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Health Experts Warn that Manipur is Witnessing the Start of Community Transmission of COVID-19

Has community transmission of COVID-19 begun in Manipur? Many health experts think the state is on the verge of it, and suggests ways to handle the situation.

Meanwhile, people are panicky and apprehensive with the increase in number of persons infected with COVID-19 through local transmission. The number of persons who tested COVID-19 positive through local transmission without travel history reached at least 257 out of 2621 COVID-19 positive cases as of July 31. Of the 2621 COVID-19 positive cases 2022 are mainly returnees while 342 are security personnel stationed in Manipur.

On a query how people without travel history came to be tested for COVID-19, Additional Director of Manipur Health Services and State Surveillance Officer, Dr. Laikhuram Tomcha Khuman told FPSJ Review that most of the local transmission has been detected from contact tracing of those returnees who tested COVID-19 positive and some of the local transmission have been detected after developing symptoms and whose contacts are traceable, while some were tested when a member of their family/office/group contacted a returnee/person already tested COVID-19 positive. There are also cases of people testing on their own since tests can be done in private hospitals and diagnostics centres like Shija Hospitals and Babina Diagnostics Centre.

Additional Director and Spokesperson of Department of Health Services of Manipur, Dr. Khoirom Sasheekumar Mangang told FPSJ Review on July 30 no doubt Manipur can be considered to have passed the stage of local/cluster transmission but it cannot be described as community transmission per se.

According to his estimate, as of now in the Manipur case, there is one local transmission in every 12 COVID-19 cases. Manipur therefore can be said to be currently on the verge of community transmission of COVID-19 as the local transmission beyond containment zones is not yet spread far and wide. However, Manipur cannot be described as a state where there is COVID-19 community transmission until a technical committee of the state consisting of experts decides to declare it officially, added Dr. Sasheekumar Mangang.

At the same time, a medical expert who doesn’t want to be named expressed to FPSJ Review, “Manipur has already four generations of transmission of COVID-19 started with the returnees who tested COIVD-19 positive. So, it can be considered as community transmission even though the number of local transmission is less than 20 percent of the total positive cases as per Government of India’s guidelines.”

Notably, Additional Director and State Surveillance Officer Dr. Tomcha Khuman said, “Till now almost all the contacts of COVID-19 cases are traceable and number of local transmission is not reaching even 10 percent of the total positive cases while community transmission is to be declared only when there is inability to relate confirmed cases through chains of transmission for a large number of positive cases and reach 20 percent.”

However, we need to take precautionary measures seriously like social and physical distancing, wearing masks and maintaining health hygiene by hand washing and sanitising frequently, and following the Standard Operating Procedures (SOPs) and government guidelines from time to time, added Dr. Tomcha Khuman.

During the stage of local transmission declaration of containment zones and search of active cases are considered best tools. On being asked if the government is going to test all within containment zones, Dr. Sasheekumar Mangang said “it is not mandatory to test all people within a containment zone. However, search of active cases within the containment zone is being conducted by District Surveillance Officers or District Chief Medical Officer and Primary and Community Health Centres. The active cases are those who show symptoms like fever, dry cough, tiredness, sore throat, difficulty in breathing etc. If the population is very small, all within the containment zone can be tested at the wisdom of the medical officers.”

Additional Director and State Surveillance Officer Dr. Tomcha Khuman also added that since there is no scope to test one and all, contact tracing is going on and those who show symptoms from the containment zones are tested and given treatment accordingly.

However, Md. Kheiruddin Shah Moijingmayum, a resident of a containment zone, Moijing in Thoubal District said that tracing of contacts after their Pradhan tested positive was not satisfactory. They themselves prepared the list of people who contacted the Pradhan and even when the list was ready, they were not tested in time. “We approached the DC, SP and authorities concerned to get them picked up for tests but in vain. Delay in carrying out tests is one reason for the disease spreading. Even those tested positive were not picked up on time. Only after I complained to the Chief Minister over the phone on July 22 night at about 10.20 pm those tested positive and who remained at home were picked up for treatment at COVID Care Centres.” Moijing is one village where the highest number of local transmission has taken place with at least 80 people tested positive.

Many people consider that the cause of local transmission in Manipur is lack of basic facilities at quarantine centres, delay in tests and violation of SOPs etc. However Dr. Tomcha Khuman said, “People’s negligence and carelessness in following SOPs – physical distancing, wearing masks and sanitising is the main cause of local transmission leading to the present stage.”

Medical Superintendent of RIMS, Dr. Ch Arunkumar added, “After one multi-tasking staff tested positive, contact tracing and tests on all the hospital staff are being done beginning with the Nephrology Department. As of today (July31) 28 health workers including doctors and nurses have tested positive. The primary source of COVID-19 transmission is yet to be established.”

Notably, Dr. Brogen Akoijam, Professor of Community Medicine and Dean of Academics of RIMS told FPSJ Review, “Exact source of infection is yet to be established. However, even if we don’t know the exact source, RIMS being a hospital risk is high; there is a high chance of transmission of COVID-19 to the doctors, nurses, health care workers and other staff from the patients and their party.”

In the present state of confusion surrounding the Covid-19 community transmission in Manipur, people are panicky and apprehensive whether there is community transmission in Manipur and how far and wide it will spread or be uncontrollable. “Amidst the COVID-19 pandemic, many non-COVID-19 patients have also died. There is no policy and programme and SOPs for the hospitals in Manipur for non-COVID patients. Therefore, hospitals need to be prepared fully for non-COVID patients to tackle spread of COVID-19 and there should be a proper policy and programme and SOPs for non-COVID hospitals. Until and unless there is a policy and programme and SOPs for non-COVID hospitals, health care providers and workers may become a potential source of infection and transmission of COVID-19, asserted Dr. Brogen.

Though once a COVID-19 green zone state, Manipur is now on the verge of community transmission with five lives already lost as of July 31. Once community transmission starts the fatality rate is likely to increase extensively as there are many persons or patients with co-morbid conditions even as the non-COVID general hospitals remain closed.

Mortality amongst COVID-19 positive patients who don’t have co-morbidity is very rare and recovery is speedy and at a high rate. Even persons who have been living with diabetes, hypertension and cancer for a short period of time, two years or so, and infected with COVID-19 recently can recover and become COVID-19 negative. However, the chances of mortality is very high amongst persons with co-morbidity like long standing diabetes for about 10 years or more, kidney problems and living with dialysis, and those cured from TB but with one-fourth of their lungs dysfunctional. They are very vulnerable. COVID-19 enhances the deteriorating health conditions of those who test COVID-19 positive over and above their chronic and systemic diseases leading to death, says Dr. Ch Arunkumar, Medical Superintendent of the Regional Institute of Medical Sciences (RIMS).

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