What next against COVID-19?
Manipur is always slow in implementing laws but there is a time to enforce it or it will be deemed that there is no governance.

ByRK Nimai

Updated on 2 Dec 2020, 5:01 pm

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The COVID-19 pandemic had been relentless and till now all the measures taken have not been successful in containing it. Perhaps the inability of the people to follow the laid down protocols contributed largely to the failure as also the wrong approach in the early part of the pandemic, when the behaviour of the disease was not properly understood.

As opposed to the earlier pan India approach, many states and UT have now started taking up measures suitable to them. Some states have imposed lockdown in specified areas as well as night curfew. In Europe, many countries have enforced strict lockdowns in specified regions following tier or level system. The approach now is to target specific area rather than the whole country or state based on the R value. In Manipur also, there is a need for an assessment to decide whether specified areas require containment or lockdown but unfortunately the proposal for an Expert Committee to work out the R value has been kept under cold storage, with no reason being provided.

The targeted mass testing using RAT in the four ACs where bye elections were held was a step in the right direction but it was poorly designed resulting in very poor participation. It has been seen for sometimes that many refrain from testing taking umbrage of the fact that rather than stay at CCC, they will self isolate or quarantine at home. There is complete misunderstanding of the purpose of the CCC; which is to isolate the infected to avoid further transmission and is not for treatment. There is also the claim that no prophylactic or therapeutic medicine or supplement is given in the CCC, such as Vitamin C, Zincovit, Paracetamol, etc and inmates have to procure it themselves. After the Home isolation protocol was announced and discharge after completion of 10 days isolation from CCC without testing of asymptomatic and those with mild symptoms but without symptoms for the last three days, it was generally believed that those who are asymptomatic or with mild symptoms can stay put at home for 10 days; without realising that without testing the asymptomatic cannot be identified and thus cannot start the isolation. Those discharged from CCC have to home isolate for another 7 days; this was conveniently forgotten. The scientific basis for the protocol is to ensure that till 21 days of infection, the person does not interact with others to contain the spread; and it has nothing to do with the treatment. If the person stay put without testing and if he develops symptoms including breathlessness, precious time will be lost in transit and in testing for SARS-CoV-2, which may be critical. This should be the argument to ensure people got tested.

By the end of the targeted testing, the positivity rate in Wangoi AC and Lilong AC is higher than the state average while it is lower in Wangjing Tentha AC. However, there is a need for precaution while coming to any inference in that many who had slight fever, cough, anosmia, ageusia, breathlessness etc in the three ACs had not reported for testing due to fear that they will return positive and may perforce stay in the CCC; so much so that local volunteers had even suggested for strict lockdown for a specified period. It may be appreciated that majority of those tested positive in the three ACs were in home isolation. The turnout for testing was very poor in contrast to the enthusiasm shown in voting on 7th November. Though Wangjing Tentha AC’s MLA had taken the trouble to cajole his constituency for the testing, the turn out continues to be poor. All MLAs need to be more proactive towards this end if they are keen to serve their people, but if they are for power only nothing more can be said. 

From the limited data available and from the information culled from the ACs, there is suspicion of higher COVID-19 infection in the three ACs and it must be ensured that all families are tested. Mass awareness of the advantage of testing need to be brought home and alternative methods to tap more persons should be put into operation. Door to door sample collection may be an alternative; with the help of local volunteers. The LCC should have been activated just after its constitution was notified and the volunteers properly trained; but alas once the order for formation of LCC etc was issued, it seems to have been forgotten.  

The proposed sero-survey for antibody testing must be properly designed by roping in experts so that the degree of infection in the state could be worked out realistically. It should not be a hash job as seen in the targeted mass testing. The data generated must be able to be used for extrapolation for further intervention.  

Lockdown for a week or ten days is illogical and if lockdown is re-imposed, it should be not less than 21 days; one cycle. Due to various reasons, lockdown in the whole of the state is unjustified and only those areas where there is uncontrolled transmission should this measure be taken recourse to.  Whether night curfew is relevant when it could not be enforced in the past needs reconsideration as it only creates panic among common people. Violations like playing football in the night under floodlight or marriages going late with crowd can be controlled by imposing heavy penalty on the hosts.

From Table-I it is clear that the positivity rate increases with time. The absolute number of positives is lower in November as compared to October but it is mainly due to lower testing, which averages only 2,280 per day as compared to 3,558 per day in October. The reason why there is decrease is testing when aggressive testing is needed is not forthcoming and only the Government can give a reply. The test per million till November in India is 101,313 per million while Manipur fares much better at 134,725 per million.

Table-I

Month-wise Number of tests, Positive results and Positivity Rate.

Month

No. of tests

Average tests per day

No. of Positives

Positivity rate

Upto September

241,648*

-

10,983

4.55

October

110,305

3,558

7,519

6.82

November

68,389

2,280

6,543

9.57

Total

420,342

-

25,045

5.96

* Month-wise data from March to September is not available with the author.

Table –II shows the month-wise mortality rate and the mortality per million. The mortality rate is slowly creeping up and may equal the All India Average of 1.53, though Manipur is at 1.29 but the high rate in November indicate that the worst is not over and in December or January, it may catch up. Even the mortality per million is almost equal to the All India figure of 99 with Manipur’s being 90. The inability to increase isolation beds may have a role in the increasing mortality.

Table-II

Month-wise death and mortality rate

Month

No. of death

No. who had an outcome

Mortality rate

Mortality per million

Upto September

67

8,527

0.79

22

October

101

6,503

1.55

32

November

113

6,817

1.66

36

Total

281

21,847

1.29

90

 

The belief that vaccine is round the corner is wishful thinking. It will take a few more months to reach even the priority groups and for the general population it may take months and even years and it is not going to provide 100 per cent protection.

Despite government’s best effort to manage a normal life, if the people do not extend necessary cooperation, the alternative will have to be harsh, including lockdown or severely penalise those violating the norms by increasing the fines for various infarctions, and even prosecuting under the relevant laws. Manipur is always slow in implementing laws but there is a time to enforce it or it will be deemed that there is no governance. At the Directorate of Health level also, there is a need to work cohesively in consultation with experts from various units rather than going solo with the task ahead, plunging into unknown territory with the hope it will succeed.

To everyone it is clear that there is lack of cohesiveness in the approach be it at the political, bureaucratic or medical level; which make the fight all the more difficult. One may have differences but these should be discussed threadbare scientifically, for which ample opportunity must be given and the best strategy adopted and once adopted, all must work towards its success. The tendency to dictate, without fully knowing the implication by the higher echelon will only lead to failure. From the past experiences, Government must walk the talk or else the people of the state will suffer heavily. Since October 23, it has been saying that the Infectious Diseases Hospital in JNIMS and Dental College Building in RIMS will be converted into COVID Hospital but even by the end of November it continues to harp without positive outcome.

(The views expressed are the writer's own)

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RK Nimai

RK Nimai

The author is a former bureaucrat, Imphal, Manipur

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