Looking beyond lockdown
Despite that fact that India has a SoP of response for almost every disaster, it has no such SoP for biological warfare.
Some studies in India have indicated that the lockdown reduced the intensity of the spread of COVID-19 by 60 per cent, thereby indicating this effectiveness. The basic reproduction number (RO) is a measure of the average number of people that would be infected by an infectious person in which no control measures are implemented while the effective reproduction number (Reff) measures the average number of people that would be infected by a single infectious person taking into account the public health interventions to control spread. Higher the Reff value higher the spread, with more cases. Lockdown, which is one of the major initiatives to control the spread has been effective in reducing community spread, as in Australia. Italy which delayed in imposing such measures saw quick spread. New York has a Reff value of 4, while Sweden has a value of 2 though it has relaxed norm but its citizens are much more responsive in taking defensive measures against the disease. Singapore which was hailed as an early success bounced back with Reff at 2. The effectiveness of lockdown depends on the effectiveness of it implementation. Reff 2 is the alert level and any value above 2 indicates that each infected person is infecting 2 other persons. Italy and UK has a Reff of 4. The unfortunate part in fighting the disease is that every country responds differently. Manipur also need to conduct such a study for better planning in combating the disease.
Despite such strict measures as lockdown, the disease continues to spread. The advantage of lockdown is that due to delayed and lower number of transmission the state is better prepared to fight the disease by mobilising resource towards this end. Unfortunately, it seems that Manipur had not done so where the response towards fighting the disease is slow. Lockdown1 was wasted in distributing food items even to the level of quarrelling rather than in preparing the health machinery in gearing up for fighting the disease. Despite that fact that India has a SoP of response for almost every disaster, it has no such SoP for biological warfare. If there was such a SoP, rather than groping around in the initial period, the response would have been much quicker. Why we do not have such a SoP is unsure but it was perhaps due to vested interest groups working against it.
Every infected person do not necessarily spread the disease, many do not though there are a few individuals who were called super-spreader who infects large number of persons. But the problem is in identifying such super-spreader and they are known only on hindsight. Our understanding on the virus and its behaviour is still in the initial stage.
Manipur was sitting comfortably after only two cases were detected and both recovered. But once the decision to bring in stranded people was made without proper preparation the problem started. A proper quarantine system ought to have been put in place with trained manpower to service the returnees, but the opportunity was not grabbed. A weak system was put in place and even for the testing, scientifically if the samples were drawn on the 5th or 6th day of their arrival it would have provided a better detection mechanism. The virus are not in detectable quantity in the first few days of infection and that is the reason why 14 days home quarantine is enforced. Even for home quarantine, the family members need to be trained about the dos and don’ts. Even though there are SoP framed for both home and community quarantine by the MHFW, it was never brought out in the public domain and hardly implemented. Very few people are aware of it and those who are aware are from the medical fraternity.
Kerala is a success model, where the health experts are in the forefront in devising the mechanism for the control with the involvement of local bodies and all citizens. In contrast in Manipur the health experts were sidelined, so is the local bodies. There is still time to correct the process and it is hoped that the views of the experts are incorporated in the response. Our weakness is such that quite a few districts still do not have a proper ambulance which can transport as suspected case!
There is a belief among experts that the virus will be with humanity for many years just like the H2N2, H1N1, H5N1, HIV, etc which had killed millions in many cases but human become adapted to them with drugs to cure them and vaccine to protect from it developed. Similarly with time for SARS-Cov-2 also drugs and vaccine will be developed. This can lead to herd immunity where sufficiently high percentage of the population is immune to the disease due to recovery from the infection or vaccinated against the virus.
Manipur is also racked by flip flop in the policy in various measures, and the latest one is n the treatment of the air arrivals. Many parents are keen that their wards are kept in institutional quarantine but no; the government decided to adopt the advisory of the MCA. Only when students bodies protest did the government reversed its decision of home quarantine to institutional quarantine leading to confusion in the airport when the first arrivals reached.
Lockdown cannot be imposed indefinitely for containing the spread and it will have to go one or the other day. Its impact on the economy is severe so much so that experts during lockdown 2 predicted India’s growth at 1.9 per cent during 2020-21. With lockdown4 in place, it is bound to further impact the economy and many experts are now predicting a negative growth this year. Hence, the lockdown will have to be eased in phases so much so that full economic activity starts. Therefore, one have to think about the post lockdown scenario, not only for the new norms in economic activities but also in the control of the spread of the disease.
The two main hospitals are now not attending to patients of other diseases though RIMS had started OPD through prior appointments. While fighting Covid-19 the state cannot neglect other diseases which are also life threatening and may cause death early. One option is to allow RIMS to treat only patients free from SARS-Cov-2 who are suffering from other ailments while JNIMS is declared as the Covid-19 hospital. Infected persons who are asymptomatic or even symptomatic but the symptoms are not that severe are kept in an isolation centre, not necessarily inside the hospital but in a properly fenced quiet location where doctors are in hand 24/7. Any patients which require hospitalisation should be transferred immediately for life support. The patients’ recovers on their own as there is yet no drugs to treat them though they may require life support system while there are claims of this and that drug’s efficacy which are yet to be verified.
Ultimately, the community quarantine also needs to go and dependency on home quarantine shall become the norm but only after the general population is properly trained in the management of such cases. In other words, the fight should not be left to the government alone but every citizen has to chip in. For this mass detailed awareness need to be carried out, which is sorely missing at present, so much so that there are still opposition on opening of fresh community quarantine centres or for that matter home quarantine for those tested negative; though such opposition has tapered considerably. Safety measure like physical distancing, restriction on mass gathering (despite the restriction recently a marriage was held with fanfare with a fairly large crowd most without masks in a place in Imphal East), regular and proper washing of the hands and use of alcohol based hand sanitisers, avoiding handshakes, unnecessarily moving around, etc should become the new norm. How we conduct in society and in work place need a major shift which at the outset will be very difficult but have to be adopted for our own safety. Adapting quickly to the new norm and entering in new opportunities should be the best option; many embroidering phanek borders started stitching facial mask, some units have even started manufacturing PPE and alcohol based sanitisers, etc are examples of grabbing opportunity. Use of ITES will reach a new height and those working in this area will have strong competition and have to bring out new softwares and apps to meet the challenges and for them sky is the limit. Other economic activities also need to adapt to the new norm, if they want to succeed or even compete, else they will become archaic and slowly disappear.
Let us prepare for the post lockdown systematically so that we come out stronger, vibrant and more competitive after the lockdown keeping COVID-19 within our stride, adjusting to the new environment. Even the government must think and devise mechanism and policy to make this unprecedented disaster into an opportunity; especially as there will be large scale unemployment with many returnees having quit their jobs and their employment need to be considered. There will many cases of psychological issues among many which will require systematic treatment. It is hoped that government is proactive in this regard rather than be reactive.