New Delhi: Union Health Secretary Rajesh Bhushan has asked Maharashtra to bring down the state’s test positivity rate, and step up contact-tracing and vaccinations. He has also called for preparing the state’s health system for a worst-case scenario in the coming months.
The country’s top health official has also asked Punjab to accelerate Covid-19 vaccinations amid concerns over the high death rate in the state.
Bhushan has flagged these issues in three strongly-worded letters — two to Maharashtra Chief Secretary Sitaram Kunte, dated 12 and 15 March, and one to Punjab Chief Secretary Vini Mahajan, dated 13 March. ThePrint has accessed all three letters.
Maharashtra figures grave concern
In his letter to Kunte, Bhushan flagged the high death rates in Nashik and Aurangabad and asked for genome analysis of the samples to get to the bottom of the cause.
“The testing has to be augmented to bring the test positivity rate to less than 5%. Whereas mainstay of testing shall be RT-PCR, the State should also utilize RAT kits as per ICMR guidance especially in containment zones and high-risk settings like super-spreader events, bus stops, railway stations, slums, densely populated areas etc…” Bhushan wrote in his second letter to Maharashtra.
A central team that went to the state earlier this month found that the positivity report ranged from 5 per cent in Mumbai to 30 per cent in Aurangabad.
In his first letter to the state, Bhushan stressed the need to step up vaccination in districts that are seeing a surge. He said a total of 54.17 lakh vaccine doses have been supplied to the state and an additional 12.74 lakh doses are in pipeline that will reach by 18 March.
“As on 12 March 2021 a total of only 23.98 lakh vaccinations have been administered as part of COVID19 vaccination drive thereby leaving adequate stocks available with the state for increasing the pace of vaccination and for focussing the vaccination effort… for eligible beneficiaries in districts showing an active case surge,” he wrote.
Top sources in the Union Ministry of Health and Family Welfare said Maharashtra’s pace of vaccinations — administering about 1.5-1.7 lakh doses a day — is a matter of grave concern.
“The stockpiles that they have, even if they do 2 lakh a day which is what the better states are doing, they have enough to last two-and-a-half to three weeks,” said an official who didn’t wish to be named.
The state accounts for 56 per cent of all active cases in India currently with eight of the top 10 districts in the country being in Maharashtra. It accounts for just 7 per cent of the fully vaccinated people in the country.
Of the 35.7 lakh vaccine doses administered in the country over the last weekend, just 3.84 lakh, or 10 per cent, were administered in the state.
On Monday, Maharashtra reported 16,620 new Covid cases out of a total of 26,294 in the country.
Central team found lapses in contact tracing
The central team that visited Maharashtra between 7 and 11 March found that though the state is currently tracing about 20 contacts for each positive case, the field staff had not been sufficiently trained for the purpose.
“…the main concept of contact tracing was not clearly understood by the field level staff, who were mainly listing the immediate family and neighborhood contacts, for the sake of listing,” the team wrote in its report, a copy of which was annexed to Bhushan’s letter.
“The high-risk contacts in workplace settings, social settings and family settings were not investigated and listed. The monitoring of the contacts was limited to conveying the message to the high-risk contacts for testing the very next day (and not as per the ICMR guidelines). For every case at least 20-30 contacts need to be traced and tracked,” it added.
In his letter, Bhushan also flagged the team’s finding about high deaths rates in Nashik and Aurangabad.
“The current case fatality was found to be very high among admitted cases in Government Medical college in Aurangabad (17%) and in Vasant Rao Pawar Medical College, Nashik [18%, (January, 2021) and 31% (February 2021)]. This needs to be investigated in detail including sending samples for Whole Genome Sequencing,” the report said.
Bhushan also spoke about the need to tackle vaccine hesitancy after the central team found that just 40 per cent healthcare workers had been vaccinated.
The team concluded: “Maharashtra is in the beginning of a second wave of Covid-19 pandemic. There is very limited active effort to track, test, isolate cases and quarantine contacts. There is no adherence to COVID appropriate behaviour among people both in rural and urban areas.”
It inferred that the “administrative mechanism should be reinstated to the level witnessed in August-September 2020” to contain the Covid transmission.
Bhushan also asked for death audits to be restarted. “Measures such as night curfews, weekend lockdowns etc. have very limited impact on containing or suppressing the transmission,” he wrote.
Punjab death rate, vaccination pace cause for worry
In his letter to Punjab chief secretary, Bhushan wrote, “…so far supplied to Punjab a total of 12,38,920 doses of vaccine (11,04,840 lakh Covishield and 1,34,080 Covaxin). Till 12 March 2021 only 358162 doses have been consumed in the state. You would agree there is urgent need to accelerate pace of COVID vaccinations in Punjab,” he said.
Sources said the central government is also “very disturbed” by the high death rate in the state — 3.15 per cent against a national average of 1.40 per cent.
“People in Punjab are dying not because they have comorbidities but they are reaching the hospital very late. It is very unfortunate that the state government has not been able to deal with it,” said a senior official who didn’t wish to be named.
In the last 24 hours, Punjab reported 20 deaths out of its 11,000-odd active cases against 15 deaths in Kerala, which has over 30,000 active cases. In the same period, Punjab reported 1,492 new cases against Kerala’s 1,792 cases.