New Delhi (TIP): The Indian government has rushed expert teams to six states showing an increase in Covid-19 cases of late, the health ministry said on Friday, and top officials reiterated warnings that the second wave has not receded fully and that states must bring back restrictions if infection or hospitalisation trends cross certain thresholds.

The warnings come at a time when cities have recorded increased rush at markets and places of business as lockdowns are lifted. Friday’s announcements identified six states where “localised” pockets are causing concern: Kerala, Arunachal Pradesh, Tripura, Odisha, Chhattisgarh and Manipur.

The six states together accounted for, on average, 36% of the daily cases seen across the country over the seven days to Thursday, with Kerala alone accounting for 26%, or 11,815new infections a day. The seven-day daily case numbers of the other five states are: Arunachal (279 cases a day), Tripura (389), Odisha (3,184), Chhattisgarh (357), and Manipur (590). As of Thursday night, these six states also accounted for 29% of the 516,378 active cases in the country.

“There are 71 districts that are showing a test positivity rate of over 10%… The second wave is still not over,” said Lav Aggarwal, joint secretary, Union health ministry, at a press briefing on Covid-19 on Friday, July 2.

The official added that states have been asked to identify locations where the test positivity rate is above 10% or hospital occupancy is higher than 60%, and implement strict restrictions which should be in place for at least two weeks.

Aggarwal’s caution was echoed by Niti Aayog member (Health) VK Paul, who said that outbreaks must now be nipped as soon as possible. “There still are certain problematic districts that are being closely monitored. Expert teams of the health ministry have been deployed in some of these states such as Kerala, Odisha, Manipur, Chhattisgarh, etc. The pockets of outbreak that are currently visible, those need to be nipped right there as these are in localised pockets at the moment. We do not allow it to spread further,” he said.

The teams sent to each state comprise two members – a clinician and a public health expert. They will assess the overall management of Covid-19, particularly testing, surveillance and containment operations, and monitor the enforcement of Covid-safe behaviour among the public.

The teams will also assess the Covid-19 vaccination speed and as a whole, suggest remedial actions, the health ministry said.

An analysis of case numbers from the six states identified by the government suggest that as a whole, most of these regions are not particularly logging a resurgence, but that the problem may be in particular districts.

According to the University of Michigan-led COV-IND-19 Study Group, Arunachal Pradesh and Nagaland (not identified as one of the six states), have an effective reproduction number (R) of more than 1 – which suggests the outbreak in these regions is growing. No other state reported an R number above 1. Kerala and Maharashtra have an effective R number of 0.97 and 0.96, but the latter has recorded a consistently high test positivity rate of around 10% — this proportion should be below 5% for an outbreak to be considered under control.

Officials said that of particular concern were some pockets in the northeastern states. “Certain north-eastern states are showing increase in case load and containment is important in these states as there are many hard to reach areas in these states where health care delivery system is not as strong. Therefore, it is important to stop the spread before it grows beyond control,” said a senior central government official, who asked not to be named.

Paul said close monitoring is crucial at this stage and the country “cannot lower its guard”. “As we are seeing in Europe right now, the disease transmission has started growing again, with cases having dropped to 50 per million at one point, which is now almost double… It is in our control to ensure India doesn’t see the third wave,” he said.