COVID-19

Containment Measures Meeting with States and Districts Hotspots- Clusters and Large Outbreaks

• Large Outbreak o Localized increase in the incidence of COVID-19 cases occurring within a defined geographic area e.g., in a village, town, or . o Cases may not be epidemiologically linked o More than 15 cases o Implies progression of a small cluster or evolvement of multiple clusters

• Cluster o Less than 15 cases in a limited area o Cases are epidemiologically linked Hotspots (Red zone)

Hotspots (Red zones) – to focus attention on districts/ reporting large number of cases/high growth rate Objective • Inclusion Criteria

o Highest case load districts contributing to more than 80% of cases in or

o Highest case load districts contributing to more than 80% of cases for each state in India or

o Districts with doubling rate less than 4 days (calculated every Monday for last 7 days, to be determined by the state government) • Exclusion criteria

o No new confirmed cases for last 28 days (Green zone) 3 Current Status (as of 14th April 2020)

All districts

Hotspots Non-hotspot Non infected Districts (Red Zone) districts (Green Zone) (170) (207)

Hotspot districts with Hotspot districts with Non hotspot districts large outbreaks clusters with clusters (123) (47) (207)

No case in last No case in Criteria for 14 days last 14 days Non infected Districts Hotspots (Red Zone Districts) (Hotspot) Orange Zone shifting (Green Zone) categories

A district currently in hotspots can move to green category if no new cases arise in 28 days 4 Strategic Approach for Containment • Defining area of operation and applying perimeter control • Active search of cases, early isolation, contact listing and tracking, quarantine and follow up of contacts • Testing all suspect cases, symptomatic contacts, asymptomatic direct and high- risk contacts of a confirmed case and SARI cases • Clinical management based on risk profile • Social distancing measures • Administer HCQ in healthcare workers and contacts • Create awareness on hand hygiene, respiratory etiquettes and sanitation Defining Area of Operation

Clusters Large Outbreak

• Geographic area mapped for cases & contacts • Geographic area mapped for cases & contacts for defining for defining the area of operation the area of operation • If data for mapping is not readily available in: • If data for mapping is not readily available in: o Rural areas: Block/Sub district/district population with o Rural areas: 3 km radius of containment buffer zone of all neighboring block/sub district/district zone and additional 7 km radius of buffer o Urban areas: zone o Containment Zone: Entire population of towns and for o Urban areas: Administrative boundaries large cities, zones/districts from where cases are of residential colony and a buffer zone of reported additional 5 km radius o Buffer Zone: Neighboring urban/rural districts

The 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 Applying Perimeter Control

• Perimeter 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 services • All 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 restricted o Details of people moving out of perimeter will be recorded & followed up with IDSP

The perimeter control operations for the clusters & large outbreaks remain the same except for the enhanced scale of arrangements for large outbreaks Buffer and Containment Zone

Buffer Zone

r Perimeter

Cluster of cases

Containment Zone

A containment operation (large outbreak or cluster) is deemed to be over 28 days from the date the last case in the district tests negative Activities in Buffer and Containment Zone

Containment Zone Buffer Zone

• Defined area around epicenter • Defined area around the containment zone • No perimeter control • Perimeter control • No active search for cases • Active search for cases o ILI/SARI cases report to health institutions falling in the • Testing of all cases as per sampling buffer zone guidelines • Testing of ILI/SARI cases reporting to health institutions falling in the buffer zone

The buffer zone is an area where new cases are more likely to appear Thus, the health institutions, including private institutions, should be aware of the signs & symptoms Surveillance & Testing

Surveillance Testing

• Active case search through house-to-house visit • All symptomatic individuals who have undertaken • 1 designated health worker to visit on an average 50 international travel in the last 14 days households • All symptomatic contacts of lab confirmed cases o ASHAs, Aaganwadi workers and ANMs • All symptomatic health care workers o Additional workforce from Red Cross, NSS, NYK, & Ayush students • All patients with SARI (fever and cough and/or shortness of • Questionnaire regarding signs, symptoms, & travel breath) • Listing of contacts and their tracking • Asymptomatic direct and high-risk contacts of a confirmed • Inform supervisory officers of cases detected and contacts case should be tested once between day 5 and day 14 of listed coming in his/her contact • Daily collection, collation, and analysis of data The surveillance and testing activity remains the same for clusters and large outbreaks For large outbreaks • For active case search & contact tracing will require large compliment of workforce deployment • Large number of samples will require testing Other Focus Areas

• All cases would be admitted to – COVID Care Center, COVID health Center or COVID hospital – depending upon clinical profile Institutional • All contacts will be kept in home quarantine except for high risk contacts who would be kept Care in institutional quarantine • Cases would be managed as per clinical management protocol

Pharmaceutical • Administer HCQ to health care workers in field & those in hospitals Interventions • Severe cases should be treated with HCQ in the prescribed dose

• Physical distancing measures, including staying at home Non- • Closure of schools & other establishments, except for emergency and essential services pharmaceutical • Public health measures (hand washing & cough etiquettes) Interventions • Ban on public gathering • Cancellation of public transport 11 Other Focus Areas

• Trained health workforce for surveillance – ANM, AASHA, Anganwadi, NSS, Red Cross, Ayush students and NYK Volunteers • Trained supervisory field staff – PHC, Ayush and CHC doctors Human • For COVID Care Center – Ayush doctors Resource • For COVID Health Center – PHC doctors • For COVID Hospitals – staff drawn from medical college/private hospitals (district-wise trained manpower made available on dashboard • All training material made available on IGOT platform

• Personal protection of health workforce is of prime importance Material • Sufficient stock of PPEs/N95 masks etc to be made available in the districts in accordance Resource with guidance on rational use of PPEs

Risk • Awareness to be created through mass communication modalities and through inter- Communication personal communication at the time of house-to-house visit of healthcare workers 12 Cluster Containment in Non-hotspot Districts

• 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 undertaken

• Effective community engagement to be ensured Action for Non-infected Districts

• 353 districts are yet not affected

• These districts needs to be under enhanced surveillance for ILI and SARI

• ILI and SARI cases in Facilities to be tested

• Preparation for dedicated COVID Care Centres, COVID Health Centre and COVID hospitals

• Health professionals training to be undertaken

• Effective community engagement for awareness creation APPENDIX Hotspots with large outbreaks (1/3)

State District State District Kurnool Ahmadabad Guntur Vadodara Spsr Nellore Gujarat Surat Prakasam Bhavnagar Krishna Rajkot Andhra Pradesh Y.S.R. Nuh Gurugram West Godavari Haryana Chittoor Palwal Faridabad Visakhapatanam Srinagar East Godavari Bandipora Anantapur Baramulla Siwan Jammu And Kashmir Jammu Chandigarh Udhampur Chhattisgarh Korba Kupwara South Bengaluru Urban South East Karnataka Mysuru Shahdara Belagavi West Kasaragod Delhi North Kannur Central Ernakulam Kerala Malappuram East Thiruvananthapuram South West Pathanamthitta Hotspots with large outbreaks (2/3)

State District State District Indore Jaipur Bhopal Tonk Madhya Pradesh Khargone Jodhpur Banswara Ujjain Kota Hoshangabad Rajasthan Jhunjhunu Mumbai Pune Bhilwara Thane Bikaner Nagpur Jhalawar Sangli Bharatpur Maharashtra Ahmednagar Chennai Yavatmal Tiruchirappalli Aurangabad Coimbatore Buldhana Tirunelveli Erode Mumbai Suburban Vellore Nashik Tamil Nadu Dindigul Odisha Khordha Villupuram S.A.S Nagar Tiruppur Shahid Bhagat Singh Nagar Punjab Theni Jalandhar Namakkal Pathankot Chengalpattu Hotspots with large outbreaks (3/3)

State District Madurai State District Tuticorin Karur Virudhunagar Shamli Kanniyakumari Tamil Nadu Cuddalore Firozabad Thiruvallur Thiruvarur Salem Moradabad Nagapattinam Hyderabad Nizamabad Uttarakhand Dehradun Warangal Urban Ranga Reddy Telangana Jogulamba Gadwal Kolkata Medchal Malkajgiri Karimnagar Howrah Nirmal Agra West Bengal Gautam Buddha Nagar Medinipur East Meerut Uttar Pradesh Lucknow Ghaziabad 24 Paraganas North Saharanpur Hotspots with clusters

State District State District Andaman And Nicobar Islands South Andamans Bidar Golaghat Kalaburagi Karnataka Marigaon Bagalkote Assam Nalbari Dharwad Goalpara Kerala Wayanad Dhubri Ladakh Kargil Munger Madhya Pradesh Morena Bihar Begusarai Kolhapur Gaya Maharashtra Amravati Chhattisgarh Raipur Palghar Delhi North West Odisha Bhadrak Gujarat Patan Mansa Ambala Haryana Karnal Punjab Solan Una Moga Himachal Pradesh Sirmaur Rajasthan Udaipur Chamba Telangana Nalgonda Kangra Bulandshahr Shopian Sitapur Jammu And Kashmir Uttar Pradesh Rajouri Basti Ranchi Baghpat Jharkhand Bokaro Nainital Uttarakhand Karnataka Dakshina Kannada Udam Singh Nagar Non hotspot districts reporting cases (1/5)

State Name District Name State Name District Name Arunachal Pradesh Lohit Porbandar Cachar Chhotaudepur Hailakandi Mahesana Kamrup Gir Somnath Assam Kamrup Metro Dohad Gujarat Lakhimpur Jamnagar South Salmara Mancachar Morbi Karimganj Panch Mahals Gopalganj Sabar Kantha Nawada Banas Kantha Bhagalpur Panchkula Bihar Saran Panipat Lakhisarai Sirsa Nalanda Sonipat Patna Bhiwani Bilaspur Kaithal Haryana Chhattisgarh Durg Charki Dadri Rajnandgaon Fatehabad Delhi North East Hisar North Goa Jind Goa South Goa Rohtak Gandhinagar Kurukshetra Bharuch Budgam Gujarat Anand Jammu And Kashmir Kulgam Kachchh Pulwama Non hotspot districts reporting cases (2/5)

State District State District Ganderbal Jabalpur Jammu And Kashmir Samba East Nimar Hazaribagh Dewas Jharkhand Koderma Chhindwara Giridih Gwalior Ballari Shivpuri Mandya Betul Bengaluru Rural Madhya Pradesh Dhar Davangere Raisen Udupi Sagar Karnataka Gadag Shajapur Tumakuru Mandsaur Kodagu Ratlam Vijayapura Satna Chikkaballapura Sheopur Uttara Kannada Akola Thrissur Latur Kollam Satara Idukki Ratnagiri Kerala Palakkad Osmanabad Maharashtra Kottayam Jalgaon Alappuzha Sindhudurg Ladakh Leh Ladakh Raigad Barwani Beed Madhya Pradesh Vidisha Hingoli Non hotspot districts reporting cases (3/5)

State Districts State Districts Jalna Churu Washim Dausa Maharashtra Gondia Alwar Dhule Dungarpur Solapur Ajmer Meghalaya East Khasi Hills Karauli Mizoram Aizawl Rajasthan Pali Cuttack Pratapgarh Dhenkanal Barmer Jajapur Dholpur Odisha Kalahandi Nagaur Kendrapara Sikar Puri Hanumangarh Sundargarh Thanjavur Pondicherry Tiruvannamalai Puducherry Mahe Kanchipuram Hoshiarpur Sivaganga Rupnagar Tamil Nadu The Nilgiris Barnala Kallakurichi Faridkot Ramanathapuram Punjab Fatehgarh Sahib Perambalur Sangrur Ariyalur Kapurthala Suryapet Patiala Telangana Adilabad Sri Muktsar Sahib Mahabubnagar Non hotspot districts reporting cases (4/5)

State District State District Kamareddy Bareilly Vikarabad Ghazipur Sangareddy Azamgarh Medak Hathras Khammam Muzaffarnagar Bhadradri Kothagudem Jaunpur Jagitial Kheri Jangoan Auraiya Telangana Jayashankar Bhupalapally Banda Kumuram Bheem Asifabad Budaun Mulugu Uttar Pradesh Hardoi Peddapalli Kaushambi Nagarkurnool Mathura Mahabubabad Mirzapur Rajanna Sircilla Rae Bareli Siddipet Pilibhit Gomati Barabanki Tripura North Tripura Bijnor Kanpur Nagar Prayagraj Varanasi Shahjahanpur Amroha Etawah Uttar Pradesh Hapur Haridwar Maharajganj Uttarakhand Almora Pratapgarh Pauri Garhwal Rampur West Bengal Kalimpong Non hotspot districts reporting cases (5/5)

State District

Jalpaiguri

Hooghly

Nadia

West Bengal Paschim Bardhaman

Medinipur West

24 Paraganas South

Darjeeling