Operational Guideline for Containment and Surveillance Plan for Third Wave of Covid-19 in Mizoram

Aizawl, the 31st January, 2022

Subject: Operational Guideline for Containment and Surveillance Plan for
Third Wave of Covid-19 in Mizoram.
No.D.33011/39/2022-HFW(SOP): In the interest of public service and in order to
contain and check transmission of SARS COV 2 (Covid-19) Virus, and to reduce
morbidities and mortalities on account of the Third Wave of the Covid-19 pandemic
in the State of Mizoram, the Governor of Mizoram is pleased to notify Operational
Guideline for Containment and Surveillance Plan for Third Wave of Covid-19 in
Mizoram as attached herewith.
The said Operational Guidelines shall be effective immediately until further
Secretary to the Govt. of Mizoram
Health & Family Welfare Department
Copy to:
1. Secretary to the Governor, Govt. of Mizoram.
2. P.S to Chief Minister, Govt. of Mizoram.
3. P.S. to Deputy Chief Minister, Govt. of Mizoram.
4. P.S to Speaker, Ministers, Deputy Speaker, Ministers of State, Deputy Govt. Chief Whip,
Vice Chairman, Lunglei HPC, Vice Chairman, State Planning Board.
5. P.S to MLA & Vice Chairman, H&FW Board.
6. Sr. PPS to Chief Secretary, Government of Mizoram.
7. PPS to Secretary, Health & Family Welfare Department.
8. PPS to Secretary, Home/DM&R Department
9. All Deputy Commissioners, Mizoram.
10. Principal Director, Health & Family Welfare Department.
11. Director, Health services.
12. Director, Hospital & Medical Education.
13. Director, Information & Public Relations for wide circulation.
14. Mission Director, NHM.
15. Director, Zoram Medical College, Falkawn.
16. Controller, Printing & Stationeries with five (5) spare copies and soft copy (MS Word
file) for publication in the Official Gazette.
17. All Chief Medical Officers.
18. All Medical Superintendents.
19. Web Manager, IT Section, Directorate of Health Services.
20. Guard file.


[Notified vide Memo No. D.33011/39/2022-HFW (SOP) dated 31.01.2022]
1.1 The whole world is currently witnessing a dramatic disruption of everyday life
owing to the rapid progression of COVID-19 Pandemic for more than 2 years now.
All the States and UTs of India, including Mizoram, are being ravaged by the deadly
second wave.
1.2 With the surge of COVID-19 in the State of Mizoram, the trends of transmission
suggest that no age group is being spared and the disease has spread to far flung
villages across all districts. Health experts have warned that as long as SARS-CoV2 is around, the possibility of a new wave cannot be ruled out. Though the
possibility of a third wave is imminent, it is difficult to predict its timing and
intensity, of which will depend on four factors:
➢ Vaccination.
➢ COVID Appropriate Behaviour.
➢ Virus mutations/variant.
➢ Infection rates.
With the emerging Variants of Concern and at present the wave of Omicron is
spreading across the globe, Mizoram also needs to keep a close vigil and, in this
light, certain operating procedures are being constantly reviewed and revised.
1.3 WHO Parameters: The WHO has set several parameters for epidemiological risk
assessment out of which 3 parameters are taken for comparison with the data of
Mizoram as follows:
Indicator Measure Thresholds and
Warning Levels
Position of
(Jan 24, 2022)
Case Incidence:
new confirmed
cases per million
per week
Measure of
<100 (green)
6199 (red =
extreme risk)
100-<200 (yellow)
200-<500 (orange)
≥ 500 (red)
Percent change in
cases: current week
versus previous
Measure of increase
in cases
≤ 0 % (green)
10% (yellow)
1 -< 50 % (yellow)
50 -< 99 % (orange)
> 99 % 5 (red)
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Test Positivity
Rate (TPR): one
week average
Measure of
< 1% (green)
16% (red)
1-< 2% (yellow)
2 -< 5% (orange)
≥ 5% (red)
Note: Meeting any one of the 3 parameters for code ‘red’ calls for a Warning Level
4 (extreme risk).

1.4 Although the rate of COVID-19 in children is lower than adults with milder
symptoms and better prognosis, it is difficult to predict the ramification of this
disease in the near future. Despite all Containment efforts, it has also been seen that
mortality continues to be more among elderly population with co-morbidities. So,
it becomes prudent to safeguard the lives of susceptible and at-risk population,
namely, unvaccinated population below 18 years of age, elderly population with coexisting morbidities, pregnant women, immune-suppressed individuals and those
who have not been fully vaccinated.
1.5 As per latest report (22nd January 2022), Mizoram has recorded a total caseload of
159484, with 10,724 active cases and 580 deaths. Total positivity rate based on
latest test results is currently at 19.35% which strongly calls for stringent control
measures which need to be imposed at the earliest.
1.6 With increasing cases of Omicron variant being reported in adjoining States and the
presence of the already circulating Delta strain, there is increasing threat of surge of
positive cases overwhelming the system. Even though evidence suggests that
Omicron is less severe than previous strain, the extremely high rate of spread,
combined with its ability to evade both full immunization and the body’s immune
system means the total number of patients requiring hospital care at any given time
is still of great concern.
1.7 So with this background, and in pursuance of the existing Containment and
Surveillance Plan on COVID-19 (No.D. 33011/22/2020-HFW(nCOV)/Pt.III, the 9th
June, 2020), a new guideline has been prepared to counter the Third wave of
COVID-19, which is intended to provide specific guidance to Programme Managers
at all levels and Districts for strengthening the Containment and Surveillance efforts
on COVID-19 within Mizoram.
1.8 In 2022, state level pandemic response plans and strategies have to be more
nuanced, granular, differential and based on composite indicators. While daily
new cases need to be tracked, strategies have to be equally informed by the
clinical condition of those who test positive. If the majority of cases are
asymptomatic and mild, the approach has to be different. Hospitalisationrelated indicators, such as hospital admission rate, how it is changing, number
of patients on oxygen beds, ICU admissions and death rate must be considered.

Page 3 of 14

The local context in terms of sero-positivity and vaccination rate needs to be
looked at. Restrictions on economic activities have to be minimal and graded.
More importantly, response has to be proportionate to the situation at that
point in time, with preparedness for a surge.

2. OBJECTIVE: The main objective of the Government is to contain and stop
transmission and to decrease morbidities and mortalities related to third wave of
COVID-19 in a defined geographic area as per current SOP being used in Mizoram.
Various actions are being taken to achieve this objective as indicated below:
(1) Screening of passengers at all entry points namely, Lengpui Airport, land
crossings at Kawrpuichhuah, Vairengte and Bairabi, Zokhawthar and
Khawkawn with Home Quarantine for minimum of 7 days for suspected cases
as per current SOP used in Mizoram dated 6th December 2021. This activity is
still important in order to check import and incursion of new cases and new
strains into the State.
(2) Surveillance and Contact Tracing of Laboratory confirmed case by Health
Department in co-ordination with Local/Village level Task Force
(LLTF/VLTF). The symptomatic contacts of a positive case shall be tested at
the earliest and asymptomatic contacts shall be tested after 5 days of exposure.
Door to door case search, testing of all SARI/ILI and vulnerable/co-morbid
(3) Surveillance for detection of clusters: District Surveillance Unit (IDSP) to
detect clustering if any, of fever cases, SARI (Severe Acute Respiratory
Illnesses) and ILI (Influenza like illness).
(4) Early Diagnosis and Treatment - Diagnosis of a confirmed case will be
followed by Isolation of the case (at home or at a designated 4C/3C facility)
and daily monitoring on health progress, early referral to DCHC or DCH if
symptoms worsen. Regular monitoring of home isolated patients through call
centre/ home visits/telephonically need to be ensured so that the virus does not
spread to others in view of its high transmissibility. Close contacts with history
of potential exposure (contact with a confirmed case for more than 15 minutes,
not using facemask and maintaining a distance of less than 6 feet) of a
laboratory confirmed case shall be immediately quarantined and tested as per
the existing State Notification on Contact Tracing, Testing and Quarantine
dated 29th December 2021 till the SOP stands.
(5) Clinical Management: Increased bed capacity, other logistics like
ambulances, mechanism for seamless shifting of patients, availability and
operational readiness of oxygen equipments, buffer stock of drugs need to be

Page 4 of 14
(6) Vaccination: All efforts to scale up vaccination for COVID-19 among eligible
age groups as quickly as possible with special focus on vulnerable groups,
Healthcare /frontline workers. Ensuring high coverage with vaccination is a
pivotal strategy for preventing future surge in COVID cases. Districts are to
identify pockets of low coverage, do reason analysis and address issues in order
to improve coverage.
(7) Risk communication and Community Engagement to the general public to
create awareness and promote COVID Appropriate Behaviour. It must be
reiterated in all localities on a daily basis that behavioural vaccines offer best
defence against all variants of SARS-CoV-2. Behavioural Vaccines include
proper and consistent use of Facemask, hand hygiene and maintaining adequate
physical-social distance. Various channels of communication maybe used for
IEC purposes – miking, TV scrolls, newspaper, pamphlets, talk shows, social
media etc. The community also is to be informed of facts to allay fear, avoid
panic and rumours.
As per letter order NO.C.16011/303/2020-DC(A), Dated 15th January 2022
and in pursuance of Disaster Management Act, 2005 Section 33 & 34 (m),
it had been decided that CAB Implementation Team has to be formed in
all locality and village under VLTF/LLTF. Once this is formed, it must be
ensured that CAB is strictly enforced under VLTF/LLTF.
This containment strategy would be to contain the disease within a defined
geographic area by early detection, breaking the chain of transmission and thus
preventing its spread to new areas. This would include geographic quarantine, social
distancing measures, enhanced active surveillance, testing all suspected cases, home
quarantine of contacts, social mobilization to follow preventive public health
4.1 Institutional mechanisms and Inter-Sectoral Co-ordination:
(1) Though the routine practice is identification of Containment and Micro
Containment Zones in high-caseload areas, additionally, in order to intensify control
efforts and have a more decentralized mode of operation, Authorities of District
Administration and Health Department will coordinate in daily data analysis of 7
days trends and identify Orange/Red Zones within their respective Districts.
(2) The Rapid Response Team (RRT) constituted by the Government for the District
and the Staff of the CMO Office concerned will conduct thorough risk assessment
of the Locality(ies) in the identified areas/clusters and the Deputy Commissioner
Page 5 of 14
and the Incident Commander(s) concerned shall be intimated for declaration of
Orange Zone or Red Zone or, as the case may be, Containment Zone.
4.2 Definition and Declaration of Green, Orange and Red Zones:
(1) Certain thresholds are specified for parameters indicating the levels of Covid-19
threat, for declaring specific areas into Green Zone (no threat), Orange Zone
(moderate threat) and Red Zone (high threat level) as shown in the Table-1 below.
Table-1: Parameters and thresholds for declaration of appropriate Zones.
Parameter Green
1 Newly diagnosed cases per 1000
population per week per locality/ village
< 5 5 – 10 10
2 Doubling rate (calculated over 7 days
> 10 days 7 – 10 days < 7 days
3 Case Fatality Rate < 0.5% 0.5 – 1% > 1%
4 Total Positivity Rate during the last 7
< 2% 2 – 5% > 10%
Note: The 7-day period will be counted from Tuesday to Monday of the next week.
(2) If any of the thresholds specified for any of the parameters is met in a
locality/village, then, based on the finding and recommendations of the RRT
concerned, the area concerned will be declared as Orange Zone or Red Zone.
(3) Keeping in mind the higher transmissibility of OMICRON, States/UTs can take
containment measures and restrictions even before these thresholds are reached,
and Bed Occupancy of 40% or more on oxygen supported or ICU beds in a
District may also be taken as trigger for action for declaration of appropriate
(4) The Rapid Response Team in association with the LLTF/VLTF concerned will
continue the Active Case Search along with “Test, Track and Treat” mode of action;
and identify areas with surge in positive cases based on the outcome of the situation
analysis, and submit their Report with recommendation for declaration of
appropriate Zone (Orange/Red Zone) to the Deputy Commissioner under intimation
to the Incident Commander concerned.
(5) On receipt and acceptance of the RRT’s Report, the Deputy Commissioner will
declare the area concerned as appropriate Zone, by issuing a speaking Order.
(6) Orange Zones will be used as Warning Triggers to promptly activate measures to
stop the transmission chain with a view to avoid declaration of Red Zone.
Page 6 of 14
4.3 Activities in Orange Zones:
The SOP issued by the the State Disaster Management Authority (SDMA), or as the
case may be, by the Deputy Commissioner will be strictly enforced within the
Orange Zone.
4.4 Activities in Red Zones: The following activities/ restrictions are recommended in
respect of Red Zones.
(1) Socio-economic activities:
• Restriction of movements – no unchecked influx of people and transport.
• All social/political/religious/sports/entertainment/cultural gatherings may be
halted except burial ceremonies.
Permissible with Restrictions:
(a) Movement of individuals and vehicles may be allowed with restrictions as may
be deemed appropriate by the Deputy Commissioner concerned.
(b) No intra-district and inter-district plying of commercial passenger vehicles for
a District which is wholly declared a Red Zone.
(c) Only in places where workers are available on site may be allowed to continue
Construction works.
(d) All shops except essential services are to remain closed in market places.
Standalone shops including groceries within a residential area may be permitted
to remain open ensuring strict compliance with the CAB.
(e) Shopkeepers should display vaccination certificates, if available, on visible
areas of the shop and ensure that all their customers wear masks, sanitize hands
and maintain social distancing while shopping. Customers should not be
allowed to stay long period inside the shop.
(f) E-commerce activities may be permitted without any physical contact.
(g) Functioning of Government offices may be as per the standing State SOP.
(h) In marriage gatherings and burial services, 50 people or half the seating
capacity whichever is less may be allowed, provided that attendees strictly
follow CAB. The LLTF/VLTF concerned shall monitor and ensure compliance
with this restriction.
(i) Night curfew to be strictly imposed in the Red Zone areas.
(j) The Deputy Commissioner concerned will ensure compliance with the
restrictions imposed in a Red Zone by deploying necessary personnel.
Page 7 of 14
(k) Few additional activities beyond essential activities may be allowed, including
functioning of important offices and institutions within the Containment
Zone with such restrictions as may be deemed fit by the Deputy Commissioner.
Note: Delivery of public services shall be ensured.
(2) Surveillance activities: After a Red Zone has been declared, the District RRT in
association with the LLTF/ VLTF concerned will do a section wise ground situation
analysis (risk assessment) of that area, and the findings will be reported to the
District Administration and District CMO Office and recommend sections where
there is clustering of cases to be declared as containment or micro-containment
(3) The District RRT shall submit their daily report to State RRT/ IDSP and the Deputy
Commissioner concerned. The Deputy Commissioner shall conduct a meeting every
fortnight and review activities undertaken in the District.
This is the primary area where intensive action is to be carried out with the aim of
breaking the chain of transmission.
5.1 Identification of Containment Zone:
(1) Whenever a Red Zone is declared, then within that Red Zone, the District RRT/
CMO team in association with the LLTF/VLTF concerned, shall identify the area(s)
and demarcate the same for declaration as Containment/Micro Containment Zone
and Buffer Zones, with technical inputs from local level.
(2) The area should therefore be appropriately defined with clear description of the
boundaries and entry and exit points, and the report and recommendation should be
submitted to the Deputy Commissioner.
(3) Once the Containment Zone is delineated the perimeter will be defined and there
should be strict perimeter control with:
i) Establishment of clear entry and exit points.
ii) No movement to be allowed except for essential goods and services.
iii) No unchecked influx of population to be allowed. People transiting to be
recorded and followed by LLTF/VLTF.
5.2 Declaration of Containment Zone:
(1) The Deputy Commissioner, on accepting the report on the demarcation of the
proposed Containment Zone, will declare the Containment Zone/ MicroContainment Zone along with Buffer Zones by issuing a speaking Order. It should
be noted that depending on the findings of the epidemiological risk assessment,
Page 8 of 14
any area (Green/Orange) may be directly declared as Containment without
first declaring it as Red Zone.
(2) Daily co-ordination will be done; and mandatory activities undertaken within
containment Zones will be reviewed invoking the Mizoram Epidemic Diseases
(COVID-19) Regulations 2022.
(3) As far as practicable, all Containment Zones and Buffer Zones are to be digitally
mapped; and the Department of Land Revenue & Settlement may be associated with
for the purpose if deemed necessary by the Deputy Commissioner.
(4) As per latest guidance note issued by Secretary, MOHFW (D.O. No. Z. 28015/ 318/
21-EMR, Dated 21 December,2021), the main elements of the framework to be used
by States and UTs to facilitate decision making at the District level are as follows:
(5) If several Red Zones are declared within a particular District, the entire District may
be declared a Red Zone by the State Government.
Buffer Zone is an area around the Containment Zone where new cases are most
likely to appear.
(1) A Buffer Zone will be delineated around each Containment Zone.
(2) It shall be appropriately defined by the District Administration with technical inputs
at local level as deemed necessary.
(3) Buffer Zone will be primarily the area where additional and focused attention is
needed so as to ensure that infection does not spread to adjoining areas. For effective
containment, it is of paramount importance that the buffer Zone is sufficiently large.
(4) The focus areas of action in the Buffer Zone include:
i) Extensive surveillance for cases through monitoring ILI/SARI cases in health
facilities – Random samples maybe collected for testing and based on the
findings, Containment Zone maybe extended accordingly.
ii) The RRT shall identify health facilities (Government & Private), healthcare
workforce available (ASHA/ANM/AWW & Doctors in PHCs/CHCs and
District Hospitals).
iv) All health facilities (including Private Hospitals and Clinics/ Labs) to report
clinically suspect cases of COVID-19 on real time basis to the concerned CMO.
v) Concerned LLTF/VLTF in association with healthcare workers should create
community awareness on preventive measures such as personal hygiene, hand
hygiene and respiratory etiquettes through public announcement, social media
and counselling. vi) Enforce CAB through enhanced IEC activities and ensure
social distancing.
Page 9 of 14
(5) In the Buffer Zone, few additional activities beyond essential activities, can be
allowed as deemed fit by the Deputy Commissioner.
The premises of Containment Zones shall be sealed and no one in that area is
allowed to step out of their houses. The lanes surrounding the Containment
Zone are also cordoned off and Police/COVID Executive Duty/LLTF/VLTF are
deployed at all entry and exit points. The movement of people in and out is
restricted, except for medical emergencies and for maintaining supply of essential
goods and services. Violation of these restrictions is punishable under law.
7.1 Surveillance:
(1) The Rapid Response Teams will list the contacts of confirmed cases and will map
the contacts to determine the potential spread of the disease, and shall coordinate
with Incident Commander and LLTF/VLTF activities like Active Case Search,
monitoring, testing, isolation and facilitating referral system.
(2) Line listing of cases should be done in Active Case Search (ACS) in containment
Zone and the record thereof will be maintained in the formats at Annexures 1 - 3.
(3) All the strategies for Surveillance and containment protocol will be followed with
special focus on the following points as soon as a Containment Zone has been
➢ It is imperative to constitute a dedicated District Rapid Response Team in each
District of Mizoram in order to expedite Surveillance and Containment
➢ The Medical Officers in their jurisdiction will automatically be designated as
the Team Leader at sub district level for surveillance and containment activities.
➢ All tests carried out within a Containment Zone or outside must be done with
prior approval from the concerned Chief Medical Officer.
➢ Priority for testing should be given to all vulnerable groups – people with
comorbidities, senior citizens (above 60yrs) and pregnant women. Healthcare
and frontline workers also be included.
➢ Self-test should not be recognised.
➢ SRF number should be generated for all Negative and Positive test reports
wherever and whenever a COVID test is conducted.
➢ Passive surveillance for ILI/SARI shall be continued in the Buffer Zone.
(4) Surveillance for variants: In order to select appropriate samples for Whole
Genome Sequencing (WGS), RRTs of each District are to sensitise Sentinel sites
to take the following cases into account:–
Page 10 of 14
(a) Breakthrough infections.
(b) Re-infections.
(c) Unexpected discordance between diagnostic tests e.g., testing positive by
Antigen and then negative by PCR or vice versa.
(d) Unusual clinical presentations.
(e) Cases with unexpected poor response to therapeutics.
(f) Immuno-compromised patients.
(5) Vulnerable groups may be identified and demarcated within the Containment
Zones; and their well-being followed up. Positive contacts identified are to be
managed as per standing State SOP.
7.2 Testing Modality: All testing shall be conducted as per current Testing protocol
used in Mizoram, while focusing on vulnerable groups.
7.3 Operational activities including Active Case Search (ACS), Intensive contact
tracing, line listing of contacts, Quarantine and Isolation protocols will be continued
as per standing State SOP. IEC and Risk communication regarding personal
hygiene, Covid appropriate behaviour must be enforced.
7.4 All other containment protocols regarding closure of educational institutions,
offices, religious institutions, cancellation of mass gatherings, movement
restrictions of public and transport shall be followed as per standing SOP, viz.–
Containment and Surveillance Plan on COVID-19(No.D. 33011/ 22/ 2020-HFW
(nCOV)/ Pt.III, dated 9
th June, 2020.
(1) The operations will be scaled down if no secondary laboratory confirmed COVID
19 case is reported from the containment Zone 10 days from the last confirmed case
and all contacts have been followed up for 10 days.
(2) However, if new cases are reported from the same Containment Zone or its Buffer
Zone before the mandatory 10 days have elapsed, the containment days shall be
extended as necessary. At the same time, within a wide Containment Zone, specific
areas with clear geographic demarcations and zero case incidence for 10 days may
be de-contained and excluded from the containment Zone depending on field
(3) Surveillance will continue for ILI/SARI even after de-containment. The Healthcare
Workers including ASHAs mapped within the Containment Zone will continue to
follow up all
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(4) Fever/ILI/SARI cases, and report to the Medical Officer in charge and ensure that
testing is conducted. Contact tracing efforts will also continue and intermittently be
followed by the Health team as the situation demands.
9. INEFFECTIVE CONTAINMENT: In case the containment plan is not effective
and new outbreaks continue to occur, then a decision will need to be taken by State
Government to abort the containment exercise and start on mitigation activities.
(1) Principal Director and State Nodal Officer, IDSP are to oversee manpower and other
logistics requirement to be utilised within Containment Zones.
(2) Transportation/ Mobility Support/Human resources: Adequate number of vehicles
and human resources required for mobilizing the RRTs and supervisory teams may
be pooled from Government departments by the Deputy Commissioner &
Chairperson of the District Disaster Management Authority concerned. The
shortfall, if any, may be requisitioned from other Districts subject to prior
concurrence of the State Government. In case of emergency where the
aforementioned course of action could not be followed, private vehicles may be
hired as per standing norms of the State Transport Authority (STA).
Date of ACS:________________
Veng:______________________ ACS titu te:
No. Particulars
Name &
Chhungkaw member zat
Chau/ Rawl
Taksa/ ruh nâ
Chawei tui lo
Rim hriatna hloh/ hnâra
rimchhe châm
Thlum leh al hriatna hloh
Positive Contact
(High/low risk)
Vaccination Status
H/O Covid-19 Test
1 Head of
Contact No.
No Veng/khua
Total CZ
lak zat
CZ hlih
hnu a

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