforcement efforts

New Delhi The Centre on Sunday warned the three worst affected states — Maharashtra, Chhattisgarh and Punjab — that Covid-appropriate behaviour was not being followed in 50 of their districts, necessitating greater enforcement efforts.

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Union health secretary Rajesh Bhushan wrote to these states based on feedback received from central teams sent last week.

“These teams were to assess the situation on the ground, share their feedback, and work closely with the state authorities in looking for solutions. The health secretary’s letter is based on the feedback received from these teams, and asks them to plug the loopholes,” said a senior official in the health ministry.

The central teams found a lack of adequate surveillance measures being taken by the state administrations, especially in areas declared containment zones, inadequate testing using reverse transcription polymerase chain reaction (RT-PCR) tests, insufficient manpower on Covid-19 duty, among other things.

The teams sent to Maharashtra found containment operations sub-optimal, especially in the Satara, Sangli and Aurangabad districts, with less than satisfactory perimeter control, a lack of active surveillance for influenza-like illness cases, mostly due to limited human resources. The testing capacity in many districts such as Satara, Bhandara, Palghar, Amravati, Jalna and Latur is currently overwhelmed, resulting in delays in reporting of results. Also, some districts have a skewed RT-PCR and rapid antigen testing ratio that needs improvement.

“According to central government guidelines, at least 70% of the tests being conducted to detect Covid-19 need to be done through RT-PCR. All states will have to comply with this directive as RAT (rapid antigen test) is meant to be used in certain situations such as containment zones where mass testing is required to know the disease spread in a short span of time. It cannot replace RT-PCR testing,” said a health ministry official, who did not wish to be identified.

Some districts are reporting a large number of cases from outside containment zones, for which the Centre advised states to expand containment areas or to notify new zones so that adequate surveillance measures can be taken.

ln Bhandara and Satara districts, a large percentage of Covid-19 patients are under home isolation, which requires rigorous follow-ups to minimise mortality. However, such a thorough follow-up is not happening currently.

In Chhattisgarh, the team from Raipur and Jashpur reported a lack of perimeter control in containment zones, with no restriction on movement of people inside these zones either.

“…Containment zones including micro containment zones need to be strictly implemented. Contact tracing efforts need to be reinforced in Korba. Resistance (even attacks on health care workers) to containment activities and testing was reported by the team from Dhaneli village, Raipur. This needs to be addressed on an urgent basis,” read Bhushan’s letter.

Another issue flagged by the expert teams was shortage of RT-PCR testing facilities in Korba, Durg, and Balod districts, for which the state has been advised to explore the use of mobile testing labs.

Ambulance services need to be strengthened in certain districts as is the overall hospital infrastructure. In Punjab, it was pointed out that there is an acute need for adopting enhanced contact tracing measures, especially in Patiala and Ludhiana.

“Additional manpower must be deployed for contact tracing on a priority basis. Low rates of testing have been reported from Patiala. Also as reported by the team, there is no RT-PCR testing laboratory in Rupnagar. This has been addressed urgently. There is no dedicated Covid hospital in SAS Nagar and Rupnagar districts, and patients are being referred to neighbouring districts or Chandigarh... Teams have also reported issues with procurement of ventilators for proper case management in SAS Nagar. ln Rupnagar, although ventilators are available, these are not being optimally utilised due to shortage of health care workforce, particularly doctors and nurses…,” the team noted.

The Centre advised the state to make contractual hiring of health care workers as per its additional requirement. Slow pace of vaccination among the elderly and those above 45 with comorbidities, especially in Patiala and Ludhiana, needs to be addressed on priority, it said.

For the lack of Covid-appropriate behaviour in the general public, stricter ground-level enforcement of rules has been suggested.

“All these problems have been discussed threadbare with the states for them to take appropriate action soonest,” said the official.

Experts say the way case numbers are rising, it is imperative to take strict containment measures to curb the disease spread.

“The virus is very much in circulation, and clearly spreading faster than before. What we need to do is take stringent measures in terms of increasing testing, tracking and isolating cases in time so that they don’t spread the disease within the community. There is also a need for enhancing community-level surveillance so that no case is missed, for as long we keep missing cases, the virus will continue to spread” said Jacob John, former virology head, CMC, Vellore.