Sanasam Yaiphaba Singh
In view of those stranded Manipuri natives outside the state returning to Manipur quarantine centres are opened with the active and dedicated participation of NGOs, social workers, local leaders etc. as per guidelines for separation and restriction of movement or activities of persons who are believed to have been exposed to infection. The guidelines for setting up of quarantine facilities during the current COVID 19 outbreak lays out all aspects of the procedures required for physical infrastructure, services required, medical monitoring of contacts, protocol for referrals of symptomatic of suspects, infection control practices by medical personnel, monitoring and evaluation etc. The guidelines emphasises the needs of monitoring, supervision and evaluation of the centre. Training and refresher training of all the health care personnel and other relevant staff are the most important and critical part to ensure that all activities takes place as per established protocol and Standard operating procedures (SOPs). Protocols for use of mask, cleaning, social distancing etc. are for smooth functioning of the centres. All the returnees are treated as contacts and kept in quarantine centre (QC) for observation and testing of the virus.
Standard operating procedures (SOPs) is framed to ensure smooth operation in the quarantine facility, which includes daily monitoring surveillance, fever triage/Isolation case and contact monitoring and response, transfers of suspect/symptomatic to designated hospital, public information, providing information for medical personnel, nursing staff, movement of health personnel and support staff and security staff. Information, education & communication (EDT) and psycho-social supports which are to explain among the quarantined people on the universal infection control measures are an important part of the guideline.
The people of Manipur is fortunate that those returnees from outside the state are all being kept and tested in the quarantine centres located in all the districts before sending them in their homes for another home quarantine for 14 days unlike the reported millions of migrants who have been returning to rural Bengal, UP, Bihar, Odisha, Chhattisgarh, Jharkhand etc. where the chance of the spread infection in these states cannot be ignored.
It is not surprising that chance of positive cases among the returnees may be occurred as they are coming back from different parts of the country by trains, buses, private vehicles, planes etc. But it is matter of concern that in centre the number of positive cases was as high as 34 in a day which is needed a thorough investigation. There is no excuse of mistake or ignorance or loophole from the virus on the parts of the management or returnees in the quarantine centres. The centres are opened to accommodate around 40 thousand returnees within a limited period of time, resources and manpower, and as such the management of the centres may not be in a position to follow the guidelines strictly to suit the local needs at the initial stages. Therefore, the returnees who have been coming back to Manipur with a hope of security after facing a lot of trouble, frustration and anxiety for loss of job, study, incomplete treatment of illness etc. before coming back, might feel discontentment, psychological fear and panic while waiting for the test results which would be addressed by a visiting team of psychologists and psychiatrists with individual counselling sessions as per the guideline in the quarantine centres in the initial period.
It was expected to manage the QC with a doctor having certain power and authority with a sense of responsibility for effective and smooth running of the centre. With the sudden increased number of returnees, the QCs have also been increased which would require doctors nurses and other staff without them the centre could not function as per guideline. If the existing manpower is not enough to man the increasing centres, the authorities may like to consider for outsourcing the required doctors from the Indian Red Cross Society and Indian Medical Association, Manipur branches, private hospitals and clinics etc. for the expected months or year to the emergency.
With the regulation of the incoming of returnees in Manipur, and resolving the discontentment among the returnees in some of the quarantine centres, the anxiety to wait test result being reduced with increasing capacity of testing facilities to over 2000 a day the burden on the management of the QCs tend to decrease. The only concern in the centre will be the possibility of spreading the virus from one to another while waiting for test result which can be averted provided the QC is properly set up and managed as per guidelines, and inmates follow rules. Transparency in the management and participatory approach from among the returnees who are in quarantines facilitates the functioning of the centres
By July, 2020, after fighting the virus for more than four months, it is expected in the state of Manipur, unlike cases in other parts of India, that the process of returning of the people is likely to complete, all of them will be quarantined and tested, and asymptomatic cases will be shifted to the designated hospitals where they will be treated with full hope of recovery as there is very little chance of severity and dead. By that time the responsibility of treating the asymptomatic cases is on the hospitals where infrastructure and number of beds are being strengthened to take care of the expected number of cases. In the meantime the infrastructure and manpower of health facilities are expected to be upgraded in the districts where patients are to be treated conveniently.
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