Preventing Covid’s second coming: Committee’s advisory to government

measures to contain second wave of covid

BBMP health workers on Covid duty. Pic: BBMP Commissioner/Twitter

On November 30, the State Technical Advisory Committee (TAC) for COVID-19 issued an advisory to Karnataka government, detailing the measures needed to contain the second wave of the pandemic in the state. According to the TAC, the second wave is expected in January-February.

Following is an edited version of the advisory.

Key measures to contain second wave:

  1. The 7-day average growth rate as well as Reproduction number (Ro) of COVID cases will be closely monitored at the district and state levels for early recognition of the second wave.
  2. An epidemic intelligence team shall support the state war room for early recognition and for alerting the Additional Chief Secretary and Commissioner of the Health and Family Welfare Services.
  3. At the state level, a minimum of 1.25 lakh tests per day should continue till the end of February 2021, of which 1 lakh should be RT-PCR tests.
  4. All teachers, pupils, and staff in educational institutions, anganwadis should be tested fortnightly by RT-PCR.
  5. By first week of January, clinical facilities in terms of beds, ICUs, ICU-ventilators, etc., should be kept ready at October 2020 levels, both in government and private hospitals. Or these services could be ramped at a short notice of 2-3 days.
  6. Explore if CCCs (COVID Care Centres) can be run on a PPP model with reputed NGOs for better facilities, services and care.
  7. After carefully assessing the COVID-19 situation in the last week of December, graded opening of schools from January may be considered. Classes 12 and 10 may start from January, and classes 11 and 9 can follow later. The month of December shall be used for revising curriculum, planning exams, for and preparing classrooms and hostels for COVID compliance.
  8. Strictly restrict super-spreader events like fairs and festivals, religious congregations, cultural events, etc., during December and January (winter months). Marriages can have up to 100 attendees, political and public events up to 200, death ceremonies 50, and funerals can have 20 attendees.
  9. Public celebrations of New Year should be banned from December 26 to January 1. Impose night curfew (8 pm to 5 am) on these days.
  10. Expedite preparedness for COVID-19 vaccine introduction, both in public and private sectors.
  11. Rope in popular cine and sports personalities to promote messages of mask-wearing and sanitiser use, hand washing, etc.
  12. Further unlocks, like those of swimming pools, sports, etc., should be delayed till February 2021.
  13. Identify and implement best practices for COVID containment from other states.
Karnataka revenue minister R Ashok has said that the government is likely to ban new year celebrations on roads and public places this year. Based on the TAC's recommendations, the government is considering a set of guidelines to prevent a second wave of the pandemic. 

Current scenario

The first case of COVID in Karnataka was reported on 8th March in Bengaluru. In the past nine months, a total of 8.74 lakh cases and 11,678 deaths have occurred in the state. In the months of July to September, there was a sudden surge in cases, largely attributed to large-scale migration of people post lockdown.

The daily incidence of cases, which was more than 10,000 in September, has now come down to around 1,500. The number of labs have been increased from two in February, to 164 in November.

Presently, on average, over one lakh tests are being done every day, of which more than 75% are RT-PCR and the rest are RAT (Rapid Antigen Tests). Test positivity rate, which was around 14% in August, has now come down to 1.6%, largely due to containment measures.

Currently the state has:

  • 36 Dedicated COVID Hospitals (DCH)
  • 174 Dedicated COVID Health Centres (DCHC), and
  • 628 private hospitals for COVID care

There are 22,602 beds, 11,452 central oxygenated beds, and 1902 ICUs with ventilators, across government and private hospitals for COVID patients.

There has been a second wave of COVID in the USA, Europe, Australia, and other countries. Recently, there has been a surge in cases in states such as Delhi, Haryana, Gujarat, Madhya Pradesh, West Bengal and Kerala. In this context, as there is a steep decline in the number of cases in Karnataka, it is important for the state to prepare for a possible second wave of COVID-19.

A second wave of COVID is anticipated usually three to four months after the first spike/wave; this would be in January- February 2021 in case of Karnataka. During the second wave, the number of infected cases would be as much or higher than the first wave. This would be due to winter, unlock, weak enforcements, population movements, etc.

 Indicators of imminent second wave

  • For easy calculation, 7-day average growth rate shall be used as an indicator.
  • Occurrence of cases in excess of normal expectancy. That is, Test Positivity Rate doubled in a week, subject to no changes in testing pattern, along with doubling of hospitalisations in the corresponding seven consecutive days.

Prerequisite conditions

  • First wave should have been contained, i.e. Ro below 1.5
  • Low rate of infection has been sustained for at least one month
  • It is increasing steadily over previous 2-3 weeks
  • Second wave is when the cases are increasing steadily after crossing the basic reproduction rate (Ro >1.5)

Additional measures

In addition to the measures suggested at the start, following additional measures shall be taken to contain the second wave:

Laboratories/testing

  • Continue with aggressive contact testing (1 case to 20 contacts). Compulsory testing of all SARI and ILI cases
  • Expedite procurement of newer testing kits that are economical and easier to use

Hospital/clinical facilities including CCCs, home Isolation/home care ambulance, etc

  • Designate nodal officer/s at the district level and down the line

Hospitals

  • Reinforce IPC (Infection Prevention and Control) strategies through training and monitoring to limit transmission in health care settings

COVID Care Centres (CCC)

  • There shall be an inbuilt plan for quick ramp up of CCC beds to meet the demand during surge.
  • There shall be one readied CCC at every district/taluk level 

Home isolation

  • Better triaging and timely shifting to hospitals
  • To run on PPP model with reputed NGOs

Public health response

  • Enforce mask wearing: More marshals/police to fine violators in busy areas like markets, bus stops, commercial areas, in buses, at traffic junctions, etc. Consider introducing tough actions like simple imprisonment of a few hours for violators, as done in Madhya Pradesh.

Surveillance

  • Strengthen contact tracing, community based active surveillance, ILI & SARI surveillance
  • Surveillance in prisons, long-term care facilities, educational institutions, offices, etc.
  • Re-orient surveillance staff to contact tracing
  • Conduct cluster investigations in high-risk settings like urban slums, marriages, closed spaces, etc.

Participation of private entities, corporates, NGOs, charity institutions, etc

  • A meeting of reputed NGOs and philanthropists shall be convened soon to explore the ways and means for their further participation in COVID control.
  • They should be engaged in mission mode to support government efforts.

COVID vaccine

  • Address the euphoria of people, suitably educate them

IEC (Information, Education and Communication)

  • With sponsorships, popular private TV channels shall be used to organise expert opinion shows, panel discussions, etc.
  • Use social media for IEC messages both in Kannada and English
  • Engage the public through fact-based information regarding COVID scenario in the state and ensure people’s participation

[Read the full advisory here.]

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