In the October 24 editorial of Imphal Free Press, it was mentioned that the impact of the Covid-19 pandemic in Manipur during this month was unanticipated and had suggested to ensure the availability of the services of healthcare providers, provisions of the Disaster Management Act, 2005 must be invoked. This writer and many experts had indicated since August that the situation will worsen from October onwards with no one listenening! The assessment was based on the empirical studies that the peaking of transmission starts about two-three months after the start of community transmission and with August being the month of the start of community transmission, peaking will start from October for about two-three months before attaining plateau. As Ro and R value was not properly determined as the data was suspect in an assessment done by a don of Manipur University, scientific prediction is still not possible.
Table-I - Comparative data on Covid-19 of Manipur as on 30.09.2020 and 26.10.2020
|
Sl. No. |
Item
Upto 30.09.2020
Upto 26.10.2020
Oct till 26.
1
2
3
4
5 (4-3)
1
Cases
10,983
17,424
6,441
2
Death
67
144
77
3
Recovered
8,460
13,057
4,597
4
Cases with Outcome (2+3)
8,527
13,201
4,674
5
Active cases
2,456
4,223
1,767
6
Case per million
3,520
5,585
2,064
7
Death/million
21.47
46.15
24.68
8
Total Test
2,41,648
3,39,764
98,116
9
Test/million
77, 451
1,08,899
31,447
10
Estd Popln Oct, 2020
3.12 million
3.12 million
3.12 million
11
Mortality Rate
0.79
1.09
1.65
12
Positivity rate
4.55
5.13
6.56
13
Recovery rate
77.03
74.93
71,37
From Table-I it is clear that the positivity rate as well as mortality rate have increased during the 26 days of October and this may be the precursor for the days to come. Another aspect is that every day in October there are deaths which numbered 77 of which 46 are 60+, comprising 59.74 per cent of the total death during the period. Till the end of September, the percentage of 60+ is much lower; indicating that the old and the infirm who took care in not coming out from their homes were now infected within the family brought by those who go out. Manipur is now going towards the global phenomenon where the majority of death occurs among 60+; during the initial phase as most of the infected are from 60-, more death occur among this category. With the transmission becoming more uniform, the infected include larger number of 60+ resulting in more death among this group. There is no gainsaying that those with co-morbidities fall victim easier to this disease.
Despite the fact that the month is still to be over, the number of death of 77 during 1-26 October is more than the death during the last 3 months, starting from July when the first case of mortality occurred. There are also concern that the number of death due to Covid-19 may be more as many suspected cases refused to get tested thereby dying at their homes from co-morbid conditions and quietly buried or cremated. An important concern which require serious consideration by both the Government and those working in the field is the lack of truthful answer when contact tracing and the refusal of many primary contacts to get tested. There is a belief that once they get tested they may return positive and will be asked to stay at the CCC, and if there is no symptoms, or the symptoms are mild and there is no symptoms during the last 3 days they will be allowed to leave after 10 days from the CCC and therefore they will get themselves treated with symptomatic medicines purchased from the local pharmacies and quarantine themselves at home for 10 days. This is a fallacious belief as after 10 days isolation in the CCC, they have to self-isolate at home for another 7 days, thus they have to self-quarantine for 17 days. Further, from which day the counting will start; can never be clearly identified as they are not tested? And the worst part is that the so called self-quarantine or isolation is never fool-proof and on many an occasion they mix with the near and dear ones and even in the locality; thereby increasing the transmission. The only way out is to force such recalcitrant quislings by imposing fines and even going to the extent of prosecuting them; as they are a menace to the society. Here both the Government and the society at large need to work together.
During October up to 26, the number of test carried out is 98,116 which average 3,774 daily a reasonable figure but during the last few days the number is below 2,000 resulting in lower positive cases sometime even below 200. High testing should be maintained as this is the time for aggressive testing and isolate the positives from the general population. But the testing show a totally different approach and this need a clarification from the government as to whether it is due to lack of testing materials or any other reasons? Or else the rumour that the government is limiting testing to show lower number of positives per day and say it is under control before the bye-election may gain traction; thereby discrediting all efforts.
Table II: Number of various tests in Manipur
|
Test Type |
Upto 30th Sep
Upto 26 Oct
During Oct upto 26
RAT
85,482 (35.37%)
1,56,847 (46.16%)
71,365 (72.74%)
PT-PCR/TruNAT/
CBNAAT
1,56,166 (64.63%)
1,82,917 (53.84%)
26,751(27.26%)
Total
2,41,648 (100%)
3,39,764 (100%)
98,116 (100%)
Despite expressing concern on the use of RAT as the mainstay of testing due to its lower sensitivity, reliance is made on it perhaps due to easier protocol and lower cost. From Table II it is clear that by the end of September 2020, RAT comprises 35% of all tests conducted but by 26 October it had risen to 46%. During October it comprises above 72% of all tests, a dangerous path to tread. Due to this thousands who are infected and in a couple of days could transmit the disease were allowed to stay within the community thereby increasing the chance of further transmission.
Table III: Type of tests and its Results
|
Upto |
RAT
RT-PCR, etc
Total
Test
Positives
Test
Positives
Test
Positives
30.09.2020
85,482
4,010(4.69)
156,166
6,973(4.47)
241,648
10,983(4.55)
26.10.2020
156,847
7,213(4.60)
1,82,917
10,211(5.58)
339,764
17,424(5.13)
Oct 1-26
71,365
3,203(4.49)
26,751
3,238(12.1)
98116
6,441(6.56)
(Figure within parenthesis indicate the positivity rate)
Table III indicate that early on, the positivity rate of RAT and other type of test were almost similar and this is due to the fact the RAT was introduced when cluster transmission started perhaps as a response to that in Jiribam while the other tests have started since the beginning when the positivity was very low. The comparison of the positivity rate in October confirms the weakness of RAT and if it continues as the mainstay of testing, with 71,365 tests returning 3,203 positives while RT-PCR and others was performed in only 26,751 cases returning 3,238 positives. The number of positives would have been much higher if RT-PCR/TruNAT/CBNAAT were the method of testing.
If October is this bad, what will happen in November and December is a question in the mind of all those involved seriously in the fight against Covid-19? The concern of further deterioration is compounded by the fact that 2 health care providers have lost their lives and many are positives so much so that the fear of the disease had made many to avoid duty of looking after covid patients. Despite the fact the 100 doctor positions were advertised, only 74 turned up for the interview indicates the fear psychosis generated by this disease. Perhaps emergency recruitment through MPSC may attract sufficient number of candidates as few are willing to risk on contract job. The rumour that senior doctors are not attending to covid patients was confirmed when government deputed 2 senior IAS officers; 1 each at JNIMS and RIMS to oversee whether senior doctors are attending such patients, a very sorry state of affairs which questions the ethics of the doctors. Soldiers who join the army during peace cannot say that will not fight in an event of war. Doctors not attending such patients must reconsider their step and start treating such patients or else quit the profession. Doctors should have empathy for the patients and respect the Hippocrates Oath and treat whatsoever patients come for treatment.
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