03rd March 2020

Novel Coronavirus
(2019-nCoV)
outbreak in China
and
Public Health Response

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Situational Status in China-Confirmed cases and Deaths
2500

2048
New Confirmed cases for the day Deaths
2009

1886
2000

1749
1500

889
1000

648

573
508

433

427
409

406
397
394
500

327

202

125
142 105 98 136 114 118 109 97 150
71 52 29 44 47 35 42 31
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 02 2 02 2 02 2 02 2 02 2 02 2 02 2 02 2 02 2 02 2 02 2 02 2 02 2 02 2 02 2 02 2 02
2. 2. 2. 2. 2. 2. 2. 2. 2. 2. 2. 2. 2. 2. 2. 3. 3.
.0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0
15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 01 02

• 125 new confirmed cases reported on 2nd March- a total of 80,151 confirmed cases so far
• 31 deaths yesterday – Total 2943 deaths so far
• Hubei Province accounts for 67,217 Confirmed cases – 84% of total confirmed cases in
China
• Hubei Province has notified 2834 deaths – 91% of total deaths in China so far
• Though the reported confirmed cases from China is showing a downward trend , the
reported death cases are still high . 2
Status of Cases : Global
Cases & Deaths – Globally due to COVID-19
• 75 Countries have reported 10,265
Confirmed Cases and 171 Deaths as on Country / Mode of
Region Confirmed Deaths transmission
today
• 39 deaths reported since yesterday South Korea 4335 26 Local transmission

alone outside China. 11 countries Iran 1501 66 Local transmission

Italy 2036 52 Local transmission
besides China have reported deaths.
Japan 980 12 Local transmission
• Major confirmed cases and deaths USA 102 6 Local transmission
notified from France 191 3 Local transmission
Australia 33 1 Local transmission
• South Korea
Hong Kong 100 2 Local transmission
• Iran Thailand 43 1 Local transmission
• Italy Taiwan 41 1 Local transmission
Philippines 3 1 Imported cases
• Japan
• 35 more countries have reported
confirmed cases in last 8 days

• 27 countries have reported ‘Local

Transmission’ of COVID-19 3
Action Taken
• 3 confirmed cases found in Kerala so far. All
patients recovered and have been
discharged.
• 2 new positive cases have been detected in
New Delhi(travel history of Italy) and
Telangana (travel history from Dubai). Both
are clinically stable.
• 6 more cases have been tested with high
viral load in UP- having contact history with
case in Delhi. Required action as per Cluster
Management SOP is initiated.
• An Italian Tourist has tested positive in
Rajasthan. 21 other accompanying tourists
are shifted to ITBP Camp for testing and
quarantine.
• 15 labs are operational.
• Reagents to test up to 25000 samples made
available.
• 19 additional labs are being operationalized
• 645 Passengers were brought from Wuhan, China through special aircrafts and kept for 14 days
quarantine in Army camp, Manesar and Chhawla camp of ITBP.
• All evacuees are discharged on 18th February 2020
Passengers are further monitored under
community surveillance through IDSP
network on a daily basis
• 26,875 Passengers brought under
community surveillance
• 1086 found to be symptomatic and
referred,
• 58 hospitalized through IDSP network
• Screening at 21 Airports, 12 major seaports
and 65 minor seaports and land crossings
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particularly bordering Nepal.
• Universal screening for all flights from
Singapore, Thailand ,Hong Kong, Japan, South
Korea and China at earmarked aero-bridges.
• Universal screening also started from
Vietnam, Malaysia , Nepal, Indonesia, Iran and
Italy.
• 5,74,276 passenger screened at Airports
• 14,642 screened at Ship Ports
Situational Status in India

Cruise Ship Diamond Princess under quarantine

at the Port of Yokohama. Evacuees from Wuhan
• Total of 705 people on board the cruise have • Total of 112 people inclusive
been confirmed to be infected with the of nationals from Myanmar
disease (2), Bangladesh(22), Maldives
• It has 132 crew members and 6 passengers (2), Chinese (6), South
from India. African(1), USA(1) and
• As of now 16 Indian national have tested Madagascar(1) from Wuhan.
positive and taken to hospitals for treatment. • The evacuees have reached
• As of now 124 people are brought back Delhi on 27th February
through Air India flight on 27th February morning and kept at ITBP
morning including 5 foreign nationals . camp
• They are kept in Army Facility at Manesar • 1st Test complete. All Negative
• 1st Test complete. All Negative

• Secretary (H) has allocated States to all Joint Secretaries in Ministry of Health to assess
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the preparedness of States for COVID-19
• A checklist provided to all JSs for follow up on preparedness at State level.
Latest Travel Advisory
In view of the emerging global scenarios the following advisory is issued for
immediate implementation:
• All regular (sticker) Visas/e-Visa (including Visa on Arrival for Japan and South Korea) granted to
nationals of Italy, Iran, South Korea, Japan and issued on or before 03.03.2020 and who have not
yet entered India, stand suspended with immediate effect.
• Regular (sticker) visa / e-Visa granted to nationals of Peoples Republic of China, issued on or
before 05.02.2020 were suspended earlier. It shall remain in force.
• Regular (sticker) visas/e-Visas granted to all foreign nationals who have travelled to Peoples
Republic of China, Iran, Italy, South Korea and Japan on or after 01.02.2020, and who have not yet
entered India stand suspended with immediate effect.
• Diplomats, officials of UN and other International bodies, OCI cardholders and Aircrew from
above countries are exempted from such restriction on entry. However, their medical screening is
compulsory.
• Passengers of all international flights entering into India from any port are required to furnish duly
filled self declaration form (including personal particulars i.e. phone no. and address in India) and
travel history, to Health Officials and Immigration officials at all ports.
• Passengers (foreign and Indian) other than those restricted, arriving directly or indirectly from
China, South Korea, Japan, Iran, Italy, Hong Kong, Macau, Vietnam, Malaysia, Indonesia, Nepal,
Thailand, Singapore and Taiwan must undergo medical screening at port of entry.
• Indian citizens are advised to refrain from travel to China, Iran, Republic of Korea, Italy & Japan 6
and advised to avoid non-essential travel to other COVID-19 affected countries.
Guiding Principles
• Situation awareness at all levels (global, national and sub-
national) for risk assessment for allowing informed and timely
decision making.
• Inter-sectoral coordination at all levels.
• Adherence to core capacities for disease preparedness and
response:
– Surveillance
– Laboratory Diagnosis
– Hospital Preparedness
– Logistic Management
– Capacity Building
– Risk Communication
• Although the need, scale and extent of each will increase
exponentially as per evolving scenario
Strategic Approach
Scenario Inference Approach
Only travel No community transmission • Continued activities at Points of Entry Surveillance
related cases in India • Concurrent review and strengthening of all core capacities
Local cluster Signalling start of local / • Cluster containment strategies
of indigenous community transmission • listing of contacts,
cases (with • deciding on the containment zone,
no travel • perimeter control (exit and entry controls) and
history) • focused actions in the containment zone for
• isolation of cases,
• home quarantine of contacts,
• social distancing measures (school closure, office closure, ban on
gatherings) and
• communicating the risk to public.

Large Widespread community • Abandon cluster containment strategy and Points of Entry surveillance
outbreaks transmission • Minimize mortality and morbidity while ensuring essential services and
continuity of operations to minimize impact on health and non-health
sectors
• Exit Screening (based on risk assessment to other countries)
• Mitigation measures :
• triage of patients (through screening clinics),
• surge capacity of hospitals for isolation and
• ventilator management and
• large scale IEC activities.

COVID-19 Pool of susceptible • Programmatic approach shall be followed – akin to that being followed
becomes population will decrease – post Pandemic Influenza 2009 (H1N1 outbreak)
endemic stabilization of incidence of • Routine surveillance as an epidemic prone disease and sentinel
new cases surveillance to know public health burden of the disease.
Cluster Containment Strategy
Objective
• To contain the disease with in a defined geographic area by early detection, breaking the
chain of transmission and thus preventing its spread to new areas.
Clustering of Cases
• Clusters of human cases are formed when there is local transmission.
• There could be single or multiple foci of local transmission.
• There may or may not be an epidemiological link to a travel related case.

Risk Assessment
• The risk assessment would be carried out at the site by the State/Central rapid response
teams (RRTs).
• The RRT shall map the cases and contacts and determine the extent of spread and decide
on containment zone and buffer zones and the scale of arrangements that needs to be put
in place.
• The risk assessment will take into consideration a number of variables such as:
• Size of the cluster (Mapping of the contacts)
• The extent of spread and time elapsed since detection of first case/cluster
• Geographical characteristics of the area (e.g. accessibility, natural boundaries)
• Population density and their movement (including migrant population).

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Operational Plan
• District collector to be the nodal person for containment operations
• Clearly identifying containment and buffer zones and applying perimeter control
• Preparation of micro-plan
• Mobilization of health workforce to the containment zone for the enhanced
surveillance
• Training of workforce by the RRT
• Active surveillance and contact tracing covering all households
• Arrangement for sample collection, transportation and testing
• Identification of health facilities for isolation of suspects
• Passive surveillance through identified health facilities
• Home quarantine and daily follow up of all contacts
• Information management and daily sitreps
• Social distancing measures in the containment zone, based on risk assessment
such as closure of schools, work places and ban on gatherings
• Risk communication through miking and inter-personal communication
• Scale down, if there is no case for 28 days from the discharge of last confirmed
case (following negative tests as per discharge policy)
Steps ahead
• States to identify all useful resources at state and district levels in terms of human resource
and institutions ( medical college, tertiary care institutions) and define their roles in
management.
• Identification of quarantine facilities in case needed.
• Effective coordination between State Disaster Management Authority along with Health
Department. Support of village level committee under SDMA’s for community awareness
should be taken up.
• Coordination with School Education, Women Development and Child Welfare, Panchayati
Raj, Drinking Water and Sanitation, Urban Local Bodies and Local Police Officials
• The control rooms should be made operational in all the States with number and contact
details of nodal person conveyed to MoHFW
• District Collector to take leadership position as a coordinating officer at the District level. He
shall review the status daily in terms of community surveillance , logistics ,availability of
isolation beds, capacity building and risk communication.
• Expected local transmission in the country and hence to be prepared for cluster
containment
• State Health officials to review the surveillance at point of entry in their jurisdiction and
support with manpower and logistics.
• International airports within the State to undertake required action as per the advice of
State’s Health officials.
• Enhanced & regular surveillance of all passengers as per the list communicated by IDSP.
Steps ahead
• Personal Protection Equipment (as per the recent guidelines issued by Ministry of Health), N95
masks , triple layer surgical masks have to procured in all hospitals and a state level buffer stock on an
emergency basis.

• States to streamline sample collection and transport particularly through flights after effective
packaging as per protocol.

• Protocol for transfer of patients in a timely manner through earmarked ambulances including proper
infection prevention management should be coordinated.

• Availability of drugs in view of limited supply of APIs from China to be ensured. Hoarding of drugs and
other consumables should be monitored.

• Isolation facilities to accommodate large number of confirmed/suspected cases to be identified in

each district and their logistics requirements ( sufficient beds , ventilators etc.) worked out.

• Tertiary care hospitals under ESIC, Defence, Railways, paramilitary forces, Steel Ministry etc. should
also be leveraged for case management

• Post National level Training of Trainers on COVID-19 on 6th March , state level Training of Trainers to be
organised in all states on 9th March . District level training of health staff and hospitals to be
completed with in next 10 days.

• Community awareness to be built utilizing print, electronic and social media in local languages
including utilizing local cable TV channels, Miking and FM radio etc.
A coordinated and collective effort in a MISSION
MODE is needed..

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