With just over a week left of the 21-day coronavirus (COVID-19) containment lockdown, the Union Health Ministry said on Monday that India has now stepped out of the local transmission phase and moved into the “large outbreaks amenable to containment phase”.

With a current case doubling rate of 96 hours and the infection having spread to nearly 300 of the 736 district across the country, the protocol presently followed has been set out in the Union Health Ministry’s recently released document “Containment plan for large outbreaks”.

This includes “re-defining the area of operation, active surveillance for cases and contacts in the identified geographic zone, expanding laboratory capacity for testing all suspect cases, high risk contacts and SARI cases, operationalise surge capacities created for isolation (COVID-19 hospitals/COVID-19 dedicated blocks) to hospitalise and manage all suspect / confirmed cases.”

The other measures under the protocol include implementation of social-distancing measures with strict perimeter control, providing chemoprophylaxis with hydroxy-chloroquine to asymptomatic healthcare workers and asymptomatic household contacts of laboratory confirmed cases and the further intensification of risk communication through audio, social and visual media.

As per the surge capacity recommendation, the government is empowered to enhance capacity and bring in private hospitals and augment laboratory testing capacity, notes the 20-page document.

The document also lists the hospital facilities to be provided to COVID-19 patients. It states that all suspect/confirmed COVID-19 cases will be hospitalised and kept in isolation in dedicated hospitals/hospital blocks.

Anticipating about 15% of the patients are likely to require hospitalization, and an additional 5% will requires ventilator management, the Centre has planned a three-tier arrangement for managing suspect/ confirmed cases which is now being implemented to decrease burden on the COVID blocks/ hospitals.

“The mild cases will be kept in temporary makeshift hospital facilities, moderate to severe cases who require monitoring of their clinical status will be admitted to COVID hospitals. Some of the severe cases may progress to respiratory failure and /or progress to multi-organ failure and hence critical care facility/ dialysis facility etc shall be required,” a senior health official said.

The Ministry is also looking at scaling down operations “if no secondary laboratory confirmed COVID-19 case is reported from the geographic quarantine zone for at least four weeks after the last confirmed test has been isolated and all his contacts have been followed up for 28 days.”

The document adds that containment operation shall be deemed to be over 28 days from the discharge of last confirmed case (following negative tests as per discharge policy) from the designated health facility i.e. when the follow up of hospital contacts will be complete.

“The closing of the surveillance for the clusters could be independent of one another provided there is no geographic continuity between clusters. However the surveillance will continue for ILI/SARI. However, if the containment plan is not able to contain the outbreak and large numbers of cases start appearing, then a decision will need to be taken by State administration to abandon the containment plan and start on mitigation activities,” the document stated.