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Trace, Test, Treat, and in this Partner with Local Bodies to Reach Deep into Communities

Manipur’s Covid 19 response is coming apart at its seam with every single day highlighting stories about the lack of any existing quality control measures to combat the epidemic. Social media platforms today are replete with testimonials of people in Covid wards sharing how places are left dirty with sweepers and cleaners not turning up for duty, how positive patients are being left to their own devices in isolation at certain locations with no medical staff or security and lately, the increasing stories of medical staff turning away patients. The State Administration and officials will only point towards statistics and say: ‘we have this number of beds, we have this number of ventilators, we have this many people being treated’. Ironically, it is this matter of handing out figures to project efficiency that is the core of the Covid 19 problem in Manipur: the utter lack of a humane response, the lack of co-ordination, the lack of foresight – all of which is taking a serious toll on the overall response, the lack of morale and the physical toll on medical frontline workers who are doing a thankless job inside the wards while political representatives play lip service and hide behind official notifications.
Enough has been said in this series regarding the matter of the spread of Covid 19 infection amongst the general community who have not had any travel history across the state’s border and who have not been exposed to any known person with Covid 19. That the State Government desists from admitting ‘community transmission’ is not a surprise: the current regime at the Center is busy projecting how India’s national response to Covid 19 has been strategic and adequate, which means that the State leaders will play to his tune. It’s only Kerala which has admitted officially to community transmission of Covid 19 after a spate of infection in a small coastal town of the state. By definition, ‘community transmission’ of Covid 19 refers to when there are cases where the source of infection or exposure is unknown. This leads to another reason why Governments do not admit to community transmission: the fact that they have not traced and tested each and every contact: primary as well as secondary and then apply the same to each and every primary and secondary contacts till the chain is broken.
As of now in Manipur, only the primary contacts of every Covid 19 positive person are being tested. There is no further testing of secondary contacts. This means that denying there is community transmission of Manipur is not going to help; declaring lockdown extensions is not going to help and marking off containment zones is not going to help: not till the last contact person has been traced and tested. Unfortunately, the announcing of containment zones in the absence of mass testing in the said areas does not help fight transmission amongst the people. Rather, it leads to social stigma and even medical systems turning away patients who are seeking non-Covid medical care and attention.
Till the time, a system is worked out to address medical emergencies in the backdrop of the Covid 19 pandemic in Manipur, there are going to be further episodes of patients being turned away or dying due to lack of medical attention. While incidences of patients being turned away are appearing in the public domain, not many know that there are countless number of people with illnesses who are coping at home in fear of a likely Covid 19 infection while seeking treatment. There is a complete lack of trust in the community today: health care workers not trusting patients and vice versa. This is where the Government as well as community leaders need to step in and build a bridge to bring both sides together. The Government on its part would need to step up on giving inputs to health care staff that not every medical treatment or procedures involving Covid positive patients will result in their infection. Barring certain medical procedures that involves drilling and high aerosol use, using protective wear and following routine tests for Covid 19 and quarantine protocols lessens the risk of infection from a Covid 19 positive patient.
But health care workers at all medical health care settings today (not just the Covid designated ones) continue to be at risk of being infected with Covid 19 from anyone in the patient party, given how widespread the cases are showing up. As this is being written, news trickle in that 5 staff of the Leimapokpam Primary Health Center (PHC) have tested positive for Covid 19 and that the PHC is to be closed down. How much of contact tracing and testing will the state authorities take up? Will announcing a containment zone without strategic testing help at all? The answer is a vehement no.
How does one address the matter of ensuring safe access to health care for the public and where the medical staff are also not put at risk? One way perhaps is to use the workforce of ASHA workers in the state: ensure they have safety wear, give them daily financial incentives and ask them to map out health needs of the areas they are operating in. In areas where ASHAs are not operating, Leikai club representatives can be roped in. The ASHAs and Leikai representatives can list out pregnant women as per their likely delivery schedule, list out patients with history of blood pressure, other chronic infections and illnesses and get them tested right now so that those found positive to Covid 19 can be shifted to the Covid ward while the negative cases can be linked up for their respective health needs when the need arises later. All health care workers: the doctors, nurses, attendants, ward staff, sweepers, cleaners, waste disposal staff at every hospital and every health care facility, including PHCs need to undergo Covid 19 tests and quarantine periods now. Not doing this puts everyone at risk. Not increasing the number of tests in containment zones puts Manipur at risk. Not paying attention to testing each and every direct and indirect contact that a Covid 19 positive patient has made will only lead to the chain getting wider.

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