Amid a slew of states reporting an exponential increase in Covid-19 cases, special teams sent by the Centre have flagged a host of issues in the virus responses of Maharashtra, Punjab and Chhattisgarh.
The central government had constituted 50 high-level multi-disciplinary public health teams and deployed them to 50 districts across Maharashtra, Chhattisgarh and Punjab in view of the recent surge in COVID-19 cases. The teams were rushed to 30 districts of Maharashtra, 11 districts of Chhattisgarh and nine districts of Punjab to assist the state health department and local authorities in COVID-19 surveillance, control and containment measures.
The two-member high-level team consists of a clinician/epidemiologist and a public health expert. “The teams will visit the states immediately and monitor the overall implementation of COVID19 management, especially in testing, including surveillance and containment operations, COVID-appropriate behaviour and its enforcement, availability of hospital beds, sufficient logistics, including ambulances, ventilators, medical oxygen, etc. and COVID-19 vaccination progress,” the ministry had said.
The teams are currently working together with District administrations in affected areas, to “provide support and supervision, and recommend workable solutions to curb the spread of disease”, a press release by the Union Ministry of Health and Family Welfare said on Sunday.
The central team from Raipur, Jashpur reported lack of perimeter control in containment zones. “There appears to be no restriction on movement of people inside containment zones too. Hence, Containment Zone including micro Containment Zones need to be strictly implemented. Contact tracing efforts need to be reinforced in Korba. Resistance (even attacks on healthcare workers) to containment activities and testing was reported by the team from Dhaneli Village, Raipur. This needs to be addressed on an urgent basis,” the release said.
The team also reported lack/shortage of any RT-PCR testing facility in Korba, Durg, Balod Districts, leading to increased testing turnaround time. Similarly, limited RT-PCR testing capacity was also reported from Balod. State may facilitate RT-PCR testing by exploring the use of mobile testing labs, the release said.
Hospital bed occupancy rates are high in Balod, Raipur, Durg and Mahasamund Districts, the Centre said, adding that the District administration needed to ramp up hospital infrastructure and other logistic requirement to meet any demand arising due to surge in cases. Similarly, shortage of Remdesivir, Low Molecular Weight Heparin needs urgent attention in Korba District, the release stated.
The teams have also reported non-adherence to COVID appropriate behavior by the public. “Overcrowding and no physical distancing was observed in vaccination center visited by the team in Rajnandangaon. There is need for enhancing at IEC activity efforts in Durg District and strengthening enforcement effort across all districts,” the document said.
The central teams in Maharashtra reported lack of Covid-appropriate behavior, oxygen and ventilator shortage, and sub-optimal efforts at surveillance and contract tracing in areas.
“Containment operations were found to be sub-optimal in Satara, Sangli and Aurangabad, with less than satisfactory perimeter control, lack of active surveillance for cases. Efforts at surveillance and contact tracing were found to be sub-optimal in Buldhana, Satara, Aurgangabad and Nanded, mostly due to limited manpower engaged in this task,” the release said, adding that the team from Bhandara has reported that most cases are being reported from outside of containment zones. This requires increasing the areas of containment zone or notifying new Containment Zones, the Centre said.
The Centre reported that the testing capacity in Satara, Bhandara, Palghar, Amravwati, Jalna and Latur Districts is already overwhelmed, resulting in delay in reporting of test results. “The Central teams from Nanded and Buldana, have reported a very skewed RT-PCR/RAT ratio. Community resistance to COVID-19 testing has also been reported from Bhandara District,” the release said.
ln Bhandara and Satara, a large percentage of COVID-19 patients are under home isolation, which requires rigorous follow up to minimize mortality. Such a follow up is not happening presently, the Centre said. lt was also observed by the teams that delayed reporting by patient to definitive treatment centers in Satara District is leading to large number of deaths within first T2 hours of hospital admission.
The teams also flagged high occupancy rates in hospitals, along with shortage of critical medical supplies such as oxygen and ventilators. “Occupancy rates of available hospital bed capacity are very high in Ahmednagar, Aurangabad, Nagpur and Nandurbar. Team to Aurangabad reported dependency of the District on neighboring districts for management of critical patients and critical care infrastructure upgradation thereon. Medical oxygen supply was found to be an issue in Bhandara. Palqhar. Osmanabad and Pune. Malfunctioning ventilators have been reported by teams from Satara and Latur Districts. Hospital level and District level oxygen planning must start without any delay,” the release said.
The teams also flagged acute shortage of healthcare workforce from Aurangabad, Nandurabar, Yawatmal, Satara, Palghar, Jalgoan, Jalna Districts. Rostering of health care workers, hiring of contractual health workers need to be expedited, the Centre said.
In Punjab, the Centre flagged the need to enhance focus on contact tracing in Patiala and Ludhiana. “Contact tracing and surveillance efforts in SAS Nagar are being hampered due to shortage of manpower. Additional manpower must be deployed for contact tracing on a priority basis,” the Centre said.
It also reported low rates of testing from Patiala, and no RT-PCR testing laboratory in Rupnagar.
The team also added that there was no dedicated COVID Hospital in SAS Nagar and Rupnagar Districts, and patients are being referred to neighboring Districts or Chandigarh.
The Centre reported the lack of any Covid Care Center/Dedicated Covid Hospital in Rupnagar District. “Hospital bed occupancy rates in SAS Nagar, Jalandhar and Ludhiana are on the higher side and suitable arrangement for the same must be undertaken by the District health authorities with sufficient lead time to prepare for any surge in cases,” it said.
The team to Patiala and Ludhiana reported slow pace of COVID-19 vaccination among persons older than 45 years (with co-morbidities) and those above 60 years.