After bringing in those stranded Manipuris from outside the state, Manipur has seen a dramatic increase in the number of positive cases; fortunately, though there has been no mortality. This is perhaps due to the fact that most of the returnees are in their prime of life. The state is now fighting with its wall on the back to ensure that the disease is concentrated only among the returnees and not spread to the community. Once community spread starts, there is bound to be mortality as many are aged and infirm.
The decision to convert a private school into a Covid-19 hospital is a right step, though a bit belatedly. There are a few violators of the restrictions among the returnees as also among the locals who had stayed put in this state during lockdown 1-4. The violators among the returnees are mainly those highly connected. Among the latter, are mainly youth and in fact an unsavoury example is the picnic (called corona picnic in the social media) by certain groups of people who were chased out by the police. Such violators must be punished with befitting penalty under Section 51 (b) of the Disaster Management Act, 2005 so that the message that the government is serious in the fight against Covid-19 trickles down to the public.
After Lockdown 4, the restrictions were relaxed all across the country with the exception of certain activities; but alas in Manipur it continues as it were! The long lockdown had had its toll, especially among the poorer section of the society. The free food items provided under the PMGKY and other schemes could not provide the victuals for the entire month and with no way to earn many families are going hungry. Manipuri are proud people who will not say they went hungry due to poverty and prefer to starve than to beg. The free dry ration could last only a fortnight at the most. Manipur is under curfew or lockdown since 22nd March onwards and the extension by another month literally benumbed the public.
Is Lockdown 5 essential or can we do without it and come to Phase 1 of the recovery. This is a question that bogs one’s mind. If the quarantine centres and the contact tracing are managed systematically, the chances of community spread are minimal. But unfortunately many of those involved in the management are not properly trained and the volunteers who are full of dedication and zeal may unsuspectingly become the link for community spread, despite all their efforts. It would have been ideal if the lockdown is partially lifted so that more economic activity is started. Lockdown cannot stop the spread of the disease on its own though it can reduce the intensity of the spread. The idea of lockdown is to delay mass spread while in the meantime preparation is made on war footing to fight the disease. Despite lockdown, India has seen rise in the number of positive cases. Perhaps the government knows its citizen well and does not trust them; which seem correct as after the guidelines were announced on Monday, the next day hardly anyone uses masks. Only about 10% of those in public places uses face mask, for the rest it seems life as usual!
Even the national policy of the lockdown was questioned by many field experts. Lockdown was claimed to be imposed based on a computer simulation result prepared by theorists with little knowledge of real life public health. If the migration to their home states were allowed before the lock down by giving some time while containing the areas where positive cases were detected, the problem now facing where the returnees are the carrier of the disease could have been avoided. This on hindsight seems correct. Now the returnees who are positive have reached different places with limited medical facilities and their detection and their treatment is going to tax the entire health care system.
There is no reason why all hospital activities are put on hold. In most of the countries, treatment of other diseases continue side by side though after taking utmost precautions; assuming that all patients may be positive. The lack of treatment for other patients is in utter violation of the rights of them. The hospitals must start to function for other diseases, though with full precautions to ensure that our health workers are inured from the disease. If the health workers start falling prey to the disease there will be utter chaos and the ill will be left unattended.
Even in the treatment of those infected, there seems to be different opinions. While in most countries the moderately serious cases were supported by CPAP (Continuous positive airway pressure) machine and only the critically are supported by ventilators, in Manipur there seem to be resistance in the use of the former machine. The difference is that CPAP is non intrusive while ventilators are and it requires intubation. Those doctors who are resisting use of CPAP machines must come out with the reasons for their resistance so that the matter can be discussed in detail with the pros and cons as the treatment must be in the best interest of the patients. So is the case for use of chloroquine and hydroxychloroquine. It was used even as a prophylactic in India though there is no medical report about its efficacy in the treatment of this disease.
It was told that a program through webinars were held some 12/13 times with outside based experts who had the experiences of treating critically ill patients from Covid-19 involving even doctors posted in the districts so that they can learn from the experiences of others. One of the main participants is a Manipuri doctor working in UK and all the experts had experience in treating such patients and their experience sharing was well received by the health fraternity here. But lo, diktats came from the high up that the doctor based in UK should not be invited and then suddenly the program was cancelled. Nobody knows who the author of the diktat was but everyone knows who passed on the diktat! A loss for our medical fraternity and consequently for the patients of Covid-19 as there is as yet no prescribed treatment regime for the disease and the best practices which are fairly successful need to be replicated. It may not be feasible to implement fully what is practiced in UK but the basic protocols can be adopted to successfully provide care to the patients of this disease. The Committee headed by the CM does not have any experts from epidemiology or community health, though there are doctors whose expertises are in other areas. Right from the inception, an epidemiologist or a community health expert should have been associated; but even now such persons can be invited for his expert views.
Returning to lockdown 5, taking into consideration the sufferings of the common people some of the restrictions need to be eased; like opening up till 4 PM instead of 2.00 PM, opening up the Khwairamband market by allowing limited activities with conditions like odd and even shops opening up on specified days as done in Delhi, opening up the three keithels on rotation basis, etc. Masks must be compulsory in all public places and limit imposed of persons in social and religious functions. Those who violate the guidelines must be penalised as per the law to ensure that these are followed.
Full training for those volunteers who are taking care of the returnees in the Community quarantine centres should be provided, including the safety measures they should take. The protocol for running the CQC as laid down by the MHFW was observed more in breach and such weaknesses must be plugged. Those in the quarantine must be bored and frustrated but taking up some activity rather than be in bed or thumbing the smart phone all the time must be encouraged. The period spent in quarantine must be taken as a service to our community to stop spread of the disease protecting their near and dear ones, especially the old and the infirm and not take this as a mandatory incarceration but in a positive light. The activity of the inmates in the CQC at Kakching Public School may be a trend setter and replicated elsewhere.
Lockdown 5 is not going to stop community spread as the returnees are kept isolated; if proper system is put in place spread to the community can be stopped. Normal life with certain changes in the social norm needs to be brought in slowly in phases to ensure that the sufferings of the common man is minimised. In other words, those who are returnees and have the risk of the disease and its spread and the remaining need to be treated separately and not clumped together.
(The views expressed are the writer’s own)