Surveillance system for COVID-19 in urban areas should be strengthened and strict perimeter control be maintained in containment zones with Section 144 enforced to ensure people remain in their dwelling units, according to the health ministry's guidelines on coronavirus management in urban settlements released on Saturday.
In most of the cities or towns, the disease surveillance system is not as well organised as in the rural areas, the health ministry guidance document for preparedness and response to COVID-19 in urban settlements said, asserting that this is more so pronounced in these urban settlements.
"Hence, the surveillance system shall be strengthened for surveillance and contact tracing mechanism. This would include identification of the health workers in the health posts/dispensaries, Auxiliary Nurse Midwife (ANM), ASHAs, Anganwadi Workers, municipal health staff, sanitation staff, community health volunteers and other volunteers etc," the guidance document said.
An orientation training will be organised by the Chief Medical Officer or Executive Health Officer to train the identified surveillance workers which would emphasize on the basic information on COVID-19, orientation on basic Dos and Don'ts with focus on hand hygiene, respiratory hygiene, environmental sanitation and use of face covers/masks.
The training would also emphasise on active case search through questionnaire during field visit, listing and tracking of contacts, recording temperature with handheld thermometer, recording oxygen saturation with pulse oximeter, identification of high risk individuals based on contact history, age, and co-morbidities, inter-personal communication with households for creating awareness on COVID-19 and other essential health service, addressing stigma, health-seeking behaviour and other issues, and establishing rapport with the community.
Informal settlements within cities that may have mushroomed due to migration have inadequate housing and poor living conditions, the document noted.
According to 2011 Census, there are 2,613 towns/cities such settlements with 6.54 crore population residing in 1.39 crore households, representing 17.4 of all urban population, they said, adding that this would have increased in number further since the last few years.
An incident commander of appropriate seniority would be identified depending upon the geographic extent of the settlements and its population size and the commander will identify its planning, operation, logistics and finance teams to implement the preparedness measures to respond to a COVID outbreak, the guidelines said.
The incident commander shall report to the municipal commissioner, they said. A coordination mechanism shall also be evolved under the leadership of Incident Commander and would comprise of representatives from Health, Women and Child Development, Integrated Child Development Services, Housing & Urban Affairs, Public Health Engineering Wing, Swachh Bharat Mission, elected representatives, prominent NGOs already serving the area, community leaders, etc, the guidelines state.
The COVID containment plan for these urban settlements will address the key challenges specific to these areas and implementation of this plan will ensure that the core capacities are available to respond to COVID-19, the document said.
Non-COVID services especially immunization, management of communicable and non-communicable diseases, and maternal and child health services should continue to be provided in these areas, they said.
"There will be community mobilization to adopt COVID-related behaviour for lifestyle changes. This would include practising frequent hand washing, following respiratory etiquettes, ban spitting in public places, following social distancing and promotion of masks/face covers, avoiding consumption of gutkha, paan, cigarettes/bidis etc.
Social distancing will be a major challenge due to many people crammed into very small living spaces, the document states.
"While sleeping the distancing can be achieved to an extent by sleeping in opposite direction in a manner that head end of one person faces the leg of the other. Social distancing should be practiced particularly in community water points, public toilets, PDS distribution points, health centers etc," it said.
A contingency plan will also be in place to move high-risk population to alternative or temporary sites, the guidelines said.
Social media should be used with appropriate messages to target these population and for refuting fake news and community groups should also popularize adoption of Aarogya Setu application, the document said.
Most of the inhabitants of such communities are daily wage workers, who might be compelled to go outside for work, hence, strict perimeter control must be enforced to regulate entry and exit from the containment zone, the document said.
"Section 144 under CrPC will be enforced to ensure people remain in their dwelling units. The local administration however must make every effort to maintain supply of essential commodities (food, milk, groceries, medicine and other essential supplies) in such an area," the guidelines stated.
If feasible, the relief centers in the containment zone may be geo-tagged and information may be made available through mobile applications, it said.