Although the number of Covid-19 infections remains low in India, the government is intensifying surveillance in emerging coronavirus clusters in the country as cases rise globally, according to people familiar with the matter.

“In fact, Covid numbers are at the lowest both in terms of new cases as well as overall number of active cases. However, globally there is being seen a rise in new cases in certain parts that is a cause for concern. The pandemic is clearly not over yet, which is why India cannot afford to drop guard,” a central government official said, requesting anonymity.

“Surveillance will be continued, and emerging clusters will be closely monitored,” he said. “Directions have been issued by the health ministry in this regard.”

The states and Union territories need to put in place robust surveillance mechanisms to detect early signs of another pandemic wave, health secretary Rajesh Bhushan recently said.

“Effective surveillance by monitoring of emerging clusters of new cases, if any, testing as per norms and monitoring of influenza like illness (ILI) and severe acute respiratory infection (SARI) cases shall be taken up on a continued basis to ensure that no early warning signals are missed and spread of infection can be controlled,” Bhushan wrote in a March 17 letter addressed to all chief secretaries, principal secretaries, and state health secretaries.

States have also been asked to submit adequate samples for whole genome sequencing that detects the Covid-19 variants.

“States should also ensure that adequate number of samples are submitted to INSACOG network through sentinel sites as per the protocol issued by the national centre for disease control (NCDC), which is the nodal agency for INSACOG, to ensure timely detection of new variants while maintaining adequate testing as per the protocols for testing laid by Indian Council of Medical Research (ICMR),” Bhushan said in his letter.

INSACOG, or Indian SARS-CoV-2 Consortium on Genomics, is a forum established under the health ministry to study and monitor Covid-19 variants.

All cases of respiratory diseases admitted to district hospitals across the country will be tested for Covid-19, and samples that test positive will be sent for whole genome sequencing as India heightens its surveillance amid a surge in infections in certain countries in Asia and Europe, HT reported on March 18.

Due to similar symptoms such as cough, fever, difficulty in breathing, chest congestion and tightness, tracking SARI and ILI cases is one of the key surveillance measures proposed by epidemiologists to determine the spread of Covid-19.

Genomic sequencing is crucial for effective outbreak management, an experts said.

“That’s a good strategy as it strengthens a syndromic approach. Further, any special clinical presentations will have to be picked up by high degree of suspicion by clinicians, as we saw initial omicron cases were picked up exemplary work of the South African physicians,” said Giridhara R Babu, head, epidemiology, Indian Institute of Public Health. “Also, at the population level, it is important to pick of cluster of cases and subject a fixed proportion of these for genomic sequencing.”

Health minister Mansukh Mandaviya on March 16 met with officials and directed them to maintain a high level of alertness and surveillance, and carry out genomic sequencing aggressively.

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