Panicky lockdown no solution, proper strategy at containment zones and QCs is key

    25-Jul-2020
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Recently Manipur witnessed unwanted spike in unwanted places resulting panicky reactions both at the Government level and public level. Special mention is made about Jiri and Thoubal scenario where Corona cases are found without unknown sources and unknown  contacts. The same scenario was seen  last month in Ukhrul and Kamjong districts.  Worthy to note are the following from various press reports and Govt. press releases at the time of this write up :
1. District Scenario :
Thoubal district – Total +ve is 167 with total lockdown from 21/07/20 for 1 week. Worrying point is – about 25 patients have no travel history and no contact history. This has put the authorities to their feet and declared the district a complete lockdown from the date indicated above. Total +ve  was 113 at the time of lockdown.
Jiri district – One ASI was found +ve followed by another 26 +ve of police personnel on 3rd this month. This was again followed by lockdown. Authorities have done a good work of collecting 200 samples for testing at the beginning. Another 17 AR personnel of 37 Bn were found Corona  +ve on 21st.
Kangpokpi – 63 from CRPF Tr. Centre, Kangpokpi and 3 Indian Army from Leimakhong were +ve on 18th July. All are returnees from home holiday.
Ukhrul – It was the highest Corona district with highest spike of 25 new cases on 17th this month. It has many problems with 10  +ve cases after discharge on 16/06/2020 and another 25 cases on  26th same month. Luckily our Tangkhul brethren kept them in village QCs for another 14 days; hence saved from further spread and damage to the community. I don’t have up to date figure for this and Kamjong district.
CCPur – This district is another one for worry and giving the authority cause of concern. In May, it was with the highest +ve cases. I also don’t have latest figure for this district. But,  a laboratory staff of private hospital-Advanced Diagnostic which treated more than 600 patients on 11 July, was found +ve . Since the hospital did not record addresses of these patients, contact tracing becomes a herculean task for the authority. Hence, DM declared entire district containment zone with curfew from 23rd until further order – a right and bold decision. Congratulation to DM and his entire team.
2. Panicky Lockdown :
With the state Govt. declaring complete lockdown wef. 2pm of 23/07/20, one can see a panicky situation everywhere - Govt and Community as well. Panicky Lockdown is no Solution, Proper Strategy at Containment Zones and QCs is the key. Your writer has been giving valuable solutions at this column as well as at various TV channels. Probably no one in the authority has time to go through it. Had those were incorporated, present situation might have been avoided. I am again putting the following treatment lines for the fight against Corona.
3. What to be done: Survey, testing and treatment at proper place be the 3 Mantras to be performed at Containment zones (areas & QCs). Please have a look as bellow:
Survey – 2 times house to house survey of all containment areas, 10 days apart, be enforced to find out any remnants of Covid cases.
Testing – Similarly, 2 times testing, 5-7 days apart, be done. Manipur Covid Team requires certain inputs here. The widely practised RT PCR testing   called “Gold Standard”,   gives 100% accurate results in 1 week after infection and then declines gradually. Too early and too late can give false +ve results. That’s why ICMR gives directive to test within 7 days of appearance of symptoms. The other ‘Rapid antigen test’, though simpler, cheaper and quicker, has very high false –ve rate.  Mumbai Municipal Corporation has warned the Country recently (at the time of writing) that it gives a 60-65% false -ve results and very unreliable. Hence, my recommendation for 2 times testing to avoid false –ve test results. Preferably, 1st test be done by the more reliable RT PCR test and 2nd one by Rapid antigen test 1 week apart.
Treatment – There is no point of home treatment and home quarantine for the poor who don’t have proper facilities at home – like, no separate bathroom, no separate living rooms, no proper water supply etc. For the well-to-do, it is alright, but not for the poor. I am very firm that this home treatment and home quarantine is a source of spread to the community and be discarded immediately. These un-affordable people be treated either in a hospital or in a designated QC.
14+14 day quarantine : All returnees + suspected persons be kept for 14 days in a QC and be tested. They should not be discharged without test results. Those +ve have to be treated either at hospitals or QCs as per severity of illness. No home treatment for the poor, except the affordable, as suggested above. For those –ve test results, they be kept for another 14 day quarantine either at a government designated QC or in a village community QC as done in Ukhrul and Kamjong districts. It is worthwhile to emulate our Tangkhul Co-ordination Forum of Covid19. Had I been in the authority, I will invite central leaders to see and study it and will recommend the same for pan-Indian adoption. Govt. and people Manipur never gives its due to deserving people, an unfortunate tradition. It is a praise-worthy model.
    Epidemiological need for 2nd test is – a person is tested –ve  in 1st week, but letter on he contacted the disease by cross infection in latter part (say 10-14 days), the person will became +ve after another 1 week or so i.e. after discharge from 1st 14 day. Hence, there is the need for another 14 day quarantine to save from these so-called false –ve either from this time factor or from test failure as described in Testing head above.
  Strict enforcement of mask use and 6 feet physical distancing, frequent hand washing along with other hygienic conditions is a must. We should ourselves impose it in self-interest as well as in the interest of the community. Whenever I go, I could see only about 60% people following it. Hence, time is now ripe for strict enforcement by the police and authority with fine and other punitive actions as circulated on 23rd newspapers. Manipuris require sterner punishment now. We are far lenient when compared with other states.
4. Restricting outside labourers : Now is not the time to bring labourers from outside. Anyone entering from outside is to be strictly restricted and strict containment measures indicated above is to be enforced. There should be no double standard.
5. Continuing education : In any district, we have many Sub-Centres, PHCs and CHCs. In any sub-centre, we have already 5-6 health workers. It is time to train and motivate them by organising a proper orientation training schedule. They, in turn, should train clubs and villagers in their jurisdictions regarding basic parameters to be followed by the community regarding the fight against Corona. A  3 course per month, 10 days apart, is recommended for the coming 3 months minimum. Budget and contingency money could easily be sanctioned from the available Corona fund. Hope, it should not be a problem.
6. Need for detailed press briefing and release : From what I gather from the daily press release, I can’t get a complete picture of Corona profile as a public health doctor and administrator. Hence, it is suggested that a district-wise profile, in a tabulated form, containing all the parameters be issued daily. It requires a little fine-tuning, that’s all.
 Conclusion : With only 655 active cases out of a total of 2115 patients (23/07/2020) Manipur don’t require a complete lockdown. It has to be area specific. Complete lockdown of CCPur district is laudable as the situation demands. Complete lockdown of Thoubal district for 25 +ve unknown contact is not required; area specific lockdown e.g. Thoubal Moijing, Lilong Haoreibi etc. is more than enough. The same applies for other districts having 3/4 +ve cases with no contact history. It is better not to apply the same criteria to other districts for the happenings in Thoubal district. We should not be panicky, be calm and face logically.  
At present, there is no community transmission; or rather it is not yet confirmed.  I would, personally favour this phase to divide into early, middle and late stage. All of us are worried for this and rightly so. All of us should try to prevent it; all of us should help the authority as they can’t fight it alone. May be we are in early stage here and there, but not sure and a theoretical proposition. Your writer can confirm it after monitoring for another 2 weeks or so. However, Panicky complete lockdown is not the solution. Also, area specific containment zone declaration is also not the solution. The solution is clearly indicated in  ‘what to be done’ headline above  where all parameters have been touched  but briefly. Hope those in authority have time to have a look into it and take +ve suggestions for the benefit of the state.