Rrt covid19

Rapid Response Team
COVID19
Dr Rishabh Kumar Rana MBBS ,MD
Life Member IEA ,USA :ESCMID, Europe:
IAPSM :IPHA : APCRI : IMA
Assistant Professor
Department of PSM
PMCH DhanbadDr Rishabh Kumar Rana Asst. Prof. , Deptt. of PSM , PMCH
Dhanbad
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Based on!!!
Dr Rishabh Kumar Rana Asst. Prof. , Deptt. of PSM , PMCH
Dhanbad
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Overview
• Quick Case Definition
• Responsibilities of State towards health
• RRT details
• Outbreak and RRT
• How RRT should proceed
Dhanbad
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Case definitions – Suspect case
• A patient with acute respiratory illness {fever and at least one sign/symptom of
respiratory disease (e.g., cough, shortness of breath)}, AND a history of travel to
or residence in a country/area or territory reporting local transmission (See NCDC
website for updated list) of COVID-19 disease during the 14 days prior to symptom
onset;
OR
• A patient/Health care worker with any acute respiratory illness AND having been
in contact with a confirmed COVID-19 case in the last 14 days prior to onset of
symptoms;
OR
• A patient with severe acute respiratory infection {fever and at least one
sign/symptom of respiratory disease (e.g., cough, shortness breath)} AND
requiring hospitalization AND with no other etiology that fully explains the
clinical presentation;
OR
• A case for whom testing for COVID-19 is inconclusive.
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State Public Health responsibilities
• Reduce disease burden
• Control diseases identified in IDSP program
• Maintain the status of diseases eliminated/eradicated
• Respond to outbreaks
• Prevention of the diseases
• Promotion of health
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Cont..
• Availability of good quality data is one of the pre requisite to fulfill state
responsibilities
• Important attributes of good quality data can be summarized by mnemonics
“olfactory”.
• O- original
• L- legible
• F- factual
• A- accurate
• C- correct
• T- timely
• R- real
• Y- yours
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Rapid Response Team (RRT )
• Constitution of RRT team is one of the step in this direction
• Multi disciplinary Team consisting of –
1. Epidemiologist
2. Microbiologist
3. Physician
4. Pediatrician
5. Entomologist
6. State Surveillance officer,
7. District surveillance officer,
8. Public Health Specialist
9. I.T, Communication Expert,
10. Veterinary surgeon
Dr Rishabh Kumar Rana Asst. Prof. , Deptt. of
PSM , PMCH Dhanbad
7

• The team is broad based to fulfill its multifarious responsibilities
• Large number of 60-70% of emerging diseases are vector borne or zoonotic it
is because of increased interphase and encroachment of human population
on the animal habitat.
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Roles and Responsibilities of RRT
• Help the state and district in investigation of outbreak
• Help in analysis of data
• Help in preparation of SOPs for management of disease
• help in identification of cause of outbreak
• Help in drafting recommendation for prevention of future outbreaks
• Coordination with other team members and meet at regular interval
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Expected competencies of RRT members
• Handle data to convert into information and translatable into action.
• Operate surveillance for decision-making
• Respond to limited, localized outbreaks
• Exchange within the health system and other stake holders
• Monitor surveillance activities
Dr Rishabh Kumar Rana Asst. Prof. , Deptt. of
PSM , PMCH Dhanbad
10

The Things which are to be done
• AFTER AN OUTBREAK WHAT DO WE DO ???
• IS THERE AN OUTBREAK ???
• WHAT RRT will DO ????
• DO WE MEET AND GO BACK as USUAL ???
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General Phases of an Outbreak
Investigation
Descriptive Explanatory Response
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Descriptive Phase
1. Prepare for fieldwork
2. Establish the existence of an outbreak
3. Verify the diagnosis
4. Construct a case definition
5. Identify cases and collect information
6. Perform descriptive epidemiology
Descriptive
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Explanatory Phase
7. Develop hypotheses
8. Evaluate hypotheses epidemiologically
9. Reconcile epidemiology with laboratory and
environmental findings
10. Conduct additional studies as necessary
Explanatory
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Response Phase
11. Implement and evaluate prevention and control
measures
12. Initiative or maintain surveillance
13. Communicate findings
Response
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Descriptive Phase
Descriptive
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Tasks to Prepare For Fieldwork
• Form a team
• Learn about the disease
• Make necessary administrative,
personnel, and logistical
arrangements
• Coordinate with partner
agencies and local contacts
Descriptive
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Form a Team
Team Leader
Interviewers Regulators
Epidemiologist Lab Technician
Environmental
Health Specialist
Clinicians
Descriptive
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Descriptive Phase
Descriptive
DescriptiveDescriptive
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More than expected?
The occurrence of more cases of a disease than
expected for a particular place and time
“Usual”, “Expected”
No.CasesofaDisease
Time
“More than expected”
= “Outbreak”
Descriptive
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Descriptive Phase
Descriptive
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Evaluate the Clues to
Verify the Diagnosis
 Signs and symptoms
 Laboratory findings
 Disease onset
 Duration of symptoms
 Suspected exposure
 Suspected virus, bacteria, or
toxin
Descriptive
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Descriptive Phase
Descriptive
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Descriptive Phase
Descriptive
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Find Cases Systematically,
Develop Line List
Signs/Symptoms Labs Demographics
Case
#
Date of
Symptom
Onset Diarrhea Vomiting
Fever
>37oC
Positive
stool
culture Age Gender
1 22/10/14 Y Y
Not
done
Y 19 M
2 25/10/14 N Y N N 17 M
3 22/10/14 N Y N Y 23 F
4 27/10/14 Y ? ? Pending 18 ?
5 23/10/14 N Y N Y 21 M
6 21/10/14 Y Y Y
Not
submitted
18 F
Descriptive
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Descriptive Phase
Descriptive
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Descriptive Epidemiology
•Describe and orient data
•Person
•Place
•Time
Descriptive
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Perform Descriptive
Epidemiology
• Time (epidemic curve)
• Ideally: when were they infected?
• More practically: when did they become ill?
• Place (spot map, shaded map)
• Ideally: where were they infected?
• More commonly: where do they live, work?
• Person (tables)
• Who was infected?
• Numerators and denominators
• What do the cases have in common?
Descriptive
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Explanatory Phase
9. Reconcile epidemiology with laboratory
and environmental findings
Explanatory
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Explanatory Phase
Explanatory
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Explanatory Phase
Explanatory
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Response Phase
measures
Response
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With title
0
2
4
6
8
10
12
14
16
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
NumberofCases
September 2014
Date of Onset
Number of Cases of Disease X
by Date of Onset, District Y, September2014
Descriptive
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Chain of Transmission
Susceptible Host
(via portal of entry)
Route of
TransmissionReservoir
Agent
Response
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Prevention and Control
Measures
• Immediate control measures
• Long-term control measures
Response
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Conduct Surveillance
measures
Response
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Communicate Findings
During the investigation
• Among team members
• To the public
• To health professionals
• To public health officials/policy makers
At the end of the investigation
• Oral briefing
• Written report
Response
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What we will be Doing???
• MOVE WHEN THE OUTBREAK HAPPENS !!!!!!
DESCRIBE EXPLAIN RESPONSE
IDENTIFY
DESCRIBE THE EPIDEMIOLOGY
HARDLY NEEDED !!!
IMPLEMENT CONTROL MEASURES
INITIATE CONTROL MEASURES
COMMUNICATE
ITS ALREADY DONE
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RUN!!! RUN!!!! RUN!!!!
THE CONTAINMENT STRATGEY
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Types of contacts
High Risk
• Touched body fluids of the patient (Respiratory tract
secretions, blood, vomit, saliva, urine, faeces)
• Had direct physical contact with the body of the patient
including physical examination without PPE.
• Touched or cleaned the linens, clothes, or dishes of the
patient.
• Lives in the same household as the patient.
• Anyone in close proximity (within 3 ft) of the confirmed
case without precautions.
• Passenger in close proximity (within 3 ft) of a
conveyance with a symptomatic person who later tested
positive for COVID-19 for more than 6 hours.
Low Risk
• Shared the same space (Same
class for school/worked in
same room/similar and not
having a high risk exposure to
confirmed or suspect case of
COVID-19).
• Travelled in same environment
(bus/train/flight/any mode of
transit) but not having a high-
risk exposure.
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Key considerations – Surveillance
• Surveillance period is for 28 days – (14 days quarantine at home or
hospital or a designated facility and next 14 days is for self reporting).
• Testing –
• All high risk contacts to be tracked, quarantined and lab-tested as per the
protocol.
• For low risk contacts – lab-test only when the person under surveillance
develops symptoms.
• Sample – Throat swab (Details in the session on lab)
• Treatment – No drug(s) or vaccine recommended presently.
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Key consideration – Contact Tracing
• A positive case may have contacts in multiple States/UTs.
• Tracking of all the contacts located in a particular State/UT will be the
responsibility of that State/UT.
• In case of any high risk contact found in the particular State/UT,
sampling to be carried out by respective State/UT along with
Home/Hospital quarantine of the said contact.
• Sampling to be carried out strictly in accordance with the guidelines.
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Containment zone
• A Central RRT will help the District administration in mapping the
Containment Zone.
• The containment zone will be defined based on
• The index case / cluster, which will be the designated epicenter.
• Geographical distribution of cases around the epicenter.
• Local administrative boundaries of urban cities /town
• A scenario based approach (e.g. a small cluster in a closed environment or
single cluster in a residential colony) while deciding the perimeter of
containment zone.
• The decision on perimeter of the containment zone is to be guided by
continuous real time risk assessment.
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Containment zone Cont…
• Implementation of strict perimeter control is vital for the containment of
COVD-19.
• Perimeter control is primarily an administrative measure – Enhanced
surveillance within the perimeter is a part of the larger administrative
response.
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Buffer Zone
• Buffer Zone is an area around
the Containment Zone, where
new cases most likely to appear.
• There will no perimeter control
for the buffer zone.
Containment Zone
Buffer Zone
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Various Scenarios
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Surveillance Activities in Containment Zone
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The residential areas will be
divided into sectors for the
ASHAs/Anganwadi
Workers/ANMs each covering 50
households (30 households in
difficult areas).
Supervisory officers (PHC/CHC
doctors) in the ratio of 1:4.
The field workers (FW) will be
performing active house to
house surveillance daily in the
containment zone from 8:00 AM
to 2:00 PM and also encourage
self reporting.
Line list the family members,
contact listing, identification of
close contacts and all those
having symptoms.
The field worker will provide a
mask to the suspect case and to
the care giver identified by the
family.
The suspect will be isolated till
such time he/she is examined by
the supervisory officer.
Follow up contacts identified by
the RRTs within the sector
allocated to the FWs.
As per case definition the
supervisory officer, visit house,
make arrangements to shift the
suspect case to the designated
treatment facility.
The supervisory officer will
collect data from the health
workers under him/ her, collate
and provide the daily and
cumulative data to the control
room by 4.00 P.M. daily.
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Local transmission – Single cluster
Containment zone
• Isolation & management of case
• Quarantine of contacts
• Enhanced IEC
• Active ARI/ILI Surveillance
• Enhanced self reporting
• Enhanced personal hygiene, hand
hygiene & cough etiquettes
• Establish control room in the local
health facility
• Ban local mass gathering
• Lockdown of identified cluster for e.g.
Schools/residential building/Hotel
Buffer zone
• Enhanced Passive ARI/ILI
Surveillance
• Enhanced Self reporting.
• Enhanced media surveillance
• Trainings on case definitions and
contacts
All health facilities in the containment zone will be listed as a part of mapping
exercise. All such facilities both in Government and private sector (including
clinics) shall report clinically suspect cases of COVID-19 on real time basis
(including ‘Nil’ reports) to the control room at the district level. For Buffer Review of
ILI/SARI cases reported in the last 14 days by the District Health Officials to identify any
missed case of COVID-19 in the community. o Enhanced passive surveillance for ILI and
SARI cases in the buffer zone through the existing Integrated Disease Surveillance
Programme. o In case of any identified case of ILI/SARI, sample should be collected and
sent to the designated laboratories for testing COVID-19.
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Large outbreak – Multiple clusters
• Isolation & management of case
• Quarantine of contacts
• Enhanced IEC
• Active ARI/ILI Surveillance
• Enhanced self reporting
• Enhanced personal hygiene, hand hygiene & cough etiquettes
• Ban local mass gathering
• Closure of schools, offices, colleges
• Environment disinfection
• Refrain from leaving home + Border measures
• Establishment of control room at the block and district level
• Enhanced media surveillance in and surrounding blocks/districts
• Monitoring of rumour register
• Mobile specimen collection units
Containment zone
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Border measures
• Refrain from leaving their homes and moving around from the
containment zone for at least 14 days
• Refrain participating in events held in indoor venues when fever
or respiratory symptoms are detected.
• Employers to cooperate for leaves or absence without a written
diagnosis
• Enhanced entry screening for travellers from containment zone
• Involvement of all concerned departments.
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IEC/BCC activities
• Education department
• Women and Child Development Department
• Transport Department
• Food safety Department
• DADF
• Tourism Department
• Other stakeholders like medical associations, nursing
associations, hotel association etc.
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Dhanbad
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Lets see an Hypothesis
• A Positive COVID19 case
• Name: Mrs.X , Age: 40year, Female
• Address: Ward No.6, Katras
• Travel History: Visited Tablighi Jamaat, New Delhi 10 days
before.
• Symptom: Fever & Cough
• Sample Collected: 2 days before.
• Result : COVID19 positive today evening(Day 0)
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Day 0:
Timelineof
Activities for
Positivecase
Timeline Activities Responsible Person
9 PM One COVID 19 Positive Case
Information to DM/CDMPHO
DM/CS
10 PM Emergency DistrictControl Room
Meeting and Planning for
Containment
DM/CS
10 : 15
PM
Information to local health &
General Administration & Police
DM/SP/CS
By 11PM Block RRT & Police will move to
Patient house for Case Investigation
MOIC KATRAS/BDO
KATRAS
By 12 PM Isolation of Patient
Investigation & Travel
MOIC KATRAS/BDO
KATRAS/BLOCK RRT
Local police will Guard the area and
the case house
KATRAS BLOCK IC
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Day 1:
Timelineof
Activitiesfor
Positive case
Timeline Activities ResponsiblePerson
9AM District RRTwill reach the patient
House
CS/DM
9: 15 AM Detailed Investigation of Case by
District RRT
CS / RRT KATRAS/Police
10:30 Detailed line listing of High Risk
Contacts and Low Risk Contact
DPM/ Epidemiologist
By 11
AM
Shifting of COVID19Positive case
to COVID19Hospital, BBSR
DPM
By 12 PM Collection of Samples from High
Risk Contacts
Microbiologist/ Epidemiologist
By 2PM Shifting of High Risk Contacts
(Household) to Govt. quarantine
facility.(Hotel)
DPM/ Gen. Admin /Police
By 3PM Shifting of Low Risk Contacts to
Govt. quarantine facility.
DPM/ Gen. Admin /Police
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Contact Tracing & travel history of COVID19 case
Mr X. has,
• frequently gone to a tea stall at Ward no. 5
• frequently visited his office at Ward no. 9
• frequently attend a house party at Ward no. 7
• visited a private clinic at Ward no. 4
• has visited a restaurant at Ward no. 10
• Close family members of Mr. X has frequently visited
relatives at Ward no. 8Dr Rishabh Kumar Rana Asst. Prof. , Deptt. of PSM , PMCH
Dhanbad
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MODEL MICROPLAN ncdc.gov.in
Format for contact tracing
SOURCE
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Containment Zone
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Day 2:
Timelineof
Activitiesfor
Positivecase
Timeline Activities ResponsiblePerson
By 11 AM Interdepartmental Meeting at Nagar Bhawan
Katras
DM/SP/CS/EO
Municipality
11: 30 AM Area mapping for containment DM/SP/CS/EO
Municipality
WHO SMO, MOIC KATRAS
12 PM- 2PM Team Planning& Formation, Mobilization of
manpowerfrom ICDS, Education,GRS & other
dept.
MOIC CHC KATRAS , BPM ,
supported by WHO SMO,
3PM Trainingof Team member for House to House
Survey in the containmentarea.
WHO SMO,MOIC KATRAS
4 PM Supervisor Training WHO SMO,MOIC KATRAS
5PM Distributionof Format & logistics(mask , Gloves ,
Sanitizer to team member) for Household Survey
MOIC KATRAS & BPM CHC
KATRAS
By 6PM Finalizationof Containmentarea, Team structure
for Household Survey
District RRT
By 8 PM Declarationof Containmentfollowed by Official
order and informationto Public
DM
Dr Rishabh Kumar Rana Asst. Prof. , Deptt. 60

Training arrangement:on Day 1
By District RRT team member
1.Surveyor: Field surveillance, contact tracing, and reporting
2.Supervisor: Coordination of team, Data compilation & validation , Data
submission to Control room, Coordination for Medical team visit and
sample collection.
3. Medical Team: Case verification and investigation, Treatment as
required.
4. Sample Collection Team: Sample collection , packaging and shipment
of sample.
5.Hospital infection prevention and use of appropriate PPEs and
biomedical waste management
6. Risk communication to general community and health service
providers Dr Rishabh Kumar Rana Asst. Prof. , Deptt. 61

Daily house to house surveillance: start from Day 2
ASHAs/AWW/ANM/ Surveyor will visit @50 Household
/day/team and interact with the family for:
(i) reporting of symptomatic cases
(Fever/Cough or any ARI or ILI case)
(i) contact tracing of all contacts of COVID19 positive
case.
(ii) information on preventive public health measures.
(iii) Sharing of dedicated helpline number.

Wall Marking
To be done for 14 days continuously

Daily Household Survey in Containment Area
Daily Household Survey in Containment Area
Dist:……………………………….Block/UrbanArea……….…………………..Name& Contact No.of Health
Supervisor…………………………………………….
Name, Designation, Contact No. of Team Member 1
Name, Designation, Contact No. of Team Member 2
S.
no
Sect
or
No.
Hous
e No.
Name of Family
member
Age sex Address Phone No
Day
1
Day
2
Day
3
Day
4
Day
5
Day
6
Day
7
Day
8
Day
9
Day
10
Day
11
Day
12
Day
13
Day
14
1
2
3
4
5
6
7
8
9
10
Signature of Team Member 1 Signature of Team Member 2 Signature of Supervisor

Daily report:
•Daily survey report from Surveyor to
supervisor
•Daily Supervisor report to Control room
•Daily Containment area report to District IDSP
•Daily State report

Protection of Health workers
• Full PPE KITS including Face Shield , Head Cover ,
Appropriate Goggles , Waterproof Apron , Double
Gloves , N95 with respirator , Shoe Cover etc. For all
those who will be in close contact with people
• Triple Layer surgical Masks and Gloves for RRT in
vehicles
• Administrative Back up

PPE Logistic Planning

Vehicle Planning
• Ambulance facility
• One for COVID 19 suspected/Confirmed case
• One for Non COVID19 cases
• Vehicle for Sample shipment
• 2-3 Vehicle for Movement of District RRT members
• 11 Vehicle for block RRT/Medical team
• 42 Vehicle for Supervisor
• Pass for vehicles

Control Room setup for containment monitoring
• Control Room to be set up at Katras HQ/ Dhanbad .
• Headed BDO & MOIC KATRAS, BPM, Data Manager
, with support from IDSP Epidemiologist & Data.
• Control Room will provide daily input/Report to the District Control
Room for preparation of daily situation report.
• A call centre will function from control room for telemedicine.
• Monitoring of health, sanitization, supply of essential commodity
activity.
• The Control Room at State/District IDSP Cell will alert all
neighbouring Districts/Block.
Dr Rishabh Kumar Rana Asst. Prof. , Deptt.
of PSM , PMCH Dhanbad
74

Its always about Money $$$$$
Serial Number Item Unit Cost Total Cost
1 Transportation
No. of vehicles hired
POL expenditure for Office vehicles/
ambulances
2 Communication
Cost of printing posters
Hiring personnel for display of posters
3 Logistics
Three layered surgical mask
N 95 mask
PPE
4 Contingency Expenditure
BUDGETING
Dhanbad
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Rrt covid19

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