Delhi:Prepare for 1 5k daily Covid cases in city this winter: Panel

AlokKNMishra

New Delhi: The expert committee on Covid-19 headed by Dr V K Paul has raised a red flag on big congregations this festival season, warning that the city should prepare for a daily surge of 15,000 positive cases this winter. It has pointed out the winter months aggravate respiratory ailments and there could also be an increase in the number of patients from outside Delhi.

The committee has advised against allowing large gatherings. “It has been seen that Onam in Kerala and Ganesh Chaturthi in Maharashtra escalated the pandemic seriously. This must not be allowed to happen in Delhi. Our emerging gains in reduction in cases will be reversed because of these festivities and rush in markets and localities,” said the committee in its report submitted to the Delhi Disaster Management Authority on Tuesday. It suggested that such events should be very low-key affairs, essentially centred around family celebrations.

The committee had been asked to prepare a revised Covid-19 management plan which will now help the government fine-tune its strategy.
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Delhi should prepare for a daily surge of 15,000 positive cases and make arrangements for in-patient admissions with moderate and severe disease amounting to roughly 20% of this surge," the committee recommended. The report added that guidelines for ICU, non-ICU and Covid care isolation beds would be made available to the government.

Underlining that the next three months would be critical, the panel has recommended revamping the strategy on containment zones with focus on creation of micro containment zones and prescribed limited RT-PCR tests on symptomatic individuals and limited contact tracing to fill the gaps. Identification of workplace clusters for risk assessment; surveillance driven testing; scaling up of critical care facilities and their optimum utilisation; launching of massive awareness campaigns in the wake of the upcoming festival season; and reducing deaths among healthcare workers are some of the other key recommendations.

Underlining that the overall case fatality rate in Delhi is 1.9%, which is higher than the national average of 1.5%, the committee has advised that the focus should be on reducing mortality. Delhi had reported 5,616 deaths till Wednesday. "The higher mortality in the comorbid (66.6%) and elderly is inevitable and reported all over states and globally. However, (a matter of) concern is the reported mortality in under-15

(1.5%) and 16-44 age-groups (17%)… (This) could be prevented by promoting early recognition of symptoms, timely testing and increased awareness in the younger population to adopt Covid appropriate behaviour," the committee has observed. It has advised a regular death audit and review of Covid and non-Covid mortalities.
The panel has suggested that there should be greater focus on vulnerable patients like the elderly and those with co-morbidities; periodic review of the triage facilities should be undertaken; focused efforts should be made for timely referral of patients from lower to higher facilities or from home isolation; and a review of the ambulance system should be undertaken.

Taking note of the extensive increase in the number of Covid tests in Delhi, the committee has observed that the positivity rate is consistently declining. At present, more than 80% tests are the rapid antigen ones with even 90-95% in a few districts. Currently test positivity is 4.3% by RAT and 20.3% by RTPCR (as on September 24). Testing in the containment zones and testing of contacts of positive patients and symptomatic people have been very limited — up to 20% of the total.
The committee has recommended testing for all high-risk contacts (irrespective of symptoms), symptomatic contacts, influenza-like illness patients, elderly and those suffering from co-morbidities in containment zones between the 5th and 10th day since the last contact if asymptomatic or as soon as symptoms begin to appear. It has asked authorities to use RAT for containment zones and symptomatic healthcare workers and RT-PCR for health facilities and retesting of all RATnegative symptomatic persons.

Testing should not be target driven but guided by surveillance in containment zones, the committee has advised, adding that merely increasing the number of tests to reduce the positivity rate would not be appropriate.

Observing that contact tracing in Delhi has been very limited since the beginning and contacts traced per positive case on an average have remained in the range of 7 to 10, the committee has advised tracing of immediate family contacts, neighbourhood contacts and close workplace contacts of positive cases and testing.
It has called for micro containment zones and home isolation in planned colonies, big apartments and RWA-governed localities and formation of new containment zones only in highly dense areas like resettlement colonies, JJ clusters or slums. It underlined the need for enlisting of high-risk groups and houseto-house search to detect all suspected cases within three days and strict perimeter control in rural areas. In many of the 11districts, the authorities are already creating micro containment zones. In fact, at many places, single houses have been converted into containment zones.

The committee also observed that the containment strategy adopted at the beginning (large containment zones) and the measures taken inside the containment zones have been fairly successful in limiting the number of cases.

The government will implement the committee’s recommendations and all districts have been asked to take measures suggested in the report.