TAC wants ban on public New Year celebrations from Dec 26 to Jan 1, night curfew (8 pm to 5 am) during this period, jail time for mask violators
Govt yet to decide on proposed strictures, says Health Commissioner Pankaj Kumar Pandey
After bringing down the daily Covid-19 infections to below 1,000 on November 30, nearly 10 months after the first cases were reported, the Karnataka government expects a second wave to hit the state in around January and February next year.
While the Covid-19 Technical Advisory Committee’s report of November 30 is yet to be formally accepted by the government, the panel has recommended various strict measures to be followed till February-end 2021.
The committee’s 8-page report said the second wave was identified and the regulators should take steps. Meanwhile, Health and Family Welfare Department Commissioner Pankaj Kumar Pandey told theBengaluruLive that it was a draft report which is yet to be accepted by the state government. “It’s only a draft report of the TAC. The government has still to decide,” he said.
TAC member and Covid-19 state nodal officer Dr CN Manjunath said that the virus has made its second appearance in the US, Europe and Australia, and has recurred in Delhi. He said a second wave in the state was expected in January and February.
Another TAC member, Dr Giridhar Babu, said at least 1.25 lakh Covid tests should be conducted daily till February 2021.
Findings of the report
1. An early recognition of the second wave of Covid-19 in the state can be done by closely monitoring the 7-day average growth rate and reproduction number (R0) at the district and state levels.
2. The second wave is expected during January-February 2021.
3. An epidemic intelligence team should support the state war room for early recognition of the second wave and alerting the Additional Chief Secretary-HFW and the Commissioner-HFW.
4. A minimum of 1.25 lakh tests per day should continue till the end of February 2021, of which 1 lakh shall be RT-PCR ( 1:5 pooled in lab as per state protocol)
5. Fortnightly testing of all teachers, pupils and staff in educational institutions, Anganwadi staff and others by RT-PCR (by 1:5 pooling of samples in lab)
6. Keep ready by the first week of January the clinical facilities at an October 2020 level in terms of beds, ICUs, ICU ventilators, etc., both in government and private hospitals, including ambulance services, or this could be ramped up at short notice of a mazimum 2-3 days.
7. Explore CCCs to be run on a PPP model with reputed NGOs for better facilities, services and care
8. After carefully assessing the Covid-19 situation in the last week of December, graded opening of schools from January may be considered, i.e., classes 12 and 10 to commence initially from January and classes 11 and 9 to follow later.
9. Restrictions on mass gatherings likes fairs and festivals, religious congregations, cultural events, etc. Strictly restrict super-spreader events during December and January (winter months). Permit events only in open areas like marriages, etc. for up to 100 persons; political and public events for up to 200; death ceremonies for up to 50; funerals for up to 20.
10. Ban New Year public celebrations from Dec 26 to Jan 1 and impose night curfew (8 pm to 5 am) during this period.
11. Expedite preparedness for Covid-19 vaccine introduction both in public and private sectors.
12. Rope in popular cine and sports personalities to promote messages of mask wearing and use of sanitizer, hand washing, etc.
13. Further unlocks like swimming pools, sports, etc., to be delayed till February 2021.
14. Identify and implement best practices of Covid-19 containment from other states
The first case of Covid-19 (imported from the US) was reported on March 8, 2020 in Bengaluru and in the last 9 months a total of 8.74 lakh cases and 11,678 deaths have occurred. In the months of July to September there was a sudden surge in cases that was largely attributed to large-scale migration of people consequent to lifting the lockdown. The daily incidence of cases was more than 10,000 cases during September, which has now come down to around 1,500 cases. In February 2020, there were 2 labs which have been expanded to 164 labs in November. Presently, on an average, over 1 lakh tests are done every day, of which more than 75% is RT-PCR and the rest RAT. The test positivity rate was around 14% in August and has now drastically come down to 1.6% — largely due to various containment measures.
The state has duly complied with the unlock guidelines of the Centre, and colleges are now open from November 17 while schools are planned to be opened at a later date. The state has 36 dedicated Covid hospitals (DCH), 174 dedicated Covid health centres (DCHC) and 628 private hospitals for Covid-19 care. There are 22,602 beds, 11,452 central oxygenated beds, and 1,902 ICUs with ventilators, both in government and private hospitals. The state has established a war room at the state level and at BBMP that provide necessary technological support to management of Covid. Various expert committees have been constituted at the state and district levels to address clinical and public health issues. The state has been very supportive in extending free treatment and diagnosis for Covid-19 to all. The state has roped in the private sector, corporate sector, philanthropists, NGOs and others for participation in the containment of Covid-19.
There has been a second wave of Covid-19 in the US, Europe, Australia and other countries. Recently, there has been a surge in cases in Delhi, Haryana, Gujarat, Madhya Pradesh, West Bengal and Kerala that has been a cause for concern in other states. In this context, as Karnataka has significantly controlled Covid-19 and there is a steep decline in the number of cases it is now considered important for the state to prepare for a possible second wave of Covid-19. Consequently, TAC considered it important to provide an advisory to the government for effective management of a second wave.
In the above context, TAC deliberated on the subject on the following lines:
• Epidemiological criteria
• Hospital/clinical facilities including CCCs, home isolation/home care, etc.
• Public health response
• Participation of private, corporate, NGOs, charity institutions, etc.
• Covid-19 vaccine
• Other considerations
What is the second wave?
The second wave of a virus typically refers to a resurgence of a viral infection, in an area where the transmission decreased to below the outbreak potential but now is continually increasing over a certain period. Besides, it is an occurrence of cases in similar proportions or more than the first wave. There needs to be a period (ordinarily, the longest incubation period) of low transmissibility between the first and second wave.
How to recognize second wave?
• For easy calculation, 7 days’ Average Growth Rate shall be used as an indicator.
• Occurrence of cases clearly in excess of normal expectancy, i.e., Test Positivity Rate doubled in a week subject to no changes in testing pattern, plus hospitalizations doubled in the corresponding seven consecutive days.
• First wave should have been contained, i.e. Ro below 1.5
• Low rate of infection has been sustained for at least 1 month
• It is increasing steadily over last 2-3 weeks
• a second wave is when the cases are increasing steadily after crossing the basic reproduction rate R0 >1.5
When is it anticipated?
• Usually three to four months after the first spike/wave; i.e. January-February 2021. This is due to winter, unlock in progress, weak enforcements, population movements, etc.
• An epidemic intelligence team shall support the state war room for early recognition of the second wave and alerting the Additional Chief Secretary-HFW and Commissioner-HFW.
• Minimum of 1.25 lakh tests per day should continue till the end of February 2021- of which 1 lakh shall be RT-PCR ( 1:5 pooled in lab as per state protocol)
• Continue with aggressive contact testing (1 case to 20 contacts); compulsory testing of all SARI and ILI cases
• Fortnightly testing of all teachers, pupils and staff in educational institutions, Anganwadi
staff and others by RT-PCR (by 1:5 pooling of samples in lab. )
• Expedite procurement of newer testing kits that are economical and easier to perform
– To keep ready by January 1st week (or ramped up at a short notice of 2-3 days) the clinical facilities as on October 2020 levels in terms of beds, ICUs, ICU ventilators, etc. both in govt and private hospitals, including ambulance services. Reinforce IPC strategies through training and monitoring to limit transmission in healthcare settings
• COVID Care Centre (CCC)
– To run on PPP model with reputed NGOs for better facilities, services, and care
– There shall be an inbuilt plan for quick ramp up of CCC beds to meet the surge in demand.
There shall be one readied CCC at every district/ taluk level.
• Home isolation
– Better triaging and timely shifting to hospitals
– To run on PPP model with reputed NGOs
Public health response
The TAC makes the following recommendations for the state to largely reduce the disease burden and prevent mortality.
• Enforce mask wearing – More marshals/police to fine mask violators in busy areas like
markets, bus stops, commercial areas, in buses, at traffic junctions, etc. Consider introducing tough actions like simple imprisonment of a few hours for mask violators as done in Madhya Pradesh.
• After carefully assessing the Covid-19 situation in the last week of December, graded opening of schools from January may be considered, i.e. classes 12 & 10 to commence initially from January and classes 11 and 9 to follow later on. Note: The month of December shall be used for revising curricula, planning examinations and
preparing classrooms for Covid-19 compliance; providing hot water, procuring masks, disinfectants, sanitizers, etc., hostel rooms, bath & toilets ; food mess, etc.
In the meantime, the effect of opening of colleges from November 17 will be known for planning further in this regard.
• Restriction of mass gatherings like fairs and festivals, religious congregations, cultural events, etc.
• Strictly restrict super spreader events during December and January (winter months) – like holding events like marriages only in open areas for up to 100 guests; political and public events up to 200 ; death ceremonies 50, and funerals 20.
• Ban New Year public celebrations from Dec 26 to Jan 1 in resorts, hotels, on roads (MG Road, Brigade Road in Bengaluru, etc. and impose night curfew (8 pm to 5 am) during this period.
• Strengthen contact tracing, community-based active surveillance, ILI and SARI surveillance, surveillance in prisons, long-term care facilities, educational institutions, offices, etc.
• Re-orientation of surveillance staff to contact tracing
• Conduct cluster investigations in high-risk settings like urban slums, marriages, closed spaces, etc. Participation of private, corporate, NGOs, charity institutions, etc.
• A meeting of reputed NGOs and philanthropists shall be convened soon to explore the ways and means for their further participation in Covid-19 control
• Should be engaged in mission mode to support the government’s efforts
• Further unlocks like swimming pools, sports, etc. to be delayed till February 2021
• Identify and implement best practices of Covid-19 containment from other states
• If and when the second wave comes, we should have all departments of government involved as was done previously and focus on surveillance, contact tracing, patient admissions, earmarking of beds in private hospitals, masks and physical distancing.