Meeting with States and Districts Hotspots Clusters and Large Outbreaks Large Outbreak Localized increase in the incidence of COVID19 cases occurring within a defined geographic area eg in a village town or city ID: 1020922
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1. COVID-19Containment Measures Meeting with States and Districts
2. Hotspots- Clusters and Large Outbreaks Large OutbreakLocalized increase in the incidence of COVID-19 cases occurring within a defined geographic area e.g., in a village, town, or city.Cases may not be epidemiologically linked More than 15 casesImplies progression of a small cluster or evolvement of multiple clustersClusterLess than 15 cases in a limited areaCases are epidemiologically linked
3. Hotspots (Red zone)3ObjectiveInclusion Criteria Highest case load districts contributing to more than 80% of cases in India orHighest case load districts contributing to more than 80% of cases for each state in India orDistricts with doubling rate less than 4 days (calculated every Monday for last 7 days, to be determined by the state government) Exclusion criteriaNo new confirmed cases for last 28 days (Green zone) Hotspots (Red zones) – to focus attention on districts/cities reporting large number of cases/high growth rate
4. Current Status (as of 14th April 2020)4All districtsHotspots (Red Zone) (170)Hotspot districts with large outbreaks(123)Hotspot districts with clusters(47)Non-hotspot districts(207)Non hotspot districts with clusters(207)Hotspots (Red Zone Districts)(Hotspot) Orange ZoneNon infected Districts (Green Zone)No case in last 14 daysCriteria for shifting categoriesA district currently in hotspots can move to green category if no new cases arise in 28 daysNon infected Districts (Green Zone) No case in last 14 days
5. Strategic Approach for ContainmentDefining area of operation and applying perimeter controlActive search of cases, early isolation, contact listing and tracking, quarantine and follow up of contactsTesting all suspect cases, symptomatic contacts, asymptomatic direct and high-risk contacts of a confirmed case and SARI casesClinical management based on risk profileSocial distancing measuresAdminister HCQ in healthcare workers and contactsCreate awareness on hand hygiene, respiratory etiquettes and sanitation
6. Defining Area of OperationGeographic area mapped for cases & contacts for defining the area of operationIf data for mapping is not readily available in:Rural areas: 3 km radius of containment zone and additional 7 km radius of buffer zoneUrban areas: Administrative boundaries of residential colony and a buffer zone of additional 5 km radiusGeographic area mapped for cases & contacts for defining the area of operationIf data for mapping is not readily available in:Rural areas: Block/Sub district/district population with buffer zone of all neighboring block/sub district/districtUrban areas: Containment Zone: Entire population of towns and for large cities, zones/districts from where cases are reported Buffer Zone: Neighboring urban/rural districtsClustersLarge OutbreakThe area should be appropriately defined by the district administration/local urban body with technical inputs at local level & it would be appropriate to err on the higher side
7. Applying Perimeter ControlPerimeter of mapped cluster, facilitated by existing geographic boundaries - like roads , rivers, etc.Establish clear entry and exit points. Only 1 or 2 arterial roads into containment zone will be kept open for essential servicesAll roads connecting the containment zone will be guarded by police/ volunteers. No unchecked outward movement except for essential services No unchecked influx of population into the containment zone All vehicular movement, public transport and personnel movement will be restrictedDetails of people moving out of perimeter will be recorded & followed up with IDSPThe perimeter control operations for the clusters & large outbreaks remain the same except for the enhanced scale of arrangements for large outbreaks
8. Buffer and Containment ZonerBuffer ZonePerimeterContainment ZoneCluster of casesA containment operation (large outbreak or cluster) is deemed to be over 28 days from the date the last case in the district tests negative
9. Activities in Buffer and Containment ZoneDefined area around epicenterPerimeter controlActive search for casesTesting of all cases as per sampling guidelinesDefined area around the containment zoneNo perimeter controlNo active search for cases ILI/SARI cases report to health institutions falling in the buffer zoneTesting of ILI/SARI cases reporting to health institutions falling in the buffer zoneContainment ZoneBuffer ZoneThe buffer zone is an area where new cases are more likely to appearThus, the health institutions, including private institutions, should be aware of the signs & symptoms
10. Surveillance & TestingActive case search through house-to-house visit1 designated health worker to visit on an average 50 householdsASHAs, Aaganwadi workers and ANMsAdditional workforce from Red Cross, NSS, NYK, & Ayush studentsQuestionnaire regarding signs, symptoms, & travel Listing of contacts and their trackingInform supervisory officers of cases detected and contacts listedDaily collection, collation, and analysis of dataAll symptomatic individuals who have undertaken international travel in the last 14 daysAll symptomatic contacts of lab confirmed casesAll symptomatic health care workersAll patients with SARI (fever and cough and/or shortness of breath)Asymptomatic direct and high-risk contacts of a confirmed case should be tested once between day 5 and day 14 of coming in his/her contactSurveillanceTestingThe surveillance and testing activity remains the same for clusters and large outbreaks For large outbreaksFor active case search & contact tracing will require large compliment of workforce deploymentLarge number of samples will require testing
11. 11Other Focus AreasAll cases would be admitted to – COVID Care Center, COVID health Center or COVID hospital – depending upon clinical profileAll contacts will be kept in home quarantine except for high risk contacts who would be kept in institutional quarantineCases would be managed as per clinical management protocolInstitutional CareAdminister HCQ to health care workers in field & those in hospitalsSevere cases should be treated with HCQ in the prescribed dosePharmaceutical InterventionsPhysical distancing measures, including staying at homeClosure of schools & other establishments, except for emergency and essential servicesPublic health measures (hand washing & cough etiquettes)Ban on public gathering Cancellation of public transportNon-pharmaceutical Interventions
12. 12Other Focus AreasTrained health workforce for surveillance – ANM, AASHA, Anganwadi, NSS, Red Cross, Ayush students and NYK VolunteersTrained supervisory field staff – PHC, Ayush and CHC doctorsFor COVID Care Center – Ayush doctorsFor COVID Health Center – PHC doctorsFor COVID Hospitals – staff drawn from medical college/private hospitals (district-wise trained manpower made available on dashboardAll training material made available on IGOT platformHuman ResourcePersonal protection of health workforce is of prime importanceSufficient stock of PPEs/N95 masks etc to be made available in the districts in accordance with guidance on rational use of PPEs Material ResourceAwareness to be created through mass communication modalities and through inter-personal communication at the time of house-to-house visit of healthcare workersRisk Communication
13. 207 districts have reported cases and could be a potential hotspot.Preemptive action for cluster containment is to be initiated in all these districts.Clear delineation of containment zone and buffer zone to be done. Contact tracing and surveillance to be initiated.Laboratory testing as per protocol.Clinical management of positive cases to be undertakenEffective community engagement to be ensuredCluster Containment in Non-hotspot Districts
14. 353 districts are yet not affectedThese districts needs to be under enhanced surveillance for ILI and SARIILI and SARI cases in Facilities to be testedPreparation for dedicated COVID Care Centres, COVID Health Centre and COVID hospitals Health professionals training to be undertakenEffective community engagement for awareness creationAction for Non-infected Districts
15. APPENDIX
16. Hotspots with large outbreaks (1/3)StateDistrictAndhra PradeshKurnoolGunturSpsr NellorePrakasamKrishnaY.S.R.West GodavariChittoorVisakhapatanamEast GodavariAnantapurBiharSiwanChandigarhChandigarhChhattisgarhKorbaDelhiSouthSouth EastShahdaraWestNorthCentralNew DelhiEastSouth WestStateDistrictGujaratAhmadabadVadodaraSuratBhavnagarRajkotHaryanaNuhGurugramPalwalFaridabadJammu And KashmirSrinagarBandiporaBaramullaJammuUdhampurKupwaraKarnatakaBengaluru UrbanMysuruBelagaviKeralaKasaragodKannurErnakulamMalappuramThiruvananthapuramPathanamthitta
17. Hotspots with large outbreaks (2/3)StateDistrictMadhya PradeshIndoreBhopalKhargoneUjjainHoshangabadMaharashtraMumbaiPuneThaneNagpurSangliAhmednagarYavatmalAurangabadBuldhanaMumbai SuburbanNashikOdishaKhordhaPunjabS.A.S NagarShahid Bhagat Singh NagarJalandharPathankotStateDistrictRajasthanJaipurTonkJodhpurBanswaraKotaJhunjhunuJaisalmerBhilwaraBikanerJhalawarBharatpurTamil NaduChennaiTiruchirappalliCoimbatoreTirunelveliErodeVelloreDindigulVillupuramTiruppurTheniNamakkalChengalpattu
18. Hotspots with large outbreaks (3/3)StateDistrictTamil NaduMaduraiTuticorinKarurVirudhunagarKanniyakumariCuddaloreThiruvallurThiruvarurSalemNagapattinamTelanganaHyderabadNizamabadWarangal UrbanRanga ReddyJogulamba GadwalMedchal MalkajgiriKarimnagarNirmalUttar PradeshAgraGautam Buddha NagarMeerutLucknowGhaziabadSaharanpurStateDistrictUttar PradeshShamliFirozabadMoradabadUttarakhandDehradunWest BengalKolkataHowrahMedinipur East24 Paraganas North
19. Hotspots with clustersStateDistrictAndaman And Nicobar IslandsSouth AndamansAssamGolaghatMarigaonNalbariGoalparaDhubriBiharMungerBegusaraiGayaChhattisgarhRaipurDelhiNorth WestGujaratPatanHaryanaAmbalaKarnalHimachal PradeshSolanUnaSirmaurChambaKangraJammu And KashmirShopianRajouriJharkhandRanchiBokaroKarnatakaDakshina KannadaStateDistrictKarnatakaBidarKalaburagiBagalkoteDharwadKeralaWayanadLadakhKargilMadhya PradeshMorenaMaharashtraKolhapurAmravatiPalgharOdishaBhadrakPunjabMansaAmritsarLudhianaMogaRajasthanUdaipurTelanganaNalgondaUttar PradeshBulandshahrSitapurBastiBaghpatUttarakhandNainitalUdam Singh Nagar
20. Non hotspot districts reporting cases (1/5)State NameDistrict NameArunachal PradeshLohitAssamCacharHailakandiKamrupKamrup MetroLakhimpurSouth Salmara MancacharKarimganjBiharGopalganjNawadaBhagalpurSaranLakhisaraiNalandaPatnaChhattisgarhBilaspurDurgRajnandgaonDelhiNorth EastGoaNorth GoaSouth GoaGujaratGandhinagarBharuchAnandKachchhState NameDistrict NameGujaratPorbandarChhotaudepurMahesanaGir SomnathDohadJamnagarMorbiPanch MahalsSabar KanthaBanas KanthaHaryanaPanchkulaPanipatSirsaSonipatBhiwaniKaithalCharki DadriFatehabadHisarJindRohtakKurukshetraJammu And KashmirBudgamKulgamPulwama
21. Non hotspot districts reporting cases (2/5)StateDistrictJammu And KashmirGanderbalSambaJharkhandHazaribaghKodermaGiridihKarnatakaBallariMandyaBengaluru RuralDavangereUdupiGadagTumakuruKodaguVijayapuraChikkaballapuraUttara KannadaKeralaThrissurKollamIdukkiPalakkadKottayamAlappuzhaLadakhLeh LadakhMadhya PradeshBarwaniVidishaStateDistrictMadhya PradeshJabalpurEast NimarDewasChhindwaraGwaliorShivpuriBetulDharRaisenSagarShajapurMandsaurRatlamSatnaSheopurMaharashtraAkolaLaturSataraRatnagiriOsmanabadJalgaonSindhudurgRaigadBeedHingoli
22. Non hotspot districts reporting cases (3/5)StateDistrictsMaharashtraJalnaWashimGondiaDhuleSolapurMeghalayaEast Khasi HillsMizoramAizawlOdishaCuttackDhenkanalJajapurKalahandiKendraparaPuriSundargarhPuducherryPondicherryMahePunjabHoshiarpurRupnagarBarnalaFaridkotFatehgarh SahibSangrurKapurthalaPatialaSri Muktsar SahibStateDistrictsRajasthanChuruDausaAlwarDungarpurAjmerKarauliPaliPratapgarhBarmerDholpurNagaurSikarHanumangarhTamil NaduThanjavurTiruvannamalaiKanchipuramSivagangaThe NilgirisKallakurichiRamanathapuramPerambalurAriyalurTelanganaSuryapetAdilabadMahabubnagar
23. Non hotspot districts reporting cases (4/5)StateDistrictTelanganaKamareddyVikarabadSangareddyMedakKhammamBhadradri KothagudemJagitialJangoanJayashankar BhupalapallyKumuram Bheem AsifabadMuluguPeddapalliNagarkurnoolMahabubabadRajanna SircillaSiddipetTripuraGomatiNorth TripuraUttar PradeshKanpur NagarVaranasiAmrohaHapurMaharajganjPratapgarhRampurStateDistrictUttar PradeshBareillyGhazipurAzamgarhHathrasMuzaffarnagarJaunpurKheriAuraiyaBandaBudaunHardoiKaushambiMathuraMirzapurRae BareliPilibhitBarabankiBijnorPrayagrajShahjahanpurEtawahUttarakhandHaridwarAlmoraPauri GarhwalWest BengalKalimpong
24. Non hotspot districts reporting cases (5/5)StateDistrictWest BengalJalpaiguriHooghlyNadiaPaschim BardhamanMedinipur West24 Paraganas SouthDarjeeling