HCFI Dr KK Aggarwal Research Fund

5^th June, 2021, 11am-12pm

Key highlights of the discussion

• Covid cases in the country are showing a declining trend particularly in the northern states; the number of cases reported in the last 24 hours is around 1.2 lakh; deaths are still more than 3000. Positivity rate is 6.38% and the recovery rate is 93%.
• In Delhi, 523 new cases and 50 deaths were reported in the last 24 hours. The positivity rate is below 1% (0.68%) for the last 5 days. The recovery rate is 97.72%. Delhi has started unlocking in a phased manner.
• The MHA has issued an order on 27^th May extending the containment measures in high caseload districts (>10% positivity rate, ICU/oxygen supported beds >60%) across the country till 30^th June. States/UTs may consider any relaxation on appropriate time, in a graded manner, after assessing the local situation, requirements and resources. 
• While the basic objective remains that we should be safe, it is also important that reopening of economy has to take place keeping in mind the public health principles. It’s a balance between “lives vs livelihoods”.
• Maharashtra and South states like Tamil Nadu, Andhra Pradesh, Kerala and Karnataka still have high covid case load. Kerala has a positivity rate of 12.8%. 
• To reopen, we need to look at the states as a whole and also districts within the respective states. Population of the state, number of people vaccinated, positivity rate, status of testing, tracking & treating strategy are the factors to be considered before reopening.
• We have to unlock systematically, unlock with caution and exercising all Covid-appropriate behavior.  
• India has relaxed some requirements of vaccines clinical trials in India like bridging trials if vaccines are approved in other countries.
• Districts having more than 600 active cases will not be reopened. The vaccination coverage has to also simultaneously increase. Closely monitor the test positivity rate. 
• Maharashtra has a 5-level unlocking strategy on the basis of test positivity rate. Percentage of occupancy of oxygen beds is another criterion for grading the districts. Doubling rate, total number of cases and deaths, case fatality rates were the parameters that were desired, but government considered only two parameters.

• There has been a fall in the number of tests conducted; screening for testing had also gone down considerably. Testing more aggressively for screening at every place where economy has to be opened.
• Home-based care is being encouraged; family physicians have been sensitised and trained. 
• At the peak of the epidemic, the time for RT PCR reports had extended. Now with RNA extraction method, the time can be reduced to 4 hours. The home testing kits developed by MyLabs were launched yesterday by the CM Maharashtra. These tests have a sensitivity of almost 70% and specificity of 100%. There is a shortage of vaccines in the state.
• Home care is a double-edged tool; if red flag is not given in time, lives may be lost. The state of Maharashtra has recently passed an order that any district which does not adhere to home care isolation guidelines with the doctor giving the undertaking that the patient is not able to do it, there will be institutional quarantine.
• The ward officers followed an ATM strategy: Assess, triage and transfer and manage. If the patient’s family doctors could not given an undertaking that he could manage home care, the patient was moved to institutional care.

• Delta strain may show immune escape, single dose Covishield may not be sufficient. So, double masking, reduction of crowding and poorly ventilated environment, Covid-appropriate behaviors are here to stay.
• This time unlocking will be slower than the last time; there is also a fear of autolock.  Now local authorities have been empowered to take a decision on locking based on situation assessment.
• Spread of infection has been much faster in the rural areas  
• IIT-Kharagpur has come up with a low cost Covid testing kit called Covirap. It will give results in 45 minutes. It is a nucleic acid-based test done in a rapid format.
• As per a press briefing, the central government has described three criteria for unlocking; positivity rate below 5% for one week, vaccination of the vulnerable population (>60 years and >45 years with comorbid conditions) and Covid appropriate behavior.
• A survey has shown that 50% of population in the country is wearing masks; out of this, only 15% wear it correctly.
• ASHA and Anganwadi workers are an important part of home-based care. They survey for SARIs.
• Rural areas have structured health care system: Health & wellness centers, PHCs, CHCs and district hospitals.
• In rural areas, people may not comply with isolation. Rather than calling it isolation, it should be called infection prevention. This is important as more than 53% cases and >50% of deaths in the last 24 hours are from rural areas. This will be a challenge during unlocking.
• The government has now also asked to get all construction workers vaccinated at the building site.
• Isolation centers may be renamed as community welfare centers, which may be more acceptable. People in the rural areas should be taught the importance of double masking. The focus now should be on rural areas.
• People in the rural areas are unaware of the home testing kits, so it has to come to their homes. ASHA and anganwadi workers can be equipped with these kits towards this end. 
• Herd immunity will only come with vaccination. 
• People who have had Covid should be asked about what barriers they have faced in the health system.
• There is lot of role for volunteers as well as family members of people who have suffered from Covid. 
• The need of the hour is to contain; hence RATs should continue in rural areas and where there are no good labs. 
• The pandemic has pushed 30% of population below the poverty line.
• Not wearing a mask or maintaining social distancing should be made a criminal offence along with a huge fine.
• As we unlock from the second wave, we must simultaneously prepare for the third wave, which may or may not come. Preventing the third wave should be the slogan for the next year. 
• Vaccination will be completed in one year. So we should have a plan for unlocking for one year and not short-term.
• Weekly tests per million populations should also be considered along with the test positivity rate.
• Covid-appropriate behavior should be studied and data regarding this should be published.
• Mask specifications and quality are very important.

Participants

Dr AK Agarwal, Dr Suneela Garg, Dr Mahesh Verma, Dr Shashank Joshi, Dr Anita Chakravarti, Dr Ashok Gupta, Dr Alex Thomas, Dr Jayakrishnan Alapet, Mr Bejon Misra, Mr Vivek Kumar, Mrs Upasana Arora, Dr KK Kalra, Ms Ira Gupta, Dr S Sharma