The ministry of Health and Family Welfare has chalked out an aggressive containment plan that will only be scaled down if no secondary laboratory confirmed COVID-19 case is reported from the geographic quarantine zone for at least four weeks after the last confirmed test has been isolated and all his contacts have been followed up for 28 days.
“The containment operation shall be deemed to be over 28 days from the discharge of the last confirmed case (following negative tests as per discharge policy) from the designated health facility i.e. when the follow up of hospital contacts will be complete,” said a 20 page strategy document.
According to the Health Ministry, 211 districts are now reporting COVID-19 cases and the risk of further spread remains very high, said the document.
India would be following a scenario based approach according to which containment for large outbreaks will be done through geographic quarantine strategy. The objective of this plan is to stop the chain of transmission thus reducing the morbidity and mortality due to COVID-19.
The Cluster Containment Strategy would be to contain the disease within a defined geographical area by early detection of cases, breaking the chain of transmission and thus preventing its spread to new areas.
Geographic quarantine shall be applicable to such areas reporting large outbreak or multiple clusters of COVID-19 spread over multiple blocks of one or more districts that are contiguous. This strategy calls for near absolute interruption of movement of people to and from a relatively large defined geographic area where there is single large outbreak.
However, if the containment plan is not able to contain the outbreak and large numbers of cases start appearing, then a decision will need to be taken by the State administration to abandon the containment plan and start on mitigation activities.
The document also gave the evidence for implementing geographic quarantine. “In 2009, during the H1N1 Influenza pandemic it was observed that well connected big cities with substantive population movement were reporting large number of cases, whereas rural areas and smaller towns with low population densities and relatively poor road, rail and airway connectivity were reporting only few cases. The current geographic distribution of COVID-19 mimics the distribution of H1N1 Pandemic Influenza,” said the document.
The government has therefore suggested that it is unlikely the spread of COVID-19 will be uniformly affecting all parts of the country. This calls for differential approach to different regions of the country, while mounting a strong containment effort in hotspots.