The Centre on Saturday advised 13 districts across eight states and a Union territory to focus on ramping up testing and addressing delays in diagnosis results, flagging that the coronavirus disease (Covid-19) case fatality rate in these regions was higher than the national average and that they contributed 14% of all deaths due to the disease in India.

At a meeting chaired by Union health secretary Rajesh Bhushan, the states were told to ensure adequate availability of ambulances, according to the Union health ministry.

The 13 districts are: Kamrup Metro in Assam, Patna in Bihar, Ranchi in Jharkhand; Alappuzha and Thiruvananthapuram in Kerala, Ganjam in Odisha, Lucknow in Uttar Pradesh; North 24 Paraganas, Hooghly, Howrah, Kolkata and Maldah in West Bengal, and Delhi.

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The districts account for 14% of all deaths due to Covid-19 in India, according to the Centre’s data. So far, the infectious disease has killed 42,518 people across the country, with 933 deaths being reported on Saturday, according to data shared by the Union health ministry. The case fatality rate — the percentage of deaths among the number of cases detected — stood at 2.04% on Saturday, according to the government’s data. In comparison, the CFR in Delhi stood at 2.8%, even as it reduced from a high of 4.1% in mid-June.

Two high-level meetings, chaired by Bhushan, were held on Friday and Saturday to advise and support states reporting higher number of cases and deaths due to Covid-19.

“These districts account for nearly 9% of India’s active cases and about 14% of Covid-19 deaths. They also report low tests per million and high confirmation percentage… A surge has been observed in daily new cases in four districts — Kamrup Metro in Assam; Lucknow in Uttar Pradesh; and Thiruvananthapuram and Alappuzha in Kerala,” the Union health ministry said.

In view of reports from some areas that patients were dying within 48 hours of being admitted to health facilities, the Union health ministry asked the states to ensure timely referral and hospitalisation of people who are diagnosed with Covid-19.

While the daily numbers of deaths have risen over the recent days, India has reported one of the lowest Covid-19 mortalities compared to the total cases, with about 30 deaths per million population. The global average stands at 91 deaths per million population. The highest mortality rate has been reported by the United Kingdom, with 684 deaths per million population, followed by the US, with 475 deaths per million, according to data shared by the health ministry.

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“There could be multiple factors at play and a retrospective analysis of data after the pandemic is over will help us understand what these factors are,” said Amit Singh, associate professor, Centre for Infectious Disease Research, Indian Institute of Science, Bengaluru.

“There are four other coronaviruses that cause common cold; infection with these might have resulted in cross-protection against Sars-CoV-2 that causes Covid-19. Or, it could be that most of us have been given BCG vaccine. It is a controversial topic, but perhaps studies will show whether the T-cell immunity from the vaccine is actually protective against Covid-19,” he said.

On Friday, the Union health secretary also held a virtual meeting with 16 other districts in four states — Gujarat, Tamil Nadu, Telangana and Karnataka — reporting Covid-19 mortality higher than the national and states’ averages.

Saturday’s meeting, however, focused on 13 districts in eight states and a UT. The states and the UT were advised to address the issues of low laboratory utilisation, low tests per million population, decrease in absolute tests from last week, delay in test results, and high confirmation percentage among the health care workers, the health ministry said.

They were asked to ensure timely assessment and make advance preparedness for infrastructure such as ICU beds, oxygen supply and other areas based on the prevailing caseload and estimated growth rate, the ministry said.