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Health Ministry to send central teams to 10 States; spike of 3,320 new cases

With India registering 3,320 new COVID-19 cases in the past 24 hours, taking the overall tally as reported by State Health Departments to 62,584, the Indian Council of Medical Research (ICMR) on Saturday said it will initiate a study in the worst-affected 75 hotspot districts to check for community transmission.

In a separate development, the Health Ministry announced that it will deploy central teams to 10 States witnessing high case load and spurt in cases.

“The teams are being sent to Gujarat, Tamil Nadu, Uttar Pradesh, Delhi, Rajasthan, Madhya Pradesh,Punjab,West Bengal, Andhra Pradesh and Telangana. This is besides the 20 central teams of public health experts earlier sent to the high case load districts. A high level team had recently been deputed to Mumbai to support the State’s efforts,” the Ministry said.

“The teams will support State health departments in containment measures,” it added.

An ICMR official said the study on community transmission was scheduled for the first week of April but had “subsequently got derailed”.

“We had drawn up places based on hot-spots, which being dynamic have changed; a final list will be announced soon,” he said.

Virus strain from NIV Pune transferred

The Indian Council for Medical Research (ICMR) on Saturday announced a research collaboration with Hyderabad-based Bharat Biotech International Ltd (BBIL) to develop a COVID-19 vaccine.

The ICMR said in a statement that it had transferred the virus strain isolated at the National Institute of Virology, Pune (an ICMR institute) to BBIL.

Fully indigenous

“... Work on vaccine development has been initiated between the two partners. ICMR-NIV will provide continuous support to BBIL for vaccine development. ICMR and BBIL will seek fast-track approvals to expedite vaccine development, subsequent animal studies and clinical evaluation of the candidate vaccine, which will be fully indigenous to India,” the ICMR statement said.

No further details were available on whether any pre-clinical studies were done or the basis for which this appeared to be a promising step forward for successfully developing a vaccine.

Revenue deficit, combined with the burden of COVID-19 and industry distress, leaves the State on edge

A precipitous slide in revenues, combined with the burden of the costs associated with the COVID-19 pandemic, has left Andhra Pradesh facing a “grave financial crisis”. Add to it the distress in industry, exacerbated by the mass migration of workers, and the State government finds itself with little option but to look at the Centre for liberal financial help, a stimulus package and statutory measures to help the industry.

Chief Minister Y.S. Jagan Mohan Reddy had apprised Prime Minister Narendra Modi of the dire situation in the State, during a videoconference in April, and made a pitch for liberal financial aid. The State’s revenue had reportedly dipped to a mere ₹2 crore a day.

“We could not pay full salaries for the month of March to our staff due to the grave financial crisis,” Mr. Reddy said during his interaction with the PM.

The revenue shortfall in A.P. in the wake of the lockdown was about ₹5,000 crore a month, Finance Minister Buggana Rajendranath Reddy said. The slump in receipts include deep deficits in excise collections, sales tax, motor vehicles tax and revenue from stamp duty and registration. And the deficit is expected to continue in the month of May, the Minister said.

While the actual calculations of the State’s finances and revenue deficit are yet to be confirmed, sources in the government said revenue receipts in the financial year 2019-20 were likely to be about ₹1.04 lakh crore as against the revenue of almost ₹1.15 lakh crore in the previous fiscal.

Despite the challenges, the government has spent about ₹1,330 crore on COVID-19 assistance to 1.33 crore white ration card holders in the State. In addition, it spent ₹1,400 crore on interest waiver to women’s self-help groups. The government has also made elaborate arrangements, including food and accommodation during the lockdown for nearly 70,000 migrant workers across the 13 districts.

As a measure of support to industry during the current crisis, the State has paid ₹905 crore of industrial incentives, which were pending since 2014, to the MSME sector.

Besides, it has waived ₹188 crore in power demand charges and decided to provide ₹200 crore in low-interest working capital.

The A.P. government is estimated to have so far spent more than ₹10,000 crore on COVID-19-related activities, financial assistance and relief measures, the government sources, speaking on the condition of anonymity, revealed.

There was also no official statement by the State government on the extent of assistance given by the Centre to address the COVID-19 pandemic so far.

Central assistance

The Centre has extended financial assistance amounting to ₹10,947 crore to A.P. through various schemes to mitigate the impact of COVID-19, BJP State Secretary V. Jaya Prakash Narayana said in a statement.

To tide over the crisis, the State government wants the Centre to take a slew of measures to boost industry. In a letter to Mr. Modi on April 30, the chief minister listed A.P.’s contributions to the country’s economy including ₹98,983 crore worth of exports during 2018-19.

Fund for MSMEs

Given the distress across the globe, the CM wanted the Centre to facilitate a fund to support MSMEs for liquidity needed to meet wage liabilities during the lockdown, allow a moratorium on payment of PF, ESI and gratuity for six months, provide for a 12-month moratorium on all repayments for MSMEs, release of delayed payments and waiver of minimum power charges among others.

On the GST front, Mr. Reddy suggested an increase in the threshold limit of GST compliance eligibility to an annual turnover of ₹100 lakh.

He sought several supportive measures for the textiles, auto components, pharma, metals and mining and food processing sectors. And besides a stimulus package, he also urged GST rate cuts.

Only patients with severe illness to be tested before leaving hospital; negative results not required for mild or moderate cases

Final test: Medics checking a COVID-19 patient who has completed the mandatory 14 days of quarantine before his discharge from a hospital in New Delhi on Saturday.PTI

The Union Health Ministry has revised its discharge guidelines for COVID-19 patients, saying only those with severe illness need to test negative (through a swab test) before discharge.

Other categories of patients — very mild, mild, pre-symptomatic and moderate cases — need not be tested before discharge.

The two-page revised guideline replaces the rule that patients could be discharged only after testing negative on the 14th and 21st day after confirmation of the infection.

Three-tier facilities

The guideline states that the revised policy is aligned with the guidelines on the three-tier COVID-19 health facilities and the categorisation of patients based on clinical severity — mild, moderate and severe.

Reacting to the revised guideline, Srinivas Rajkumar, general secretary, All India Institute of Medical Sciences Resident Doctors’ Association, said the decision to send back COVID-19 positive patients without testing was a disaster in the making.

“People sent back untested may spread the virus in the community. What was the government doing for 40 days without arranging enough testing facilities? Is the government ready to sacrifice 2 lakh Indians or more to COVID-19 based on estimates?” he said.

Under the latest guideline, mild, very mild and pre-symptomatic cases admitted to a COVID-19 care facility will undergo regular temperature and pulse monitoring.

“Patient can be discharged after 10 days of symptom onset and if they have no fever for three days. There will be no need for testing prior to discharge,” the revised guideline says.

It adds that at the time of discharge, patients will be advised to follow home isolation for seven more days.

It further clarifies that after discharge from the facility, if patients develop symptoms of fever, cough or breathing difficulty, they must contact a COVID-19 care centre, State helpline or call 1075. Their health will again be followed up through teleconference on Day 14.

Moderate cases will undergo monitoring of body temperature and oxygen saturation.

If fever resolves within three days and a patient maintains saturation above 95% for the next four days (without oxygen support), he or she will be discharged after 10 days of onset of symptoms in case there is no fever without anti-fever drugs, no breathlessness and no need for oxygen.

“There will again be no need for testing prior to discharge, and home isolation for seven days is suggested, with close monitoring of health,” notes the guideline.

Explaining the rationale for discharging mild/moderate cases without testing, a senior ICMR scientist told The Hindu: “Studies outside India have shown that positive test result does not mean the person is still infectious. They may be positive for the virus but can remain non-infectious.”

Spread of infection

He further explained that 10 days after the disease set in, people might not be infectious. But once discharged, they should stay at home for five days. The Ministry’s revision also takes into account the fact that hospitals are reaching their handling capacities.

The U.S. Centers for Disease Control and Prevention too had revised the guidelines on May 6, saying that no negative test for the virus is needed before a hospitalised person can be discharged.

The CDC says decisions about discharge should be based on “clinical status and the ability of the accepting facility to meet their care needs and adhere to recommended infection prevention and control practices”.

(With inputs from

R. Prasad in Chennai)

5 groups set up in National Task Force

The group was to set up to review evidence and develop concept notes.

The Indian Council for Medical Research (ICMR) has dissolved a key committee, which was part of the National COVID-19 Task Force (NTF) and tasked with developing a research protocol, a team and partners for vaccines and drug development.

The NTF’s key responsibility was to create a “India COVID-19 Clinical Research Collaborative Network”.

The group for ‘Vaccines/Drug Research and Development’ — one among five constituted by ICMR Director-General Balram Bhargava on April 6 — was to identify ‘research priorities, review evidence and develop concept notes’.

However, these objectives were not met, multiple members of the group confirmed to The Hindu. The group met thrice.

One member told The Hindu that the team was probably constituted to help ICMR gain an overview of potential vaccines, existing capabilities in India and research institutions with expertise in specific areas of drug- and vaccine-development.

“I don't think it was a statutory committee. There were experts from different institutions such as DBT (Department of Biotechnology) and CSIR (Council for Scientific and Industrial Research) and we gave our views on the strengths and capabilities that existed,” Srivari Chandrasekhar, Director, CSIR-Indian Institute of Chemical Technology, told The Hindu. “From the discussions, ICMR would have got clarity on where they could best invest their expertise and time. A colleague from ICMR was recording deliberations.”

In the last month, the Department of Science and Technology, the DBT and the CSIR have compiled the existing knowledge base on drugs, diagnostics and potential vaccine development pathways.

According to the ICMR website, members of the group included Gangandeep Kang (Chair), Suman Kanungo (National Institute for Cholera and Enteric Diseases- NICED), Bikash Medhi (Post Graduate Institute for Medical Education and Research), S.S. Das (NICED), Debashish Mitra, (Centre for DNA Fingerprinting and Diagnostics), Sarah Cherian (National Insitute of Virology), Sanjay Mehendale (Hinduja hospital) and Niraj Agrawal (ICMR).

Dr. Mitra told The Hindu that the group was “likely reconstituted” and that he was unaware of further developments. Dr. Kang didn't respond to requests for clarification on whether the terms of reference of the group were achieved. Dr. Bhargava, in response to queries, referred this correspondent to ICMR’s Saturday announcement of the Council partnering with Bharat Biotech International Ltd/ for developing an indigenous potential COVID-19 vaccine.

The other groups constituted as part of the NTF include a clinical research group headed by Dr. Randeep Guleria of AIIMS and on Research on Diagnostics and Biomarkers headed by D.A. Gadkari.

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