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Limit red zones to localities with dense population, suggests panel on Delhi’s Covid strategy

Containment zones should be limited to places such as resettlement colonies and slums, contact-tracing activities have to be rationalised and districts should follow leads provided by their own surveillance instead of just chasing targets when it comes to testing.

Updated: Oct 09, 2020, 04:58 IST

By Abhishek Dey, Hindustan Times New Delhi

A health worker at a Delhi clinic speaks to a person before a Covid-19 test. (AP photo)

Containment zones should be limited to places such as resettlement colonies and slums, contact-tracing activities have to be rationalised and districts should follow leads provided by their own surveillance instead of just chasing targets when it comes to testing. These are some of the recommendations drafted by the National Centre for Disease Control (NCDC), with an expert group led by Dr V K Paul of Niti Aayog, to help formulate a revised strategy for Covid-19 management in Delhi.

The document related to the revised Covid-19 strategy for Delhi, which HT has seen, says home isolation cases in high-density areas could have led to transmissions and warns that Delhi may witness around 15,000 cases per day in the winter months because of respiratory illnesses adding to Covid-19 symptoms and the likelihood of more patients with severe symptoms coming from other states.

The strategy document recommended that the Delhi government should engage with community leaders, organisers, etc., to ensure festivals – Durga Puja, Dussehra and Chhath – are low key with little or no gathering.

The Delhi Disaster Management Authority (DDMA) is relying on these recommendations for chalking out a fresh Covid-19 management strategy for the Capital.

On September 18, lieutenant-governor (L-G) Anil Baijal had asked DDMA to draft a fresh strategy as Delhi had witnessed too many ups and downs in the Covid-19 graph since June 26 – when the plan was last drafted, said a senior government official who did not wish to be identified.

At its peak, the seven-day Covid-19 case average was 4119, on September 19

The DDMA is chaired by Baijal and its vice-chairperson is chief minister Arvind Kejriwal. Dr Paul leads separate advisory committees for both the central government and DDMA.

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The DDMA is scheduled to draft its strategy and submit it to the L-G by Tuesday (Oct 13) when the next meeting of the authority is scheduled, the senior official said.

The official said these recommendations have been submitted to the offices of the L-G, chief minister and chief secretary Vijay Dev – and discussed with district magistrates earlier this week.

Senior officials in the L-G office did not comment.

A Delhi government spokesperson refused to comment on the issue.

The document said, “Cases are being reported from all areas of all the districts and hence existing containment zone strategy needs to be revised.”

It said, “The formation of new containment zones could be restricted only for highly dense localities such as resettlement colonies and JJ clusters /slums areas...For planned colonies, big apartments, RWA (resident welfare association)-governed localities, the strategy of micro containment zones or home isolation may be continued.”

“Proportion of active case under home isolation is to the extent of 50-60 %, which constitutes the major proportion of active cases in Delhi. Home isolation is observed in densely populated colonies as well. With the number of cases in thousands, the strict monitoring of movement restriction of all cases under home isolation, especially in densely populated areas, is challenging and may be one of the reasons for the spread of infection,” the document noted.

It said, “It is recommended that the guidelines for selection of cases to be put on home isolation need to be strictly followed and all symptomatic positive cases reported from densely populated areas should be isolated only in covid care centres (CCC) to ensure optimal utilisation of these facilities.”

It said that each home isolation case should be better monitored.

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On contact tracing, the document suggested the government’s policy can be further “rationalised”. It said, “The contact tracing could be restricted to forward contact tracing only -- immediate family contacts, neighbourhood contacts and close workplace contacts, should be traced and tested as per ICMR guidelines on a priority basis.”

It said the government’s current policy on testing was insufficient when it comes to containment zones, and recommended district-wise scaling up of tests and tests based on surveillance findings instead of chasing targets. “Criteria for scaling up of testing should be based on positivity in each district (preferably ward) vis-à-vis the total number of samples tested,” it said.

It noted, “Testing should not be target-driven, rather it should be guided by the surveillance in containment zones, number of positive and their symptomatic contacts identified and number of symptomatic persons identified at screening sites. Increase in the number of tests should be reflected in increased case finding. Merely increasing the number of tests to reduce the positivity rate would not be appropriate.”

“Winter months that make respiratory illnesses severer...Patients may come from outside Delhi in large numbers… Patients coming from distant areas are likely to be more serious. In addition, with festival-related gatherings, there could be a sudden rise in cases. Therefore, it is recommended that Delhi should prepare for a daily surge of approximately 15,000 positive cases and make arrangements for inpatient admissions of patients with moderate and severe disease roughly amounting to 20% of this surge.”

Dr Jacob John, former head of clinical virology at Christian Medical College in Tamil Nadu’s Vellore, said: “As the economy opens up more with time, high-population density areas remain at high risk as far as transmission is concerned. In other areas, they can isolate cases and improve monitoring, without creating containment zones. So, the containment zone strategy that the government is currently discussing sounds reasonable.”

“Also, the government should consider localised isolation facilities near slums and high population areas so that patients can be isolated without being taken to a place far away from residence. As far as the predictions regarding the surge of cases in the winters are concerned, there is not much concrete study on that so far,” he said.

Dr Jugal Kishore, head of community medicines department in Delhi’s Safdarjung Hospital, said: “First of all, the government should scale up RT-PCR tests. With their awareness campaigns, they should help bring change in behaviour and encourage people to get tested on their own. As far as containment policies are concerned, Delhi can do away with the concept of containment, even in high-population areas, at this juncture. Positive cases should be isolated in facilities.”


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