The Union health ministry on Monday asked nine states, including Bengal, to analyse deaths among coronavirus disease patients at the level of hospitals every day and intervene to reduce mortality wherever necessary.

Union health secretary Rajesh Bhushan in a meeting with state officials also urged the states to promote “health-seeking behaviour” among the public to reduce the proportions of early deaths that occur within 24-72 hours of hospital admission.

Health officials are concerned that some districts in the nine states — Andhra Pradesh, Assam, Bengal, Haryana, Himachal Pradesh, Kerala, Punjab, Rajasthan, and Telangana — have shown rises in daily new cases, declines in daily tests, and high mortality within 72 hours of admission.

In a similar meeting with Chhattisgarh, last week, a senior health official had pointed out that 34 per cent of Covid-19 patients had died in some districts within 24 hours of admission.

Bhushan said states should focus on increased testing, targeted testing in marketplaces, workplaces, and places of religious congregations that could have the potential to become super-spreaders. He also asked the states to trace an average of 10 to 15 contacts per new case detected.

Health officials say daily analysis of in-hospital deaths would allow authorities to identify possible factors that might be contributing to unusually high mortality. Late diagnosis, poor clinical management or critical care infrastructure issues could lead to high mortality.

The directives come amid a near-steady nationwide decline in daily new counts — only about 45,000 cases recorded on Monday compared to a peak of over 93,000 cases in mid-September — yet worrying signs of a slowdown in the pace of decline in several states and surges in others.

India’s count of active Covid-19 patients has fallen steadily to about 500,000 cases on Monday from the mid-September peak of over a million cases. But this fall has not eased pressure on Covid-19 hospitals in Delhi, Haryana, or Kerala with large accumulating numbers of active patients.

Delhi, which appears to be in the grip of a third epidemic peak with larger daily case counts, recorded over 7,000 new cases on Monday. Several private hospitals treating Covid-19 patients in the capital have reported that their full ventilator bed capacity is occupied.

“The pressure never went away, but it looks like it is getting worse,” said Sumit Ray, a senior critical care medicine specialist at the Holy Family Hospital in Delhi. Ray is among medical experts concerned over how the epidemic will change in the weeks after Diwali.

Some health experts attribute the surge in cases in certain states despite the overall decline in the epidemic as largely driven by behaviour. “Human behaviour is the critical factor driving the epidemic at different places,” said Tarun Bhatnagar, a senior researcher at the National Institute of Epidemiology, Chennai.

“We could expect differences in behaviour depending on the prior experience of case loads and differences in risk perception,” Bhatnagar said. “These would be influenced by local narratives and the resultant perceptions among people.”