Two interesting things happened this outgoing week. One, the Chief Minister of Manipur, N Biren Singh, squarely blamed those staying at Quarantine centres as solely responsible for the rise in the number of Covid cases in the state as they have not been following quarantine rules strictely. Two, the Manipur Cabinet decided to make the wearing of face masks mandatory in public places, including offices to prevent the spread of Covid 19 following which the Health Department has issued instructions to be followed by the government offices for immediate compliance.
Putting the blame on those staying at the Quarantine Centers absolves the way such centres are being run and managed which has come to light over a period of time: mixing up different batches of those returning to the state in the same area, keeping more people in a room in contrary to physical distancing norms, not providing protective masks every day to every one at the said centres, lack of adequate toilets and bathrooms as well as perhaps lack of disinfecting the quarantine premises etc. This is an unfortunate statement to make as a political leader and smacks of posturing on flimsy grounds, not to mention taking advantage of the lapses of a few to duck responsibly as the head of a state.
It is the Government that has to ensure institutional mechanisms are in place in the first place before taking the high moral ground on the basis of some undisciplined returnees scattered across a few quarantine centres. The case of one Quarantine center at Moirang with over 30 Covid 19 infections but no case of flouting any quarantine norms says all there is to say on the matter. As for mandatory wearing of masks, it is strange that it has taken this long for this basic preventive measure to be placed in public domain. Hopefully, Ministers and public representatives will ensure they themselves follow the basic thumb rule of wearing masks when they appear for public and state functions or on media. It is almost become the norm for many Ministers and bureaucrats not wearing masks at all or not wearing them properly, like looping the masks on but pulled down entirely or wearing them but keeping their noses out of the mask cover. It will surely be interesting to see who will tell these eminent people to pay heed to the Cabinet decision in the days ahead. Will the public be allowed to call out any of the Ministers or bureaucrats who appear in public/media without wearing masks?
On more pressing matters though, with active Covid 19 cases now going over the 300 mark in Manipur, it is clear that the situation is going to make very tough demands on medical frontline staff involved in battling it on the ground. Arranging for bed slots is the easier task for there is already progress on the Covid dedicated facility at Meitram and a few media reports have quoted the Health Minister as ‘looking at the option of turning Hotel Imphal Classic into a Covid facility’. Notwithstanding the fact that the recovery rate of Covid 19 patients in the state is high, the nature of infection and how it affects the physiology of each infected person is different, which then leads to a variance in the number of days needed for a full physical recovery and additionally involves allocation of adequate medical staff and resources in a timely and strategic manner.
Due to the nature and spread of Covid 19 contagion and infection, the allocation of working hours to medical staff on duty for treatment of patients is to be made in such a manner that they do not end up physically exhausted. To begin with, when health workers put on the PPE suits, apart from the discomfort it makes it totally impossible for them to even drink water or use the loo as any opening of the suit will not only make them vulnerable to possible infection but also leads to contamination of the gear. This means having to change the entire get up: the body suit, the head cover, the eye protection, the feet cover; an option that is not encouraged due to the sheer number of protective gear and other materials that are needed with the growing number of cases. The average time period that a health worker in a full PPE suit put in is a 6 hr cycle, not taking into consideration the mandated 45 minutes of step by step wearing of the suits and another 45 minutes of the doffing (removal) stages. Ideally, another shift is to be kept ready to take on the next 6 hrs of duty so that health workers do not end up dehydrated or physically exhausted. It is this planned out phasing of health care staff and their duty hours that make it imperative for authorities to pull in staff from district or block level or those who have the required medical degrees into Covid 19 care and treatment, of course after a period of training in safety protocols.
The move of the Manipur Government to put in isolation wards at Primary Health Centres and Community Health Centres in districts though is a hasty move. The intent might have well been to ease the strain on treatment slots at the Covid 19 isolation centres at JNIMS and RIMS but given that the existing staffing at PHCs and CHCs do not make it possible for the rotation of healthcare staff as mandated, this move should have been made only after allocating extra staff and resources.
Additionally, PHCs and CHCs are a lifeline for people in semi rural and rural areas for a range of health needs including minor operations to delivery cases. Putting in Covid isolation wards at PHCs and CHCs without ensuring mechanisms like extra staffing for general health care concerns and needs or arrangements of putting in fully staffed mobile ambulances for the community was an unnecessary call to trouble as can be seen from the incident involving the CHC at Wangoi where the staff had to turn away a case of a pregnant woman who had been taken to the Center for the delivery of her child.
The talks about engaging private hospitals to be involved in tackling the Covid 19 wave would need careful thinking as can be seen from the many cases elsewhere in the country where the private health care sector has only profited from the pandemic by shooting up their pricing. A better arrangement could perhaps be the utilization of medical staff from the private health care sector in Government settings, which can also work to assuage the anger of community people over being denied their access to health care at PHCs and CHCs. But then again, it is up to this Government to wake up to what public health measures mean and how much of a difference it can make in this battle against the Covid 19 pandemic.
My Dinner with Sydney, or, Roy Batty meets HAL?
– Now [Scarlett O’Hara’s husband] saw that she understood entirely too well and he felt the usual masculine indignation at the duplicity of women. Added