Our brethren Tangkhul Naga Long knew better meaning of Quarantine than many officials
Dr Th Suresh Singh
Hats off to Tangkhul Naga Long for isolating those 10 +ve cases after discharge and keeping them for another 14 day quarantine after they became +ve. It is worthwhile to remember that 10 returnees were discharged from Government run Quarantine Centres(QCs) without test results. These persons were probably discharged as per the Principal Secretary, Health notification dt. 11th June, 20. One point mentioned in the notification is- “those completed 14 days quarantine, but test results not yet declares, will be discharged for home quarantine”. I have no idea whether it is based on sound medical advice or a bureaucratic decision. But it sounds strange to me at least. I hope it is modified now. This is the mater not to be taken lightly as it has severe repercussions.
Trouble in Community quarantine centres : We are hearing off and on trouble in many quarantine centres like demonstrations for lack of food, hygienic conditions, keeping +ve cases with -ve ones etc. These are all manageable and one can’t find the reason why it is still continuing. In the initial stage, it was tolerable when many returnees arrived, but not now and should not continue indefinitely. Some rough dies were sent to Sajia jail rightly by the authority and should continue to do so.
Lack of farsightedness on the part of authority : It is clear that there is no proper planning from the authority from the very beginning for the returnees. When one knew that 1000s of returnees will be back from the red zones, we should have earmarked QCs with full facilities including proper management control. We also should have enhanced our testing facilities to at least 2-3000s per day. Sadly it was lacking leading to confusion everywhere. There is also the allegation in selecting priority in testing. All these are very sad things to hear and publicised in all newspapers/ TV channels.
Testing : With present 1,200 test capacity per day, the situation is much better now. Hope, those in authority do it in a systematised manner, results are known quickly and proper discharge methodology followed. No person be discharged without completing 14 day quarantine whether one is +ve or –ve. Your writer has recommended 2 times testing 1 week apart in view of possibility of false –ve and chance of becoming +ve in later stage among those –ve ones. We have a very good system of contact tracing, still, there are chances of loose possibilities here and there as seen in Ukhrul and Kamjong districts. There is also possibility of false –ve test results. We can’t take chances in corona.
QCs : Presently Manipur has 133 Institutional QCS & 600 Community QCs; we have enough centres. Things to be implemented is – adequate water supply, adequate toilet, keeping physical distance of 6 feet apart for those serving them along with proper PPEs, frequent hand washing, separating +ve cases in a different wings of QCs etc. Proper health education of volunteers and returnees is to be done at least 2 times per week. These are easy things to be enforced and followed. One only requires good administrators to plan, execute and implement it.
Institutional quarantine vs Home quarantine : I have recommended that home quarantine and home treatment is never to be done for those poor living in congested rooms/areas where there is no proper facility. Imagine doing it in congested Dharavi of Mumbai and Delhi slums. One can see increasing +ve case now even with best efforts from the respective state Governments. I have pointed out these deficiencies to PMO, one can see it in its website. But those theoreticians won’t listen to low profile but practical people like me.
We should not allow it to happen in Manipur. Home Q can be done for those rich having abundant rooms with separate bathrooms attached and adequate hygienic conditions. The question is how many of us are having these facilities? We can’t do quarantine for the sack of quarantine.
14 day quarantine ineffective now in India : With many +ve cases found among returnees/migrants, it is now confirmed that many QCs opened in red zones are ineffective. All spikes in N-E states are returnees from these highly infectious red zones. Bihar reported a spike of 30% case in early stage of migrant returns, 4,300 +ve cases (out of 7000 ) in Karnataka are returnees from Maharastra. The same is true for many states. Manipur should learn lesions from this and should not allow the situation to slip out of hand. All returnees are to be treated as contacts. Their 14 day quarantine can also be counted from the day of their boarding; this will also lessen burden on our QCs.
Conclusion : Fortunately there is no death and severe cases here. But, with the reported 2 doctors and 1 nurse becoming +ve in Bishenpur District Hospital, we have to be careful for these frontline workers. The fault lies probably in defective PPEs. One has to investigate it. In respect of quarantine, our Brethren Tangkhul Naga Long knew better meaning of Quarantine than many officials. Tree cheers to them. I recommend no home quarantine and no home treatment for the poor, strict compliance of 14 day quarantine even with –ve test and better management practice for the reasons elucidated in above paras.
Manipur will have a maximum of 1000 active case with all returnees. As on today, we have only around 600 active cases. By July, we will be free from Corona. There is no need to panic. I don’t understand why everyone is in panicky mood. By all means, we should prevent community spread. Once community spread occurs, the situation will become explosive. With abundant beds in all district hospitals and CHCs, we can handle it easily. Had I been in the authority, I would have strengthened these institutions instead of opening Community QCs. That would have been far more beneficial in the long run. It could have prevented outstretching of resources, manpower and materials. But alas, that could not happen. It is a question of applying sound management technique.
Hope authorities hear voices like this and take remedial measures before it is too late.
About the author: Dr Th Suresh Singh, MD WHO Fellow (Holland and UK), Ex- Director, Health, Manipur, Chairman (mobile-09436026349