New Delhi: A report jointly prepared by the National Centre for Disease Control (NCDC), Union ministry of health and family welfare (MoH&FW), the Delhi government, Indian Council of Medical Research (ICMR) and NITI Aayog has stated that a door-to-door survey to identify those with symptoms of Covid-19 may not be “suitable for Delhi at this juncture”. HT has seen the report.
As per the directive issued by the Ministry of Home Affairs (MHA) on June 29, district administrations were directed to complete door-to-door survey in all the 445 containment zones of Delhi by July 6. This was to be followed by a similar survey across the city.
But now, the second part of the survey, which meant covering more than 40 lakh households in Delhi, is likely to be tweaked to cover more specific geographic and demographic areas based on the emergence of Covid-19 cases, officials privy to the development said.
The report says that while an extensive survey may help in early identification of symptomatic and high-risk individuals, it could also adversely impact contact tracing. Instead, it suggests a modified approach for survey by classifying the localities into containment zones, areas with isolated cased and areas which are yet to report any cases or “free areas”.
“Conducting such an extensive survey may help in early identification of people with influenza like illness (ILI) and severe acute respiratory illness (SARI). It could also identify the high-risk individuals including senior citizens, pregnant women and malnourished children in the city…But the ongoing survey in containment zones already covers most of the population, and that such a survey could adversely impact contact tracing,” the report dated July 1 states.
The report also says that a one-time survey may not be “beneficial” because ILI and SARI symptoms may appear any time. It says that a large population living in the containment zones in Delhi are already part of an intense surveillance programme, which has included all cluster cases that account for 43% of all cases.
“There are also practical difficulties with the ongoing intense surveillance work. This (such a survey) may also hamper proper contact tracing in the high-risk areas or containment zones across the city or district or state,” the report states.
It said that more than 2,000 new cases and on an average 50-100 deaths per day are being reported daily in Delhi. “Although efforts are being undertaken by the state government and other relevant agencies for containment, numbers of new cases are still increasing daily,” it added.
Senior government officials on Saturday said a modified approach to surveillance, including the door-to-door survey, is currently under “active consideration” of the Centre’s expert committee led by Niti Aayog member Dr VK Paul.
While the MHA did not respond to text queries sent by HT , calls and messages sent to the media advisor to chief minister Arvind Kejriwal went unanswered.
Enhance surveillance
As part of the modified approach, all districts have been advised to enhance surveillance in containment zones with strict perimeter control.
“All districts have been asked to strengthen house-to-house surveys by immediate personal, not telephonic, visits. In buffer zones, apart from the ongoing drill of the same survey, SARI and ILI surveys have to be conducted in all private and government health facilities as well, including OPDs,” said a senior official in the health department.
In areas with isolated cases, the district surveillance officers (DSOs) have been asked to review localities which have been regularly reporting cases for over 14 days by mapping of cases in terms of time and geographic location. Epidemiological situation analysis and tracking the transmission chains will also have to be done by the districts in this case.
Until July 4, Delhi reported 97,200 cases and 3,004 deaths (accounting for 26 deaths added to the cumulative number). There were 448 containment zones spread across all the eleven revenue districts of the city.
Rope in residents
In areas categorised as “free areas”, officers have been asked to focus on reducing morbidity and mortality among high-risk groups. Apart from this, special surveillance groups are to be formed across the city to ensure the rules of social distancing, wearing masks and disinfection are being followed.
The focus of these groups will be rickshaw/auto, taxi, goods carriage and lorry drivers, domestic helps, daily workers (plumbers, electricians, carpenters, etc) and daily suppliers of food, general stores and delivery persons, the report says.
“In housing colonies, all elderly and others with co-morbid conditions have to be listed by the districts. Entry of persons coming from affected areas should be avoided. And screening upon entry of everyone must be ensured. The RWAs have to ensure these aspects and stay in touch with district authorities,” a senior official in the revenue department said.
In villages, the report states that the same protocol is to be followed with the help of the sarpanch and by constituting Nigrani Samitis (surveillance committees), comprising locals.
Lalit Kant, a scientist and former head of epidemiology and communicable diseases at ICMR, said instead of house-to-house survey in entire Delhi which merely involves asking questions about any flu-like symptoms, high risk members in the family and possible contact with Covid-19 patients, the authorities should scale up serological survey across the city.
“The authorities should rather scale up antibody testing which basically is the serological survey. It will help determine who has antibodies and find out who has been infected with the virus. Even if someone never reported a positive test or experienced symptoms will be identified through this. So, the serological survey should be expanded further as it gives a sense of the extent of the virus in Delhi,” said Kant.
On Saturday, sample collection under the serological survey in Delhi was completed and the results of the antibody tests are expected in 2-3 days from the NCDC, senior government officials said.
The sero-surveillance study was jointly conducted by the NCDC and Delhi government in all the 11 districts of Delhi focusing on as many as 20,000 households on a random basis. Those who were tested also included individuals below 18 years of age.
