Need for a fresh stimulus in combating Covid-19 pandemic in Manipur

By: Dr Rajkumar Giridhari Singh
On Tuesday the July 20, 2021 India reported 30,093 new COVID-19 cases lowest in 125 days. Unfortunately in Manipur in the next day on July 21 the figure is 1327 the highest ever surge in a single day for the state. Inspite of having a strict curfew/lockdown, the continuous rise of COVID-19 cases and fatality is a matter of grave concern for the state. The nine districts of the State are now leading the club of districts in the country of having more than 10% positivity rate. Though Covid-19 pandemic is much larger than a health issue however primarily and predominantly it is health issue.  Manipur, one of the eight northeast states of India, the health infrastructure has been far from satisfactory. However, the state has been proud of possessing the highly qualified doctors. At present the state has two medical colleges: one the centrally sponsored Regional Institute of Medical Sciences (RIMS) and the other State owned Jawaharlal Nehru Institute of Medical Sciences (JNIMS). The state is also having state of the art one private Hospital Shija Hospitals and Research Institute (SHRI) besides sizable number of small private hospitals.  
The record that we have successfully handled the first wave effectively in the state largely contributed to the hard work of the doctors and health workers. The effort was duly acknowledged by awarding the doctors by the state Government. As the second wave is continuously giving up challenges and that the covid-19 containment and prevention process worked so far has not made us contended, there is a need to relook afresh in the way how the Covid-19 pandemic is handled.  Some of the observations debated in the public domain are the differences in how the two waves of COVID-19 are handled in the state. It can be examined from the perspective of 4Ts which PM Modi has advocated for confronting the COVID-19 pandemic. The 4Ts are Test-Track-Treat-Tika.
In terms of treatment, as on 22nd July, 2021 there are 10, 395 active cases in the state. The total number of COVID general beds and COVID ICU beds available in the state is 633 beds and 150 respectively. Of the total hospital beds 321 are in Government hospitals, the rest are in private hospitals. Private hospitals are businesses which run on the fees paid by patients and expectedly, private health facilities are beyond the reach of a larger section of the public.  Hence, major responsibility of handling the covid patients and treatment primarily lies on the tax-payers run government hospitals. Regarding ICU beds 80 are in Government and the rest 70 beds are in private hospitals. Regarding Covid care centre (CCC) there are seven centres operated by the state comprising a total bed of 1449. There are also 2793 beds in Community health isolation centres (CHIC) open in different parts of the state.  Besides this, there are a few beds in different district hospitals of the state. In comparison with the active cases the available number of beds seems to be inadequate. There are cases of sorry visuals of positive patients not getting the hospital beds and lying in the wet veranda of the health centre in Bishnupur district going viral in social media.  
Regarding tracing it may be recollected how things were handled in the first wave where different quarantine centres were open with the initiation of the government and local MLAs. Passengers coming back from outsides the states were mandatorily quarantined for a specified number of days. It would be worthwhile to ponder – did gross mistake have been made by not learning the lessons from the past? Not following the stringent tracing could be the one critical reason for this mass community transmission. Criticism which many experts and opinion makers already concede is that most of the COVID-19 positive patients have been allowed to be in home isolation. As per the information available as on 22nd July, 2021 the total number of person in home isolation in the state is 4145.  Given the condition of housing in the state where largely dwellers serve the same bathroom and toilets, the home isolation of positive people is considered as the root cause of wide spread of coronavirus in Manipur.
Testing and Tracing usually go hand-in-hand, testing is the only means to identify the infected persons. Testing cannot be taken lightly. If we have to bring down the positivity rate, ramping up the testing is the only way out. More testing will obviously lead to the increase in numbers of positive figures but it’s the best and only way to begin tracing. Most of the testing conducted is through RAgT however for effective result; shouldn’t the mode of testing be opted for RTPCR wherever possible?
Out of the 4Ts, Phase 1 of Tika, which means vaccination, an effective tool in avoiding fatalities was launched on 16 January 2021 covering the healthcare and frontline workers. Phase 2 began on 1 March 2021 to cover 45plus year old’s with comorbidities and 60 plus year old’s.  On 1 April, vaccinations were opened for everyone above 45 years. Phase 3 of the vaccination campaign was opened up to include all eligible adults (18 plus) from 1 May 2021 following a surge in cases in April, a second wave. The total number of vaccinations in the state is 11,11,138 out of which 9,79,896 are given dose 1 and 1, 31242 are given dose 2 as on 22nd July 2021.  The progress in vaccinations still needs to be ramped up significantly if we have to win the fight against COVID-19. It would be prudent to reiterate what WHO upholds ”Vaccines are incredibly effective in preventing severe disease and death so we need to get fully vaccinated”.
The recent announcement that health officials would visit every household and conduct random COVID-19 testing of at least one member of the family; if that one person is tested COVID-19 positive, then the entire family members would be tested. The launching of Mobile Insulated Vaccination Bus at Khurai on June 30, 2021 by the H/CM. Free ration to households during curfew are all welcome steps in combating the Coronavirus.
People are concerned regarding the continued mortality in the state. COVID-19 is deadly however given the timely and proper medical attention, only a small percentage of people with comorbidities do not recover. The continued number of fatalities in the state is morally disfiguring in comparison to the claims that state possess healthcare specialists. General public are inquisitive such as – Is there a moral degradation among the healthcare providers in the state? The question is more pertinent with the sense prevailing among the senior doctors. There have been cases of challenges to the extension of Health Director by the Additional Director Health and revolt to the extension of the erstwhile medical Director of JNIMS. As opined by one of the senior doctors in the state that there is dissatisfaction among the rank and file of the healthcare providers on how the affairs in the institutions are being run by denying eligible persons their due promotion; if it is true then it needs to be rectified seriously and immediately. Questions are raised from different quarters of the society whether are we heading into whole new territory of manipulating the system and institutions with a vested interest? The very fact that the probable are denied their due reward itself is a demoralising factor.
We have complete faith in the authority that strategies are chalk out to combat this deadly virus and prevent further fatality with the support of the people. The essence required is the authority must take a stance of effectiveness and the manner in which it is enforced should have the outcome which is prudently befitting in combating the issue in front. It’s time for the authorities to search for a fresh stimulus with sincerity and objectivity in conformance with the PM Modi’s 4Ts, the Test-Track-Treat-Tika . Giving a heed or not is laid best to the authority which have the luxury of having many experts at their disposal!!! 
(The writer is Assistant Professor, Department of Management, Mizoram University)