Pune Platform For COVID-19 Response Proposes Scientific, Logical Metrics Related Unlock 1.0 After 2nd Wave 

Pune, 28th May 2021: The Pune Platform for Covid-19 Response (PPCR), a volunteer network coordinated via the Mahratta Chamber of Commerce, Industries and Agriculture (MCCIA), has prepared a roadmap for Unlock 1.0 of 2021. 

This proposal has cross-sectoral representation (Manufacturing, Services, Social, Public Health Research, Jobs and Livelihood, Education). The central premise of this proposal is that the unlock decision should be based on a balanced view about priorities in public health, economy, livelihood, and overall well-being of the citizenry. Furthermore, the final decision to “open” and “shut”, partially or fully, should be linked to some precise scientific and logical Measures or Metrics rather than the feelings/views of the decision-makers. 

All over the world, the successful management of pandemic has shown the need to undertake public health research for policy-making in the local context. 

Similarly, PPCR recommends that there is a need for embracing a data/evidence-driven approach that will enable regular monitoring of the unlock impact and potential development of 3rd wave. In this context, there is a need for (a) daily availability of diagnostic/testing data (for modelling and predictions of pandemic patterns), (b) All clinical data (in every hospital) to capture complications (minor and major) immediately (c) Central mechanism to report and monitor various types of data daily.

While this decision making is dynamic, there needs to be continuity of a pattern for a sizeable period. This will enable people to plan their lives and activities with some assurance that there will not be a rapid disturbance. These measures should be made public so that people understand the causal relationship and moderate their conduct (which affect these parameters).

These PPCR recommendations have been presented to the State and local government authorities for further brainstorming and action. 

A.RECOMMENDATIONS ABOUT ADVANCE INDICATORS TO SAFELY UNLOCK/REOPEN

Rule of 5

1. Follow a set of five key metrics
2. Daily New COVID Cases
3. Daily Hospital/ICU COVID Census
4. COVID Positivity rate
5. Availability of hospital beds and oxygen and manpower

e.Longitudinal serosurveillance

2. When on decline, phased reopening
3. Prioritize activity based on health/economic/social needs/benefits
4. Follow metrics with phased opening every 2-4 weeks
5. Maintain hospital and oxygen capacity at all times

Advance Indicators for Decision Making

• Need for direct linkage between advance indicators and decisions .
• Level 0 (completely normal) ; Level 4/5 (complete lockdown)
• Level based operating conditions (for factories, offices, shops).
• No social, public, religious, or political gatherings till the advance indicators are at a safe level.
• Weekly review of levels
• Small committee from PPCR to advise/monitor levels
• Restaurants (indoor dining), cinemas, gyms : closed for some more time

B. RECOMMENDATIONS ABOUT INDUSTRIAL SECTOR

1.Movement of Domain Leaders

All fully vaccinated owners/ CEOs/leaders : allow free movement

2. Application of Weekly Average Positivity Ratio (PR)

• PR should be the Set-off/Trigger for decisions/actions.
• Proposed PR bands : < 10%, 10-20 %, > 20 %.
• Doctors are in the best position to modify these bands on a scientific basis.
• Sector based decision matrix.

3.Opening of Retail Sector

• Demand on factories will happen only if retail opens up.
• Cars, 2 wheelers, garments / electronic appliances / appliances / white goods, etc.

4.Opening of Manufacturing Sector

• Covid behaviour protocol : Strict adherence irrespective of scale.
• Unlock permission : Linked to Demand ( essential and non-essentials both).
• 2-dose vaccination : freedom to be at the place of work at any time
• Tier1-Tier2 manufacturing segments should be opened up for all operations.

5. Opening of Service Sector

• All Service segments : open in phased manner.
• Essential Services : laundries, saloons, stationery shops and more

6.Use of Oxygen for Industrial Use

• Medical Oxygen : demands met , production is high.
• Oxygen should be permitted for use in Industry

C.RECOMMENDATIONS ABOUT SENTINEL TESTING TO MITIGATE FUTURE COVID WAVES

1. How to Choose Measurable Parameters?

• Test Positivity (TP) and Case Fatality Ratio (CFR)

2. Based on analysis of PMC’s COVID data (1st and 2nd wave), we propose the following:

• Establish “Sentinel Testing” : randomized testing across PMC.
• To keep TP level below 5-10%: 100 tests/100,000 persons
• Perform random testing of 4000 persons : every 3 days atleast.
• Sentinel Testing Data : digitisation and real-time analysis
• Increase in cases : increase in number tested
• Can identify high TP at the individual Prabhag level.
• Testing can be intensified in such locations as soon as high TP is detected.

3. What would be the Methodology to Implement Above Recommendations?

       How should we increase testing?

1. Low TP and high CFR: Increase contact tracing and testing of low-risk contacts
2. High TP and low CFR: Increase random testing
3. High TP and high CFR: Maximum increase in testing, using contact tracing and random testing.

      Which testing method to use: RAT vs. RTPCR?

1. If RAT is used for sentinel testing, we recommend increasing the number of tests to 125 tests/100,000 persons, or 5000 tests.
2. What will be the Essential Data Requirements?
3. ALL sentinel testing data must be available for analysis within one day of collection.
4. ALL testing and patient data from public and private labs must be made available for analysis within a week.
5. Ward-level information of daily tests and positives should be made available within a week.

D.RECOMMENDATION TO UNDERTAKE PUBLIC HEALTH DATA COLLECTION

• Continuous and real-time data analysis : epidemiological and clinical data sets , AI-ML
• Continuous genomic surveillance for SARS Cov-2 genome variants
• Breakthrough infections : Cases positive despite vaccination.
• Sewage Surveillance : Industrial areas ( low TPR) and non-containment zones.
• Sewage Signal : Increase symptomatic surveillance in community new home-based test if cheap.
• Sentinel surveillance among certain at-risk groups.
• Short- and medium-term cohort studies on immune response to vaccination.
• Community survey : correlating immunotyping to various comorbidities in the population
• High risk/Severe cases : Nutrition deficiency and serum biochemical parameters

E.RECOMMENDATIONS FOR UNLOCK ABOUT VACCINATION

• Continue vaccination drives above 18 years aggressively
• Allow masked activities, keep unmasked activities closed
• Schools and colleges not to reopen till vaccinated
• Restaurants to run at 50% capacity only for vaccinated people
• No marriage/religious ceremony till vaccination crosses 60% in city.
• Malls, shops to open with less crowd but longer hours.
• People who are vaccinated can travel freely.
• Industry at 70% workforce if vaccinated.
• Haircutting salons and spas to start at 50% if they display vaccination status of their employees.

F. RECOMMENDATIONS ABOUT EDUCATION SECTOR

• Continue complete online schooling for all grades
• Continue 15% physical work for school/college staff.
• Grade 10th and 12th : 3 times a week , practical classes only
• College/University students: only 15% essential services related attendance.
• Online learning : less than 3 hours sessions, physical homewors
• Outdoor Activities : mandatory masks , parks/gardens, adult supervision
• Mental Health : Increase playtime, home/social activities, reduce gadgets exposure

G. RECOMMENDATION ABOUT COMMUNICATION WITH PUBLIC

• Unambiguous Public Messaging: Regular and frequent official communications
• Official COVID norms and enforcement : Unlock, rules for various establishments
• Data Access : open access to Testing data and protocols for applying restrictions
• Communication Campaigns: Social distancing and wearing masks in all public places.

CONTRIBUTIONS

PPCR : Mr. Sudhir Mehta, Mr. Mukesh Malhotra Mr. Pradeep Bhargava, Dr Ganesh Natarajan and several members

Pune Knowledge Cluster : Dr Ajit Kembhavi, Dr LS Shashidhara, Dr Santosh Dixit, Dr Joy Mervin Monteiro, Dr Rupa Mishra, Dr Ashwini Keskar

CPC-Analytics : Mr. Sahil Deo, Mr. Omkar Sathe, Mr. Shardul Manurkar

DeAsra Foundation : Dr Anand Deshpande, Ms. Pradnya Godbole, Ms. Anshika Kushwaha

Special Thanks : Dr Manoj Jain (Emory University, USA), Dr Karishma Kaushik (Savitribai Phule Pune University) , Dr Bhooshan Shukla (Trimiti Clinic, Pune)