AJAY BHALLA, IAS

Home Secretary
Government of India
North Block
New Delhi

No. 40-3/2020-DM-I(A)

26th April, 2021

 

Dear Administrator,

Please refer to the guidelines for effective control of COVID-19, issued vide Ministry of Home Affairs’ (MHA) Order of even No. dated 23.03.2021, wherein it is prescribed that States and UTs, based on their  assessment  of  the  situation,  may impose local restrictions at district/sub-district and city/ward level, with a view to contain the spread of COVID-19.

2. In the recent past, a sharp increase in COVID-19 cases has been observed along with high positivity Considering this unprecedented  surge,  there  is  an urgent need for States/UTs to consider  strict COVID  management and  control  measures,  in the surge areas to bring the situation under control. Accordingly, Ministry of Health 8s Family Welfare (MoHFW), vide their DO no.  Z.28015/85/2021-DM  Cell  dated  25th April 2021, has advised all States  and  UT  Governments  to  implement an  intensive, local and focused containment framework, focused on specific districts/  cities/ areas, and identified based on a prescribed criterion. The containment framework has been outlined in detail in the Annexure to the said MoHFW letter (copy enclosed). All States/UTs have also been advised to consider a further graded response in accordance with local situation, requirements and resources.

3. I would, therefore, urge you to issue directions to district authorities in your State/UT, to take all necessary measures, as advised by MoHFW in their letter, for the implementation of the containment framework, so as to flatten the curve. I would also advise that Orders issued by the respective State Governments/UT Administrations/district authorities, for imposing restrictions, should be widely disseminated to the public and to the field functionaries for their effective

With regards,

yours sincerely,

(Ajay Bhalla)

Enel, as above

Administrators of all UTs

Annexure to  Ministry of Health  85 Family Welfare  (MoHFW)  DO  no.
Z.28015/85/2021-DM Cell dated 25th April 2021

Annexure – A

Implementation Framework for community containment/large containment areas

Understanding the virus transmission dynamics:

The virus transmits through the human host. It is imperative to understand that in order to contain the transmission of the virus, the strategies involve not just containing the virus but also the human host.

Broadly, the strategies are:

1. Individual actions such as wearing of masks, maintaining a distance of 6 feet from others, sanitizing one’s hands frequently and not attending any mass gathering; and

2. Public Health measures to contain the virus by:

  • quarantining and testing individuals suspected to be positive including contacts of SARS-CoV-2 positive persons, SARI cases, persons with flu like symptoms and ensuring that they are not mobile and thus able to spread the infection
  • isolating all those who are positive, tracing their contacts, quarantining and testing
  • where there are clusters of cases, simply quarantining individuals or families will not In that case, containment zones with clear boundaries and stringent controls will be required to ensure that the infection does not spread outside. This is in line with the containment strategy followed worldwide and also already enumerated in SOPs of the Ministry of Health. This would mean a large geographical area like a city or district or well defined parts thereof, where cases are high and spiraling up, gets contained physically, However, regulated movement of public transport would be permitted.

3. Evidence Based Decision: The decision on where and when to go for large Containment Zone (CZ) has to be evidence based and done at the State/UT level after proper analysis of the situation, such as; the population affected, the geographical spread, the hospital infrastructure, manpower, the ease of enforcing boundaries

4. However, in order to facilitate objective, transparent, and epidemiologicaily sound decision making, the following broad-based framework is provided to aid States UTs in selection of districts/areas:

s. No. Parameter Thresholds
1 Test positivity Test positivity of 10% or more in the last one

week

OR
2 Bed occupancy Bed occupancy of  more than 60% on either

oxygen supported or ICU beds

5. The areas requiring Intensive action and local containment connotes specific and well defined geographical units such as cities/town/part of the towns/district headquarters/semi-urban localities/municipal wards/panchayat areas etc.

6. The areas so identified for intensive action and local containment will primarily focus on the following strategic areas of intervention:

A. Containment

i. Focus will be on containment as a major approach to flatten the current curve of the

ii. Night curfew: Movement of individuals shall be strictly prohibited during night hours, except for essential activities. Local administration shall decide the duration of the night curfew hours and issue orders, in the entire area of their jurisdiction, under appropriate provisions of law, such as under Section 144 of CrPC, and ensure strict compliance.

iii. The spread of the infection has to be controlled through restricting the intermingling amongst people, the only known host for the COVID-19

iv. Social/ political / sports / entertainment / academic / cultural / religious / festival- related and other gathering and congregations shall be

v. Marriages (attended by up to 50 persons) and funerals/ last rites (attended by up to 20 persons) may be allowed.

vi. All shopping complexes, cinema halls, restaurants & bars, sports complexes, gym, spas, swimming pool and religious places should remain

vii. Essential services and activities such as healthcare services, police, fire, banks, electricity, water and sanitation, regulated movement of public transport including all incidental services and activities needed for a smooth functioning of these activities shall Such services shall continue in both public and private sector.

viii. Public transport (railways, metros, buses, cabs) to operate at a maximum capacity of 50%.

ix. There shall be no restrictions on inter-state and intra-state movement including transportation of essential goods.

x. All offices, both government and private, to function with a maximum staff strength of 50%.

xi. All industrial and scientific establishments, both government and private may be allowed subject to the workforce following physical distancing norms. They shall also be tested through RAT (in case of individuals identified with flu like symptoms) from time to time.

xii. The SOPs already issued by MoHFW, including training manuals for surveillance teams and supervisors are available on the website & must be

xiii. However, these are indicative activities, and States/ UTs should make a careful analysis of the local situation, areas to be covered, and probability of transmission and then take a decision.

xiv. The restrictions as above shall continue for a period of 14

xv. Before declaring a containment area, make a public announcement, outlining the rationale for the same and the kind of restrictions that will be in place (a leaflet in local language may be distributed highlighting the gravity of the situation and restrictions to be followed)

xvi. Community volunteers, civil society organizations, ex- servicemen, and members of the local NYK/NSS centers should be involved for sustainable management of containment activities, translating  the aforementioned leaflets and for encouraging people in the community for sustained behavior change as well as vaccination.

B. Testing and Surveillance

 Districts will continue with the strategy of ‘Test-Track-Treat-Vaccinate’ and implementation of Covid Appropriate Behavior across the district as the ongoing strategy for the management of COVID-19.

i. Ensure adequate testing and door to door case search in the area through adequate number of teams formed for such

ii. Plan for testing of all clinically resembling cases of Influenza like illness (ILI) & SARI through All symptomatic individuals turning out to be negative for SARS-CoV-2 infection with RAT need to be retested through RT PCR.

iii. Ensuring compliance of COVID Appropriate Behaviour aggressively both through creation of awareness through involvement of the community based organizations and through stringent regulatory

C. Clinical Management

i. Analysis to be undertaken with respect to requirement of health infrastructure so as to manage the present and projected cases (next one month) and necessary action initiated to ensure sufficient oxygen-supported beds, ICU beds, ventilators, ambulances including creation of makeshift hospitals, as Sufficient quarantine facilities shall also be re-activated.

ii. Leverage government, private health facilities including hospital facilities available with central ministries, railway coaches, temporary  field hospitals

iii. Ensure that people satisfying protocol for home isolation only are allowed under home Create a mechanism for their regular monitoring through Call Centres along with regular visit of surveillance teams to such houses.

iv. Provision of a customized kit for all patients under home isolation, including detailed dos and don’ts to be followed by

v. Specific monitoring shall be done for high risk cases and their timely shifting to the health Similarly, elderly and co-morbid contacts of positive cases shall be shifted to quarantine centres and monitored.

vi. Appoint senior district officials as In-charge for all Covid dedicated hospitals and create a mechanism for seamless shifting of patients (including home isolation cases) as per their symptom to the relevant

vii. Ensure availability of sufficient ambulances for such

viii. Coordinate availability of oxygen, other related logistics, drugs in collaboration with state officials and ensure their rational use.

ix. Oxygen therapy for the admitted cases shall follow the guidelines issued by Ministry of Health on the rational use of oxygen

x. Use of investigative drugs (Remdesivir / Tocilizumab ) shall also strictly follow the clinical management protocol/advisories issued by Ministry of Health.

xi. Facility wise cases and deaths shall be analyzed on daily basis by the Incident Commander/District Collector/Municipal Death- audit shall be undertaken for all deaths in the hospitals and in the community to provide supportive supervision to field staff/hospitals.

D. Vaccination

100% vaccination for the eligible age-groups shall be undertaken duly creating additional vaccination centres and optimal capacity utilization of existing Centres.

E. Community Engagement

i. Ensure adequate advance information to community, also highlighting the need for stringent containment actions so as to win their involvement and

ii. Provide enough time for people  movement for essential   requirements before announcing the large scale containment

iii. Take necessary actions to avoid misinformation & panic in the community.

iv. Involve local level  NGOs/CBOs/CSOs, Opinion Makers and subject experts to create a positive environment and for sustained dialogue with the community.

v. Create wide publicity on early warning signals and self-reporting so as to identify cases early and to prevent avoidable deaths among home isolation

vi. Give wide publicity on the mechanism whereby people can get themselves tested, details of available health facilities, requisitioning an am bulance etc (community based organizations should be encouraged to create WhatsApp groups for quick dissemination of information so that the individuals in need of prevention and/or care services do not suffer delay).

vii. Ensure that details of hospital beds and their vacancy status is made available on-line and also released to media on a daily basis.

viii. Details on availability of oxygen, drugs, vaccine and vaccination centres; including the guidelines related with use of Remdesivir/Tocilizumab etc. be also widely publicized so as to create confidence in the community.

ix. Community should be oriented about the feasibility of managing mild COVID-19 cases at home with appropriate monitoring of vital parameters such as temperature and oxygen saturation with the help of pulse

x. Need for COVID Appropriate Behaviour including regulatory framework for enforcement should be widely publicized.

xi. Build confidence in community duly highlighting the nature of disease, the fact that early identification helps in early recovery and more than 98% people recover to remove fear as well as stigma related with Covid-19. Involvement of civil society organizations to hold such orientations go a long way in this regard.

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