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Amidst Grim Situation Nationwide, Preparing to Prevent Manipur’s Health Infrastructure Being Overwhelmed is Vital

In terms of numbers alone, India has just become the sixth worst hit country by Covid 19 and with the number of infections rising every day, it is likely to climb further. But not helping the situation are – the announcement of easing of lockdown restrictions nation wide, the opening of flights, public places etc which will mean more risks of infection aided by new guidelines from Indian Council of Medical Research (ICMR) that now says that those being treated for Covid 19 can be discharged after the first negative test post their treatment. Compare this to when WHO guidelines stipulated at least three negative test results after treatment for Covid 19. The issue here is that one needs to critically read between the lines to assess what is not being disclosed – that India is on the back foot in its fight against the pandemic.

The real reason for the guidelines regarding discharge of Covid 19 patients is simple: the existing health care facilities across the country are being stretched far beyond its capacity and hospitals are now overburdened by the sheer number of people who need tests and/or treatment. Kerala of course, is not included for it has a robust health care system, which is aided by a intersectional link with an efficient social service set up and mechanism in place. In Delhi for instance, every fourth person taking a Covid 19 test is positive and even as the Government and the administration keep saying that there are enough beds for Covid 19 patients, the truth is out on media domains and social media: that people are being turned away from testing, that people with Covid symptoms are being refused to be taken in as patients due to the lack of medical beds. With the high Covid infection rates, medical facilities in Delhi and other metro cities are now reluctant to take in patients with other medical emergencies, even the most critical ones without them undergoing tests for Covid, which is delayed or almost impossible due to the sheer backlog in tests or lack of enough testing kits.

One may well ask: why are we talking about metro cities? Is it of any relevance to the Manipur situation? The answer is simple: there are lessons to be learnt from what is going wrong in other places, ironically seen as those with better medical resources and capabilities in the pre Covid 19 era. The foremost lesson from the experiences across the word and the country for Manipur to imbibe is to ensure more testing slots, supply and maintain the quality of PPE as well as strict adherence of disposal for health workers. The later part is important for Manipur has now reported a case of a nurse involved in the care of Covid 19 patients who has tested positive herself. Amongst the medical staff who have been infected with Covid 19 overall, it is the nurses who are at the most risk as they stay hands on for patients more than doctors. Ironically, not many know that PPE suits are cut out and manufactured for size and structure that are more suitable for men. Not many know that it takes 45 minutes to put on a PPE suit on in the correct manner and another 45 minutes to take it off in a sequence (known as doffing) that does not risk infection to the medical caregiver.

Not many know that the PPE suit are uncomfortable and restricts movement and that most medical staff end up wearing them for 6/7 hrs, most of it standing. Not many know that those wearing PPE and doing their duty in the Covid 19 isolation wards often have to do without any food or water as they cannot just take off their protective gear like one takes off clothing. Thanks to the revelation of the nurses from the state who came back from West Bengal, many would be aware that due to shortage of PPE materials, many health providers looking after Covid 19 infected patients are being given substandard wear or worse still, asked to re-use soiled PPE. But how many realize then that all of these factors mean that the nurses, mostly the women in PPE suits will not be able to change their sanitary napkins as required during their menstruation time when they are on duty in the Covid wards? Has anyone thought of this? Has this concern being flagged and addressed? The most practical way to address this is to ensure that the duty roster is made keeping in mind the menstruation dates of the concerned staff on duty.

Meanwhile, some of the Covid 19 stories emerging from Manipur are disturbing: there was the case of the girl who was discharged after her report came in negative post her treatment and who could not go back to her district. The auto driver who came in as a Samaritan to help her by driving all the way from Imphal to Ukhrul had to be taken for quarantine. The message being sent out from this incident? ‘you are on your own because we have ensured your treatment’ to the girl and to the rest, it is this: do not even think of helping anyone who has come out of treatment. That there was no transport being arranged for the girl in the first place says a great deal about the lack of co ordination between the hospital and the transport support system. The State Government also needs to make up its mind on what it wants to convey to the people. The SOPs calls for maintaining physical distancing and to wear masks but if one is to go by the newspaper photos of Ministers and other public figures present at this Government function or that, it is easy to notice that majority are not following the same guidelines they have put in place. The Government cannot be speaking one thing and act in the opposite manner themselves.

What would bode well for the Government is to take the time at hand given by the landslides on the Highways that is delaying the trickling of state domiciles to send out informed and well articulated messages on how to address if God forbids, a Covid 19 related death happens in the state. To stay in a total state of confidence that there will be no Covid 19 related deaths in the state on the basis of the high recovery rate would go against the State administration in the long run. All it takes is one death to trigger panic, stigma and a volatile public reaction.

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