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Lessons From HIV/AIDS for COVID Battle is, Never Let Guards Down and That Sentinel Surveillance is Vital

[avatar user=”Chitra Ahanthem” size=”thumbnail” align=”left” link=”file” target=”_blank”]CHITRA AHANTHEM[/avatar]

As mentioned in an earlier article: there are many parallels between the Covid-19 situation and the HIV/AIDS epidemic, which had a long drawn out struggle to get health infrastructure in place, apart from the concerns over fear and social stigma. The only difference between the two is that Covid-19 is more potent in its transmission route thereby making it imperative that we learnt lessons from the HIV/AIDS experience while also taking note of the rise of communicable diseases like Swine flu (H1N1 epidemic), the Ebola outbreak and the Nipah virus outbreak.

So, what factors and lessons from the HIV/AIDS experience are important to be taken note of today? First things first: the supply of good quality protective gear for medical staff and workers in the form of gloves, three layered masks and running water supply with soap and sanitizers. During the HIV/AIDS pandemic when it was at its peak in Manipur, doctors and nurses even at the two main State hospitals did not have adequate supply and it took many stakeholders and various advocacy measures to ensure that these items were provided. With or without the HIV/AIDS and Covid 19 factors, three layer masks and gloves are a necessity for health care workers: at state and district hospitals, at Community Health Centers (CHC) and Primary Health Centers (PHC).

How is it then that there are donation drives of cloth masks by socially minded people who mean to extend help to doctors and nurses at PHCs and CHCs, happening? Does it mean that there are no triple layered masks being given adequately to these frontline medical staff? Is everyone not aware that cloth masks are NOT meant for medical workers? And if even triple layered masks are not being handed to doctors and nurses at CHCs and PHCs, what about N95 masks at all?

Many will say, ‘there are no Covid cases in Manipur’ so why the fuss? The fuss lies in the fact that this pandemic is not yet done by a long shot yet. Scientists and researchers are pointing out that there will be swell in Covid cases when lockdown eases and then more when lockdown is lifted. Additionally, another seasonal change will bring in yet another round of infection and transmission. A statement like ‘There are no Covid cases in Manipur’ from the political leadership could possibly lead to the people at large taking it easier and be less on their guards thereby throwing caution to the wind. Cloth masks will no longer be thought of as a necessity and social distancing norms would be forgotten. A parallel to the HIV/AIDS pandemic would be when it was assumed that the virus was prevalent only amongst certain high risk populations like injecting drug users who shared injecting paraphernalia, sex workers and others and it was conveniently forgotten these ‘at risk’ populations also had transmission routes to the ‘general community’.

With the low number of testing being done so far, a ‘Covid free Manipur’ statement is totally problematic. It would take a comprehensive Sentinel Surveillance to give a clearer picture. In the HIV/AIDS context, the Sentinel Surveillance was being done through informed and confidential testing of high risk populations AND through the Ante Natal Check Ups where pregnant women undergo testing for HIV. The scenario would change for Covid definitely but sentinel surveillance is the definite need of the hour.

The problem here for Manipur would be the lack of clarity over the ‘Revised Strategy for COVID19 testing in India, Version 4, dated 09/04/2020 as put out by the Indian Council of Medical Research (ICMR). The testing strategy is focused on only symptomatic cases while the only mention for testing of asymptomatic people are only meant for those with direct and high-risk contacts of a confirmed case (once between day 5 and day 14 of coming in his/her contact). The rider here is the statement by Raman R Gangakhedkar, Chief Epidemiologist of the ICMR who made a statement a few days back that over 80% of Covid 19 patients in India are asymptomatic. But because the testing in India has been focused on only the people who have come into contact with people who tested positive to Covid 19, leaving the room wide open to easy and rapid transmission from amongst the pool of untested people.

The Covid 19 experience is best tackled with foresight by drawing on lessons from earlier pandemics. It is time to ensure adequate quality health services at Government settings and to make assessments of laboratory and diagnostic needs. It is a good time to get rapid testing kits: there are many good quality ones approved by ICMR which are not that expensive and use them at the state’s border areas to begin with. Getting them now rather than thinking of them later when cases pop up would be a better move than spending money on

Thermal scanners, which are not going to be of any help given the majority of asymptomatic cases. It’s taken a PIL to highlight that the foremost health frontline worker on the ground – ASHAs do not have masks provided to them. Let’s hope there won’t be another PIL to take stock of what protective gear is being made available to doctors and nurses.

Interestingly, the nature of the unpreparedness of the health sector in the state and in most parts of the country in the response to Covid 19 (except for Kerala) has resulted in the pandemic further impacting health services. People in Manipur are fortunate as most hospitals treating Covid 19 cases in many states today are no longer taking in any other health related cases. If you have been following news across the country, you would have read of how cancer patients, dialysis patients, pregnant women are not getting any treatment or being turned out of hospitals. In Manipur at least, deliveries are being carried out as well as other emergency operations. But one worrying factor is that the routine health check up for pregnant women and immunization schedules of infants and small children would have gone to a toss specifically beyond the Imphal districts given that the lockdown would have impacted movement while social distancing norms would have cut out the elements of monthly screening and health camps for anemia amongst women and other pregnancy related services, apart from routine immunizations for infants.

What the Covid 19 response needs is a public health approach and not a mere medical emergency response. There has to be strategic analysis and even questioning of government guidelines if need be, for one glove cannot fit all and it’s only with critical thinking that solutions can be arrived at. The HIV/AIDS pandemic in Manipur was a learning curve and saw doctors and nurses who were not scared to express what was lacking in the Government response. Government officials often faced flak but to their credit, were on board with activists in the fight against HIV/AIDS. That certainly helped the entire community as a whole. It’s time the same happened with the response to Covid 19.

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