State’s low vaccination rate and increasing +ve rate throughout India with super spreader variants Covid test a must for all incoming flights

Dr Th Suresh Singh
India perspective : India is witnessing exceptional increase in Corona +ve cases. For 14 consecutive days, it is having more than 40,000 new cases per day since March 20. Out of this, more than 50,000 new cases are accounted in 11 days since 27 March with highest peak of nearly 1 lakh (93,249) on 4 April.  8/9 States are problematic with Maharashtra contributing more than 53% (49,447) and Mumbai having highest 1 day spike of 11,163 on 4 April. Many States have started partial lockdown with Maharashtra leading with weekend lockdown throughout the State, closure of mall, restaurants etc.. Many States will follow the same as the mad virus had spread to many States and GOI not enforcing its discretionary power of limited lockdown in red States/areas and allowing the virus to spread further.
As on 24/3/2021, according to GOI source,-36 UK, 34 South African and 1 Brazilian variants were found. A total of 206 double mutant variants (E484Q+L452R) have also been detected in Maharashtra though the Centre maintains no direct link with the ongoing surge in the State. According to Punjab CM Amrinder Singh, 81% of She state’s samples are +ve for UK variants. Hence, we have to be super-vigilant.
Herd immunity : According to WHO - 'Herd immunity', also known as 'population immunity', is the indirect protection from an infectious disease that happens when a population is immune either through vaccination or immunity developed through previous infection. For Sars-CoV-2, it is based on R0 (R nought) 2 and 3 i.e. number of secondary infections. However, it is not static and depends upon many variables-viral mutation, physical distancing etc.   Based on this R0, the community should have a threshold of around 60-70% of herd immunity to stop transmission. At present, we don’t have reliable all India herd community data with authority always hiding lacking data. Many authors are of the view that “R-the effective reproduction rate’ to infection within a population due to vaccination or “Rt-R specified at a particular time” are better methods. In case of super-spreaders like UK variant, R0 is 7-8. It means 1 person can spread to 7 persons, then 7x7=49 and so on; not only more infection-it spreads very fast. Hence, those dealing with corona have to understand this danger.
Though the country had vaccinated around 7.6 crore people so far, it hardly covers about 21.4% of the 1st phase target of 30 crore in about 10 weeks since the beginning of the campaign. At this pace, it will require about 4 years to cover about 1.20 crore targeted population to achieve herd immunity explained above. Around 92.6 lakhs are fully vaccinated with 2 doses so far.  By adding 2nd dose regime to this, one can imagine the number of years required to complete 2 jabs.
Manipur perspective : Though new cases are hovering around 10 and less per day in last 2 weeks, we have to be exceptionally careful. Our testing rate is very less when compared with other high profile States. But daily testing +ve rate at airport is high and is a cause of worry - on March 21, out of 1147 tested, 8 were found +ve. On April 3, out of 49 tested-2 passengers were found +ve.  Total no of air passengers found +ve so far are 35 out of 22,126 according to Health Deptt. sources.  The number of active cases remain above 50 since 24 March.
All incoming air passengers be tested by TR–PCR and not by Rapid Antigen : The State is conducting testing of incoming passengers at airport from 8 sensitive States only at present. It will increase to 9 States according to Health Director. With rapid increase of new cases throughout many States, the writer’s plea is that all incoming air passengers be tested, and that too by RT-PCR, not by rapid antigen. When GOI has given instruction for Corona testing to all States by RT-PCR as far as possible, I have no idea why Manipur is conducting rapid antigen.
Manipur’s low vaccination status-a cause of worry: So far, we have vaccinated about 86,740 people-it includes about 31,600 health workers, 53,900 frontline workers, 600 co-morbidities and 1,500 above 60 years. We have to vaccinate about 60-70% of population to have a semblance of Herd (community) immunity, i.e. we have to vaccinate 18-21 lakhs of our population out of about 30 lakhs.
Presently, we have covered only 4.35% of this targeted population in about 11 weeks. God only knows when we will complete the targeted vaccination. It will take about 6-7 years to complete the target. Well that is the fact we have to live with.
Laudable thing : The most laudable thing is that of Biren Government’s prevention  of Thabal Chongba and Lila Festival. It is timely and worth praising. But by this alone, we can’t prevent criss-crossing of people from one place to other. Many strategies are required to prevent the virus spread. Hence, the following treatment lines are kept forward for the  authority to implement  :
1. Test all incoming flight passengers by RT-PCR test and not by rapid antigen test. Till the result is out, they be kept in a corona waiting room specially arranged for them. Or, all air passengers may be asked to bring a corona –ve result by RT-PCR test., this is a better option. In the present scenario, GOI has instructed all States to do testing by RT-PCR as far as practicable. Hence, one is at a loss why Manipur is not following GOI directive and continuing rapid antigen test. As stated in many of our write ups, rapid antigen test gives about 20-30% of false -ve result. In simple term -  it means out of 100 +ve persons tested, it will give 20-30 persons as –ve corona result in spite of having +ve corona disease. Hence, it is not reliable and be discarded immediately. Rapid antigen test is meant for only for community survey.
2. Once the result is found +ve for corona, he or she be kept at a quarantine treatment centre/hospital till discharged.
3. No home isolation and home treatment for those not having proper facilities e.g. separate room, separate bathroom, adequate water supply, proper sanitary disposal etc. Not only me but many of my public health specialist colleagues are firmly of the view that this home treatment and home isolation without proper facility is the main reason for spread of corona not only in Manipur, but throughout India.
4.  Home isolation and home treatment can however be continued for those having proper facilities.  There is no harm in it provided the person follows strict protocol.
5. Basic principles of infectious disease control : Manipur, and in fact any State, should follow the basic principle of fighting infectious disease control i.e. case finding by house to house survey and by testing, treatment at appropriate place and preventive measures.
6. Strict fine for those not following SOP : The 3 basic principles of “use of mask, 6 feet physical distancing and frequent hand wash” are not adhered to by the majority of population.  The population in general is now having a casual attitude to these 3 basic SOP, hence, strict fine/punishment has to be adopted by the authority.
7. Time for police and other para-military forces to strictly enforce SOP: These forces are also fed up of corona.  The casual attitude is seen not only in the general population but in the forces as well while enforcing SOP. One can see many buses, autos, other 4 wheelers without physical distancing  with about 70% of passengers not using mask. The police remain a silent spectator. Hence, time for the authority to overhaul these forces  for effective SOP.
8. Strict  SOP for Marriage , mapam chakkouba and other main festivals : On every occasion, it is found, on average, the presence of more than 300 people in one occasion. In VIP function, it is more than 1000.  Out of this, about 70% have mask but with no physical distancing. It is a dangerous situation specially with the presence of super-spreader UK, South African and Brazil variants.  Again time for Govt. to enforce strict SOP.
8. Daily coverage by newspapers, TV channels, other news channels reminding the public to follow SOP; The authority may appeal to these mass media groups to cover at least 3 times a day appealing the public to follow SOP.
If the authority follows these main treatment lines, the mad virus can be controlled. One should learn from past mistakes.  We should strike before the virus strike us with a  2nd wave, and the sooner the better for all it would be.