‘Prevention is always better than cure’ – this is one idiom that holds true in hindsight but seldom given due attention before things unravel and get worse. Contextualize this with the current Covid-19 situation in Manipur for it does not take any rocket science to work out that the nature of recent breakouts outside of quarantine centers to people not associated or involved in Covid care is primarily because of a more stringent approach to tacking the spread and management of the epidemic. To begin with, precious time was lost in between the time Manipur was declared a green zone and the influx of people returning home; time that could have been used to learn from what was happening around the world and in the country. It was the perfect window period to lay the ground for a strategic response: to take up awareness programs on Covid-19, to ensure quality quarantine centers which would be made available for health care workers and volunteers etc but most of all, to draw estimates of potential Covid 19 cases to prepare the required infrastructure and support systems which would include testing facilities, human resource so that the administration wouldn’t be caught sleeping when things blew up.
Unfortunately, the Manipur Government’s response to the Covid-19 pandemic looks like a case of a lack of understanding just how the pandemic was likely to play out. This when the pandemic had played out its different phases in other states within the country already. For starters, the nature of most quarantine centers was such that there was less physical distancing amidst the shared spaces aided by delays in testing even as new numbers kept being added up. This added pressure to the limited testing slots besides triggering more infections. Next came in the antigen testing kits to tackle the swell of testing samples with the spin given that more people would now get tested and then sent home in case they tested positive. This is where it gets messy and might well have contributed to the swell of Covid-19 cases in people outside of quarantine centers. The rapid antigen tests are known in medical and epidemiological circles to give false negatives. In medical speak, even the RT-PCR test exclusively used earlier in Manipur has a sensitivity of only 70 per cent while the later rapid antigen test has a sensitivity of 40 per cent.
In simple language, this means that RT-PCR tests can also give false negative results for Covid-19 while the percentage of false negatives from rapid antigen tests are much higher. It is in the backdrop of these Covid-19 false negative results from the rapid antigen tests being taken as the final verdict for people returning back to Manipur who were then allowed to head to their homes. Case in point being what happened with a person from Singjamei who tested positive again for Covid 19 after he had been discharged following a ‘negative’ test after his treatment stint. Estimate the chances of how many such cases have the potential of further spreading the Covid 19 infection – one to many, the many to many others and so on.
To come to the current situation in Manipur: Is lockdown the only way to arrest Covid-19 infection? Yes and No. Both. Lockdown can only help the part of possibly infected people not getting into public space and hence, not spreading it further. But lockdown cannot help exclusively till each and every contact that a Covid-9 infected person has been in touch with or exposed to, is also tested BEFORE they in turn have made contact with other people. The lockdown has to be used to trace each and every contact made and the contacts they further make and so on and then test them, ideally with the RT-PCR test to cut down the chances of false negatives. The state administration would do well to procure additional RT-PCR machines and other support systems given the still high number of people with Covid 19 occupying available treatment slots. The possibility of massive spikes at the community level would mean a mad scramble for hospital beds, which in turn can lead to serious turns.
The Government must take a long hard look at the current situation and then decide if it can advocate for home quarantine of non serious Covid-19 cases but with due support systems like awareness programs in the locality so there is no panic or hostility; proper disposal of waste from such homes; delivery of all essential items or even delivery of cooked food for families where say, the infection has spread to the entire family and cooking would take a toll on their recovery, doctors and nurses nearby on call. The other option is to get more testing slots for RT-PCR and segregate and test, isolate and treat. This would mean providing quarantine facilities for health care workers and volunteers at Covid care facilities including quarantine centers. Both scenarios would have to be aided by stringent adherence to safety protocols: proper and correct use of masks, maintaining physical distancing and use of hand wash or sanitizers. The use of face masks remains a major concern with even people representatives not leading by example and a casual conversation or observation of people in public spaces before the current lockdown would have shown too well just how much of understanding of the use of masks is there: most people using surgical masks or pollution masks for days on end, thereby putting themselves and others at risk. The Government would do well to invest in a few awareness programs on the use of masks, how to wear them and how long. As for the public, it is high time every one took a bit of responsibility to stay safe and ensure the safety of people around them. That picnic can wait, that get together can wait, that social gathering can wait. Please remember that Covid-19 lies in wait for anyone who slips when it comes to safety protocols. Take care!