Amid the massive surge in Covid-19 infections in the country, the Centre on Sunday wrote to Maharashtra, Chhattisgarh and Punjab over reports submitted by Central health teams regarding Covid-19 testing and containment operations, hospital infrastructure and vaccination to contain the virus spread.
In the letters addressed to the three states, Union Health Secretary Rajesh Bhushan noted that a brief summary of key performance indicators related to testing, hospital infrastructure and vaccination, as reported by the health teams, has been shared and asked state or district administrations to take appropriate corrective measures.
30 Central teams were deployed to the worst-affected districts in Maharashtra. After feedback from them, Bhushan pointed out that containment operations were suboptimal in Satara, Sangli and Aurangabad, with less than satisfactory perimeter control and a lack of active surveillance for influenza-like illness (lLl) cases.
“Efforts at surveillance and contact tracing were
found to be sub-optimal in Buldhana, Satara, Aurangabad and Nanded, mostly due to limited manpower engaged in this task. The team from Bhandara has reported that most cases are being reported from outside of containment zones. This requires increasing the areas of containment zones or notifying new containment zones,” the health secretary stated.
Feedback on the testing capacity in Satara, Bhandara, Palghar, Amrawati, Jalna and Latur districts is that it is already overwhelmed, resulting in delay in reporting of test results. The Central teams from Nanded and Buldana have reported a very skewed RT-PCR/RAT ratio. Community resistance to Covid-19 testing has also been reported from Bhandara district, Bhushan observed.
“ln Bhandara and Satara, a large percentage of Covid-19 patients are under home isolation, which requires rigorous follow up to minimize mortality. Such follow up is not happening presently. It was also observed that delayed reporting by patients to definitive treatment centres in Satara district is leading to a large number of deaths within the first 72 hours of hospital admission,” the letter further noted.
The Central team also highlighted that occupancy rates of available hospital beds are very high in Ahmednagar, Aurangabad, Nagpur and Nandurbar.
“Team to Aurangabad reported dependency of the district on neighbouring districts for management of critical patients and critical care infrastructure upgradation thereon. Medical oxygen supply was found to be an issue in Bhandara, Palghar, Osmanabad and Pune. Malfunctioning ventilators have been reported by teams from Satara and Latur. Hospital-level and district-level oxygen planning must start without any delay, as per the guidance issued by this Ministry,” the letter added.
An acute shortage of healthcare workforce has also been reported by the teams from Aurangabad, Nandurbar, Yawatmal, Satara, Palghar, Jalgoan and Jalna. The rostering of healthcare workers and hiring of contractual health workers need to be expedited as well. The letter also noted that data management in Satara and Ahmednagar is facing issues due to a shortage of manpower.
“Adherence to Covid-appropriate behaviour was found to be lacking by almost all Central teams that visited the districts. This would require greater enforcement effort,” the letter stated.
Meanwhile, in the letter to the Government of Chhattisgarh, Rajesh Bhushan noted that containment zones are not strictly observed and RT-PCR tests are also decreasing.
“The team from Raipur, Jashpur has reported a lack of perimeter control in containment zones. There appears to be no restriction on movement of people inside containment zones too. Hence, containment zone including micro containment zones need to be strictly implemented,” the letter said,
“Contact tracing efforts need to be reinforced in Korba. Resistance (even attacks on healthcare workers) to containment activities and testing was reported by the team from Dhaneli Village, Raipur. This needs to be addressed on an urgent basis,” Bhushan added.
Highlighting the low testing rate in the districts of Chattisgarh, the letter further read, “A lack/shortage of RT-PCR testing facilities in Korba, Durg, Balod districts is leading to increased testing turnaround time. Similarly, limited RT-PCR testing capacity was alsoreported from Balod. State may facilitate RT-PCR testing by exploring the use of mobile testing labs.”
According to feedback received from the Central teams, patient referral in Durg is being hampered by the unavailability of an adequate number of ambulances and it needs to be strengthened without any delay.
Bhushan also noted that hospital bed occupancy rates are high in Balod, Raipur, Durg and Mahasamund. “The district administration needs to ramp up hospital infrastructure and other logistical requirements to meet any demand arising due to surge in cases. Similarly, shortage ofRemdesivir, Low Molecular Weight Heparin needs urgent attention in Korba,” Union Health Secretary added.
The feedback also highlighted limited availability of oxygen and oxygen wastage in Raipur. “District-level and hospital-level oxygen planning must start in all districts, as per the formal guidance of this Ministry,” the letter suggested.
Further, a shortage in workforce was reported in Durg, Jashpur and Rajnandangaon. The letter advised that rostering for healthcare workers and contractual appointments be explored in Chhattisgarh too.
Bhushan also said that there is a need for refresher training of surveillance teams and vaccinators in Balod and Korba, respectively.
“The teams have also reported non-adherence to Covid-19 appropriate behaviour by the public. Overcrowding and no physical distancing was observed in the vaccination centre visited by the team in Rajnandangaon. There is a need for enhancing IEC activity efforts in Durg district and strengthening enforcement effort across all districts,” observed the letter.
The Health Ministry deployed Central teams to 11 of the most-affected districts in Chhattisgarh. They were tasked to work along with District Health Authorities on Covid-19 preparedness and response, with a focus on testing, contact tracing and containment operations, Covid-appropriate behaviour and its enforcement, hospital infrastructure and the availability of logistics, and vaccinations.
Finally, in Punjab, the Ministry noted that there is a need to enhance focus on contact tracing in Patiala and Ludhiana. Contact tracing and surveillance in SAS Nagar are being hampered due to shortage of manpower and additional workforce must be deployed, Bhushan said in his letter to the Punjab health secretary.
Feedback from the northern state showed that there is no dedicated Covid hospital in SAS Nagar and Rupnagar, and patients are being referred to neighbouring districts or Chandigarh. Low rates of testing were reported from Patiala and the unavailability of RT-PCR testing labs in Rupnagar. These need to be addressed, said the letter from the Centre.
Hospital bed occupancy rates in some districts are high and arrangements must be made by authorities to deal with the surge in cases, the letter suggested. The Central teams also reported issues with the procurement of ventilators in SBS Nagar and less than optimum use of ventilators in Rupnagar due to a workforce shortage. A shortage in workforce was reported in Patiala and SAS Nagar. The Centre’s letter said that contractual hiring of health workers can address the problem.
Further, it said that Patiala and Ludhiana have reported a slow pace of vaccination among people above 45 years with co-morbidities and those above 60 years.
The Union Ministry of Health and Family Welfare has been actively engaging with states in coordinating and collaborating preparedness and response to Covid-19, said all the letters, adding that the Centre has taken note of issues related to vaccine availability in the states, and required action to augment supplies will be taken based on available stock.
WITH AGENCY INPUTS