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New Delhi, Mar 27: Cabinet Secretary Rajiv Gauba has asked states to urgently strengthen the surveillance of international travellers who entered the country before the lockdown as there appeared to be a "gap" between the actual monitoring for COVID-19 and the total arrivals.

In a letter to chief secretaries of all States and Union Territories, Gauba said such a gap in monitoring of international passengers for coronavirus "may seriously jeopardise the efforts to contain the spread of COVID-19", given that many amongst the persons who have tested positive so far in India have history of international travel.

"As you are aware, we initiated screening of international incoming passengers at the airports with effect from January 18, 2020. I have been informed that up to March 23, 2020, cumulatively, Bureau Of Immigration has shared details of more than 15 lakh incoming international passengers with the States/UTs for monitoring for COVID-19.

"However, there appears to be a gap between the number of international passengers who need to be monitored by the States/UTs and the actual number of passengers being monitored," Gauba said in his letter.

The government had started monitoring of all international passengers who have arrived in India in last two months in the wake of the coronavirus outbreak.

Gauba said,"it is important that all international passengers are put under close surveillance to prevent the spread of the epidemic."

He said the Ministry of Health and Family Welfare (MoHFW) has repeatedly emphasised the importance of monitoring, and requested the states and UTs to take immediate steps in this regard.

"I would, therefore, like to request you to ensure that concerted and sustained action is taken urgently to put such passengers under surveillance immediately as per MoHFW guidelines," he said.

The cabinet secretary also urged the chief secretaries to actively involve the district authorities in this effort.The screening of international incoming passengers at airports was done from January 18 in a phased manner.

The Central and state governments have unleashed unprecedented and extraordinary measures to contain the spread of the fast-spreading coronavirus, which has already infected more than 700 people in the country and claimed at least 17 lives.

A nationwide lockdown was also announced by Prime Minister Narendra Modi on Tuesday for 21 days.

The Ministry of Health and Family Welfare has prepared a draft for guidelines for home quarantine, as well as for the use of masks by public, in view of coronavirus.

What to do in Home Quarantine?

The government says, for those taking refuge to home quarantine should stay in a well-ventilated single-room preferably with an attached or separate toilet. It adds that if another family member needs to stay in the same room, it's advisable to maintain a distance of at least 1 metre between the two.

The government advised, coronavirus patients to stay away from elderly people, pregnant women, children and persons with co-morbidities within the household as their immune system may be low. The health minister also suggested to restrict the patient's movement within the house. "Under no circumstances attend any social/religious gathering e.g. wedding, condolences, etc, said the guideline.

It also instructed the corona virus infected person to avoid sharing household items like dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items with others at home. The guideline also demanded that even though home quarantine, the patient should wear a surgical mask at all times. "The mask should be changed every 6-8 hours and disposed off. Disposable masks are never to be reused, it added.

"Masks used by patients/ caregivers/ close contacts during home care should be disinfected using ordinary bleach solution (5 per cent) or sodium hypochlorite solution (1%) and then disposed of either by burning or deep burial," instructs the government.

Even for family members of a patient, the health ministry clearly instructs to use disposable gloves when cleaning the surfaces or handling soiled linen. No visitors, under any circumstances will be allowed, said the guideline.

"In case the person being quarantined becomes symptomatic, all his close contacts will be home quarantined (for 14 days) and followed up for an additional 14 days or till the report of such case turns out negative on lab testing," states the draft.

How to wear & dump masks?

There is a specific and elaborate do's and don'ts also released by the ministry. For those unsure in which mask to choose, it says, "Medical masks of different sizes and shapes are available in the market. The common ones are flat pleated masks of woven fabric which covers the nose and mouth and affixed behind the head with straps/ elastic fasteners. There are also conical or duck bill shaped masks with valves (or without valves) that fit in the contour of face over the nose and mouth, but are costlier."

However, the ministry warns, medical masks should not be used by healthy persons who are not having any symptoms "because it creates a false sense of security". Instead, it suggests to refrain from touching face, mouth, nose and eyes as well as washing hands regularly with soap for 20 seconds each time.

However, when a person develops a cough or fever, the suspected patient needs to switch to medical masks. "Use of medical three layer masks when ill, will prevent your infection from spreading to others. However you also need to wash your hands frequently to avoid spreading infection to others," read the guideline.

Even if one is not tested positive but showing symptoms, they are advised to wear masks while visiting a healthcare facility. "Close family contacts of such suspect/confirmed cases undergoing home care should also use Triple layer medical mask," it warns.

The ministry has also given point by point guideline on how to use a mask like to make sure that they are facing down while unfolding or for that matter to ensure there are no gaps on either side of the mask.

It even warns, "Fit flexible nose piece (a metallic strip that can easily be located) over nose-bridge" to ensure no one else are infected. The government also warns against simple dumping of the masks once used. Instead one should disinfect "using ordinary bleach solution (5 per cent) or sodium hypochlorite solution (1 per cent) and then disposed of either by burning or deep burial," says the Health Ministry.

COVID-19 emerged in early December 2019 in China's Wuhan province and has now spread to over 100 countries. As on March 9, 2020, India has reported 42 cases mostly among those who had travelled from affected countries.

However the government says, "It causes a minor illness in majority of patients with symptoms of fever and or cough. A small proportion of such persons may progress to severe disease with difficulty in breathing."