Health dept asks DTFs to ramp up Covid tests

 Covid tests in Nagaland lowest in the country

State health & family welfare (H&FW) department has asked all District Task Forces (DTFs) to ramp up Covid-19 tests as directed by High Powered Committee (HPC) on Covid-19.

In an order, H&FW principal director Dr Neikhrielie Khimiao also instructed all chief medical officers (CMOs) and medical superintendents (MS) to ensure that the Covid-19 testing targets assigned to the districts were achieved. (Read full order on www.nagalandpost.com )

As directed by HPC to scale up testing in the State under “Mission X5”, he said directions and guideline on measures to scale up testing has been developed to guide and facilitate CMOs, MS and DTFs in this regard.

The order stated that testing was not only a vital epidemiological tool, but also helped people determine if they were infected or not. Cases, including those without symptoms, could be detected, isolated and treated only through testing, it pointed out.

With the details of contacts provided by the confirmed cases, the order pointed out that persons who came in contact with the confirmed case could be traced, tested, isolated and treated, thus breaking the chain of transmission and prevent the virus from replication and mutation.

Noting that Covid-19 testing in Nagaland was lowest in the country at 1,12,330 per million compared to national average of 3,10,790 per million, the H&FW department explained that positivity rate would be high if the number of positive tests was too high, or if the number of total tests was too low.

A higher positive rate suggested higher transmission and likelihood of more people with the virus in the community who haven’t tested yet.

While the State’s overall positivity rate is presently around 7%, there are wide variations among the districts – 19% in Mokokchung, 15% in Kohima, 9% in Peren, 7% in Wokha, 6% in Dimapur and 5% in Tuensang and in the remaining district the positivity rate is less than 5%.

The department warned that hiding or concealing illness from others, refusal to undergo test and withholding or not revealing details of contacts by confirmed cases would only increase spread of the disease to family members, friends, co-workers and others.

MISSION X5

Testing is not only a vital epidemiological tool but also help people determine if they are infected or not. Only through testing, cases including those who have 110 symptoms can be detected. isolated and treated. Further, with the details of contacts provided by the confirmed cases, persons who have come in contact with the confirmed case can be traced, tested, isolated and treated. Thus breaking the chain of transmission and prevents the virus from replication and mutation. Early detection and isolation of potentially infectious individuals are the keys to successfully fighting a viral pandemic.

COVID-19 Testing in Nagaland is lowest in the Country at 112330 per million as compared to National average of 310790 per million. The number of tests per million of various districts are- Wokha (21496), Kiphire (41569), Phek (43583), Zunheboto (46642), Longleng (55707), Tuensang (62413), Mokokchung (64244). Mon (77317), Peren (84364), Kohima (213827) and Dimapur (235632).

The Positivity Rate will be high if the number of positive tests is too high, or if the number of total tests is too low. A higher percent positive suggests higher transmission and that there are likely more people with coronavirus in the community who haven’t been tested yet. The positivity rate is presently at around 7% in the State with wide inter district variations- Mokokchung ( 19%), Kohima  (15%), Peren (9%), Wokha (7%), Dimapur (6%) and Tuensang (5%) while the remaining district are less than 5%.

Hiding or concealing illness f om others, refusal to test & withholding or not revealing details of contacts by confirmed cases will only increase spread of the disease to family members, friends, co-workers and others. Low testing, poor health seeking behavior, low vaccination coverage coupled with not adherence to covid appropriate behaviors & flouting quarantine norms, unless effectively tackled would lead to grave consequences.

Therefore, as directed by the High Power Committee the following measures will be taken by all DTF to ramp up the COVID-19 testing.

DIRECTIONS AND GUIBANCE FOR AUGMENTING/ UP-SCALING COVID-19 TESTING:

1.            Expansion of RAT Testing Facilities:

a. RAT facility to start in all DH, CHC, PHC & SC-HWC, Testing facility should also be provided at strategic SCs/ PHC without Doctors where skills can be imparted to the HCWs.

b. RAT Testing Centres or Mobile Testing facilities should be setup in highly populated areas

particularly in Urban areas.

c. Training of HCWs on RAT testing, uploading in ICMR Portal and Infection Prevention & Control including proper donning/ doffing of PPE. The training where ever not carried out should be completed on or before 15th July 2021 positively. The District Team will be responsible for the training and submission of the list of all trained HCWs to the directorate.

d. Particulars of Trained HCWs should be registered in ICMR portal through NIC. Whoever are trained should be registered on immediate basis. The CMO shall assign a specific person for the registration.

e. Wherever Truenat/ RT-PCR testing is not feasible, testing should be done through RAT. However, all symptomatic and high risk contacts tested Negative through RAT should be retested by Truenat/ RT-PCR. Accordingly, adequate VLM/ VTM and cold chain logistics for transportation of samples for Truenat/ RT-PCR testing should be kept in all Testing Centres for collection of samples.

2.         Microplaning:

a. Prepare Microplan with weekly target for each testing centres, keeping in view of overall district target assigned by the Department.

b. The strategies shall include intensive contact tracing, random testing of high risk groups, and mandatory testing of all ILI/ SARI cases detected through House-to-House visits and at Health Facilities.

c. ldentify means of Transportation of samples from villages in the respective jurisdiction of health facilities or for transporting samples to the District Headquarters. The DTF shall ensure necessary vehicles available with various departments at the location (sub-division/ block) should be pooled/ requisitioned for carrying out these activities. The DTF may also explore other sources such as vehicles belonging Church/ Village Council or sponsoring hiring of vehicle by CBOs, SHGNRLM etc for transportation of the samples.

d. Funds under Result Base Funding provided under Nagaland Health Projects to health facilities can be utilised for Transportation of samples. Separate fund has also been provided for operational cost under the State budget and as well as NHM. Funds are also provided for COVID-19 related and other activities to ASHAs under NHM to all districts.

e. All tested positive may be advised immediate Home Isolation/ CCC care. All RAT negative symptomatic individual may be treated as suspect COVID-19 cases and also should be advised for Home Isolation while awaiting the test results. The DTF/ BTF/ VTF should facilitate community support for such home isolation cases wherever required.

3. Intensive Awareness Campaign:

a.        The content and material on importance of addressing concerns of Stigma, Testing, Contact Tracing. Disclosure of Contacts, Health Seeking Behaviour, Early Detection & Prompt Treatment

(EDPT) to reduce mortality. Breaking the Chain of Transmission & its impact on mitigating Viral Mutations as well as COVID-19 Vaccination, to be used for the Intensive Awareness Campaign shall be provided by the Directorate and should be used with necessary adaptation including translations into local dialects by the DTF.

b.       As a strategy for wide dissemination and better impact local influencers including from elected representatives, government departments, Churches, CBOs, etc should be identified and engaged as part of the intensified awareness campaign.

c.        Conduct Advocacies, Group/ Panel Discussions etc in villages and wards/ colonies with representatives of various stakeholders and the proceedings may be broadcasted through Local Cable Network, Church & Village Council PA system.

d.       The DTF may also explore means to widely publicize testimonials from Recovered Patients (Covid Hospital/ CCC/ Home Isolation) and Vaccinated persons.

e.       DPRO machinery should be extensively used for the awareness campaign including Miking, translation into local dialects etc.

4. Surveillance and Testing:

a.       Intensify Community Surveillance and Testing of all ILI/SARI cases. There should be close coordination between the team at Health Facilities and Community Surveillance Team comprising of ASHA, AWW, SHG etc who are tasked with House-to-House Visits for detecting ILI/SARÍ cases.

b.        Intensify contact tracing to capture all contacts of positive cases.

·         Ideally 25-30 contacts are to be traced for every positive case. In the villages it has been observed that the numbers of contacts were much larger. In some cases 60-80 contacts have been traced for a single positive case.

·         All household members should be taken as contacts and should be mandatorily tested.

·        In the villages wherever positive cases are detected, it will be advisable to involve the Village Council after due sensitization to trace all contacts. Some progressive village councils have decreed mandatory disclosures of all contacts by very positive cases.

·         In case of refusal for testing or disclosure of contacts, powers under the Epidemic Act 1897can be invoked by the competent authority.

c.       Periodic testing in high risk settings like Shops, Saloon. Taxis/ Public Transport, Home delivery, offices, Banks. HCWs every 15 days.

d.       All members of the Household should be tested if one Household member is tested positive in viewpresence of highly transmissible variants.

e.       Testing and surveillance of travellers is critical to detect & spread of highly transmissible variants like the Delta Variant, Delta PLUS ete. The DTF shall also ensure RAT testing on payment or production of Vaccination Certificate of/by all in-bound travelers as per the extant SOP at the Point of Entry including Railway station and Airport.

f.        The Rapid Response Team at the district or block level shall be responsible for Surveillance and Testing in all areas of clustering of ILI/SARI.

5. Supplies &Logistics:

a.        The CMO shall ensure availability of testing kits, cold chain equipment for transportation of VTM etc and PPEs.

b.       The State Immunization Officer shall provide sufficient quantity of cold carriers to each district to enable transport of VTM etc from the state store to district and then to various health facilities.

c.       Further. the Store i/c of the directorate shall ensure that the stock issued at one time is sufficient to meet the requirement for at least 1 month based on the targets given to the districts. This is  important not only reduce the number of trips that the district would be required to make the collection but also to ensure the microplan is implemented without any disruptions.

6. HR Requirements:

a. Besides Lab Technicians, other categories of HCWs should be engaged for COVID-19 Testing with RAT upon training.

b. DTF should identify employees of Government departments who shall be used to augment the health care workers in COVID-19 management activities such as contact tracing, sample collection, RAT testing, data management, IEC etc.

c.       ASHA, SHG-NRLM and AWWs shall be involved in all COVID-19 surveillance, mobilization and awareness related activities.

d.       Volunteers from NYKS, NCC, NS, NGOs & CBOs can be used to community surveillance,

awareness campaigns and mobilization.

7. District Wise COVID-19 Testing Targets:

8. Sentinel Surveillance for Whole Genome Sequencing (WGS):

To curb spread and timely detection of more transmissible variants samples are to collected and sent for Whole Genome Sequencing.

a. 6 Sentinel surveillance Sites have been selected in Nagaland. Namely- (1). BSL-2 Lab CIHSR, (2). CIHSR. (3). DH Dimapur, (4). State Referral BSL-3 Lab, NHAK, (5). NHAK, (6). DH Mokokchung. (7). BSL-2 Lab, Tuensang (8) DH Tuensang.

b. Each Site are to send 15 samples every 15 days to the Designated Lab for WGS. This will be coordinated by the State Referral BSL-3 Lab, Kohima.

c. The Samples from the aforementioned sites should be randomly selected.

d. The samples from the health care facilities should include samples of patients with severe illness/prolonged admission, suspected re-infection, suspected vaccination failure/infection following vaccination, any other special cases, etc.

e.  Each sample to be sent for WGS should have a CT value <25 and must be accompanied by a completely filled sample referral form (Attached as Annexure-A).

f. The objective of the special surveillance is to gather WGS information in the community by targeting events like clustering of Covid cases. suspected super-spreader events, clustering of cases in institutions. suspected vaccine failure and re-infection clusters, etc.

g. The concerned Sentinel Sites Incharge/District Surveillance Officer (DSO) may send appropriate number of samples (after discussion with the State Nodal Officer for WGS and SNO, IDSP) for WGS on a case-to-case basis and also taking into consideration the clinical-epidemiological correlation.

h. Use of IHIP (Integrated Health Information Platform) is required by Sentinel sites for sample referral information. The user name for Sentinel Sites has been created by CSU, NCDC. MoHFW and are ready to be used. The Sentinel Sites have been provided the credentials (Already shared with the Sentinel Sites) for accessing the WGS Surveillance Portal on IHIP.

(Dr NEIKHRIELIE KHIMIAO)

Principal Director

Directorate of Health & Family Welfare

Nagaland: Kohima