Targeted testing in containment zones and genomic surveillance are among the measures that have been suggested by the Centre to Kerala amid a surge in Covid-19 cases in the southern state. In a letter to the Kerala chief secretary on Friday, Union Health Secretary Rajesh Bhushan said the state has witnessed a sustained and significant transmission of Covid-19 since July.
It reported an average of 13,500 cases per day in July and almost 19,500 daily cases in August. Kerala remains one of the top contributors in terms of daily cases and is accounting for more than half of the active Covid cases in the country at present, Bhushan said in the letter. "Despite efforts by the state government on increasing testing, the test confirmation percentage still remains very high (more than 15 per cent), signalling high and widespread transmission. All 14 districts in Kerala have been identified as districts of concern due to high test positivity rates and high case per million reported in the past four weeks," he added.
Further, Thrissur, Kozhikode and Ernakulam have reported more than 4,000 cases per million (10 lakh) population in the week ending August 25, the Union health secretary pointed out. Considering the recent sharp increase in the number of cases, deaths and the test positivity rate after the Onam festivities and the likelihood of this trend continuing for a few more days, he suggested certain measures.
Bhushan said the Covid containment zones in the state need to be defined with a special focus on the high-transmission clusters. "Such zones need to be re-defined if the proportion of cases being reported outside of containment zones is showing an increase. Buffer zone around the containment zone needs to be identified clearly and passive surveillance needs to be enhanced to detect any spillover of cases from the containment zone," he said.
He said the contact-tracing efforts should further be scaled up to ensure that at least 20-25 contacts per positive case are identified and all contacts thus identified are put under quarantine. "The district administration needs to ensure strict compliance to MoHFW's home isolation guidelines and ensure that there is intensive follow up of all such cases under home isolation. Enforcement of Covid-appropriate behaviour needs to be further intensified," the Union health secretary said.
He stressed on avoidance of mass gatherings and said it needs to be enforced by the district administration. On testing, he said the current positivity rate is high, mandating a further increase in the number of tests conducted to detect the infection, in accordance with the guidelines issued by the Indian Council of Medical Research (ICMR).
"Targeted testing needs to be enhanced in containment zones and especially to cover high-risk contacts," Bhushan said. He also said Kerala should ensure enhanced genomic surveillance in areas of high and sustained transmission.
"Samples of all cases of vaccine breakthrough, infections and re-infections need to be sent for genome sequencing positively. Clinico-epidemiological assessment of all such cases needs to be done promptly. Results of such assessments need to be shared with the National Centre for Disease Control," he said. The Union health secretary said while expanding the coverage of Covid-19 vaccination is required, it is reiterated that a state-specific strategy to complete the second-dose vaccination of the beneficiaries may be adopted.
He said other measures such as a graded response action plan at the district level may be prepared and deployed in accordance with the MoHFW's containment implementation framework for community containment or large containment areas and its advisory on graded restrictions or relaxation measures for Covid-19. "I would like to reiterate that any laxity in ensuring strict adherence to the five-fold strategy of 'Test-Track-Treat-Vaccinate and Ensuring Covid Appropriate Behaviour' may result in further surge in Covid-19 transmission in Kerala and its neighbouring states," the Union health secretary cautioned in the letter.
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