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The ministry’s “updated containment plan for large outbreaks COVID-19” said a large outbreak is defined as a localised increase in the incidence of a coronavirus case occurring within a defined geographic area, for example, in a village, town, or city.
This could also imply progression of a small cluster, earlier noticed for which cluster management action is under implementation, into multiple clusters, the health ministry document said, noting that the cases may or may not be epidemiologically linked.
“For operational purposes, as a working definition a large outbreak is deemed to be present when there are 15 or more cases,” it said.
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In simple terms, it is a barrier erected around the focus of infection.
“Geographic quarantine shall be applicable to such areas reporting large outbreak and/or multiple clusters of COVID-19 spread over multiple blocks of one or more districts that are contiguous based on the distribution of cases and contacts,” the ministry document said.
Noting that the current geographic distribution of COVID-19 mimics the distribution of H1N1 pandemic influenza, the document said this suggests that while the spread of COVID-19 in India’s population could be high, it’s unlikely that it will be uniformly affecting all parts of the country.
This calls for a differential approach to different regions of the country while mounting a strong containment effort in hotspots, it said.
“Large scale measures to contain COVID-19 over large territories have been tried in China. Mathematical modelling studies have suggested that containment might be possible, especially when other public health interventions are combined with an effective social distancing strategy,” it said.
The document, however, said a number of variables determine the success of the containment operations through geographic quarantine such as number and size of clusters, the effectiveness of geographic quarantine, how efficiently the virus is transmitting in the Indian population, taking into account environmental factors like temperature and humidity, public health response in terms of active case finding, testing of a large number of cases, immediate isolation of suspect and confirmed cases and quarantine of contacts.
Geographical characteristics of the area, population density and their movement, ability to ensure basic infrastructure and essential services, and action plan for geographic quarantine for large outbreak also determine the success of geographic quarantine.
“The states should review the existing legal instruments to implement the containment plan,” it said.
The boundary for geographic quarantine will be defined based on mapping of cases and contacts, geographical dispersion of cases and contacts’ area having well-demarcated perimeter and enforceability of perimeter control.
Once the containment zone is delineated, the perimeter will be defined and there would be strict perimeter control with the establishment of clear entry and exit points, no movement to be allowed except for medical emergencies and essential goods and services, no unchecked influx of population to be allowed and people transiting to be recorded and followed through Integrated Disease Surveillance Programme (IDSP).
Activities in the containment zones would include active search for cases through the physical house to house surveillance by special teams formed for the purpose.
“Also, there should be testing of all cases as per sampling guidelines, contact tracing, identification of local community volunteers to help in surveillance, contact tracing and risk communication,” the document said.
“Extensive inter-personal and community-based communication, strict enforcement of social distancing, advocacy on hand hygiene, respiratory hygiene, environmental sanitation, and wearing masks or face covers and clinical management of all confirmed cases shall be carried out,” the document said.
The residential areas will be divided into sectors for ASHAs/ Anganwadi workers/ANMs each covering 100 households (50 households in difficult areas), it said.
An additional workforce would be mobilised from neighbouring districts (except buffer zone) to cover all the households in the containment zone, the document on containment plan for large outbreaks said.
The health ministry document also talks about the discharge policy for suspected cases of COVID-19 tested negative will be based on the clinical assessment of the treating physician.
On dead body management, the document said the dead body of a COVID-19 patient does not spread infection.
“The healthcare worker, however, handling the body immediately after death is at risk in case there is exposure to bodily fluids and shall be protected,” it said.