India’s stringent measures to contain the COVID-19 outbreak are being carefully orchestrated by the Ministry of Health & Family Welfare. A plan for containment of local transmission has now been put in place, as the entire nation stays under lockdown.

On March 29th, 2020, India recorded 1000 cases of COVID-19, an infection that originated in China’s Hubei province late last year, and has now claimed over 38,000 lives.

Prime Minister of India Narendra Modi announced that the country would go into a complete and total lockdown for a period of 21 days, starting midnight of March 25th. Soon after, India’s Ministry of Health & Family Welfare (MoHFW) released a document that outlines a micro plan to contain local transmission of COVID-19.

Behind the scenes, the MoHFW has been strategising the country’s response to COVID-19. A cluster containment plan has been in place since late-February. However, as disease transmission evidently enters phase 2 – local transmission – the MoHFW has released a micro plan to stimulate the containment at this stage.

HealthLEADS breaks down the 26-page document for you.

The “Micro Plan for Containing Local Transmission of COVID-19” aims at containing the outbreak in a “defined geographic area”.

Table of Contents

The Mapping

Each confirmed case is to be considered as an epicenter, and a containment zone will be decided upon by the Rapid Response Team (RRT), based on the extent of cases/contacts listed and mapped.

However, if the RRT’s mapping takes more than 12 hours, an arbitrary zone of 3 km radius will be created around the epicenter. On top of this, an additional 5 km buffer zone will be created. For rural setups, the buffer zone is 7 km.

The RRT’s mapping will serve to refine this arbitrary zone.

The containment zone will be divided into sectors, each having up to 50 houses or 30 houses in difficult areas. Containment activities will be facilitated in each of these sectors.

The Manpower

The plan allocates the personnel and responsibilities for containment, broadly as administrative & field operations.

District Magistrates (DM) or District Collectors will serve as the nodal persons for containment within their respective districts. The nodal officer will constitute a Control Room with a contact number.

Rapid Response Teams are to be formulated at state and district levels. Various functionary arms are made operational for the field activities involved in the containment activities.

Teams of ASHA/AHM/Anganwadi workers will be engaged in daily house visits in each sector to search clinically suspect cases. Contacts of cases and suspects will also be identified, monitored and kept a record of. These workers are also tasked with ensuring that contacts are on home quarantine, and use a 3 layered surgical mask at all times.

In the event of a human resource constraint in the engagement of the aforementioned workers, the Indian Red Cross Society, NDRF, Civil Defense, NCC, and NSS will duly engage volunteers.

The Lady Health Visitors (LHV) shall undertake supervisory roles at the block/village level covering the epicenter, with daily visits to each sector. These supervisors are to report in real-time, any person showing symptoms of COVID-19.

Block extension educators and communication staff will coordinate public information, education and communication campaigns.

A supervisory officer would oversee the fieldwork, verify suspect cases, arrange shifting of cases to health facilities, and report it all to the control room. A DM-designate or the block level manager of the National Health Mission will coordinate the finances and information management within the containment zone.

The Action Plan

The plan comes with a two-component surveillance approach.

The ‘active surveillance’ will include house-to-house coverage, identifying suspect cases, if any, counseling households on basic precautions, hygiene, etc.

For ‘passive’ surveillance, all health facilities in the containment and buffer zones will be listed. All such facilities both in Government and Private sector (including clinics) are to report clinically suspect cases of COVID-19 to the identified supervisory officer for that sector. Clinically suspect COVID-19 cases identified by these facilities are to be reported to the supervisory officers.

The contacts of the cases and suspects will be traced and listed. The network of officers across sectors, zones and jurisdictions will be informed to ensure the contact(s) are brought under a mandatory 28-day quarantine.

The Supervisory officer in whose jurisdiction the case or suspect falls shall inform the Control Room about all the contacts and their residential addresses. The control room will, in turn, inform the supervisory officers of concerned sectors for surveillance of the contacts.

The Healthcare Support

The nearest ICMR-approved laboratory will be identified by the microbiologist in the RRT. The doctors manning the epicenter isolation facility shall be responsible for sample collection, packaging, and transportation.

The Physician in the RRT will identify the nearest hospital best suited for isolation, ventilator management, critical care management, and salvage therapy.

Ambulances are to be earmarked for transfer of patients, drivers of which will be trained in infection prevention and control practices.

In addition to complete PPE kits, a log will be maintained for N-95 masks, triple-layer surgical masks, gloves, and biohazard bags. RRT members will train identified field functionaries in the use of equipment.

It all hinges on…

The plan promises to cover all aspects and provide multi-faceted support in the form of equipment, infrastructure, and treatment. But much of its success relies on the plan’s execution and reliability of the resources promised.

A widespread local transmission will need this plan to take action quickly. The training and preparations involved are challenges the government will need to steamroll over. It is likely that every last rupee of the ₹15,000 crores sanctioned for emergency support will be needed.