Guwahati: Alarms in Northeast India went off when the first case of COVID-19 from the region was reported from Manipur on March 24. In a period of 28 days, the region registered 53 cases of the novel coronavirus pandemic which is an average of about 2 cases every day. Assam leads the tally among the Northeastern states with 34 cases followed by Meghalaya with 12. Sikkim is the only state in the region in particular, and in India in general, to not register even a single case of COVID-19 so far.

However, the cluster of the eight Northeastern states, which is seldom looked upon by ‘mainland India’, has set an example for the rest of the country on how to prepare and fight the deadly virus.

Assam health and family welfare minister Himanta Biswa Sarma in a recent press conference said that the state has managed to break the COVID-19 chain as all the positive patients are either in quarantine or has tested negative. He also said that there was no further contact between the society and positive patients and the state has successfully flattened the curve.

Considering Assam’s huge population, urban clusters and socio-economic characteristics, the rate of new cases remained much lower in comparison to other states such as Maharashtra, Delhi or Madhya Pradesh. The state has tactfully managed to separate the infected and their contacts from the healthy ones.

Table showing total number of cases, recoveries (cured/discharged) and deaths across Northeast

As a precautionary measure and in order to maintain physical distancing, Prime Minister Narendra Modi announced the extension of the lockdown till May 3. Although governments across the states in the region had also stepped up preparedness against the pandemic, it has kept the governments on the edge.

As per health experts, the impact of COVID-19 on a human body can range from no symptoms to severe illness featuring pneumonia. Everyone infected requires to be quarantined, either at home or at a medical facility but people with severe symptoms need to be hospitalised.

Preparation for phase 2

So far, 19 infected persons have been discharged in Assam and the health minister is hopeful, that in the coming days, all the patients will be cured and discharged. Not just this, the state is also preparing for the second phase of coronavirus, if and when that happens after the lockdown is lifted.

Assam’s health and family welfare minister launched helpline number ‘9615471547’ under the initiative of Assam Cares. All persons from lower income families, like students and working persons and those of short-trips who got stranded outside the state due to the lockdown can give a missed call on the helpline number, then they will get a link to a perquisite form and on verification they will be given some financial relief.

The helpline number received around 9.5 lakh. Then with the help of telecom companies, it was identified that 4.32 of these were unique calls. Out of these, more than 2 lakh people completed the forms, and then, authentication process was carried out for 1 lakh forms and eventually, the number was narrowed down to 86,000 people.

In the first phase on Monday, Assam disbursed Rs 2,000 each to these 86,000 stranded persons. Further, health and finance minister Sarma said that the state is considering another instalment of financial aid before the lockdown is lifted.

The minister explained that through the process the state now has a huge data as asset. And when travel is permitted among the states, these persons will return to Assam, the government will already know their off boarding stations, and given that the verification process was carried out, the DCs and SPs already know their addresses in the state.

This data will help the state in preparing for the inflow of people and accordingly make provisions for precautionary medical arrangements.

Contact tracing

As soon as the first case of the region was reported in Manipur on March 24, prohibitory orders were issued in various districts of the state including Churachandpur, Bishnupur, Noney and Ukhrul ordered restriction on public movement outside to prevent further spread of the deadly virus. Sub-section (2) of Section 144 of the Code of Criminal Procedure (CrPc), 1973, was imposed. Further, many villages were also seen voluntarily locking down and prohibiting vehicular and public movement as precautionary measure.

As many as 486 people who came from COVID-19 affected countries or states were put under home surveillance, said state officials.

Authorities and Manipur police swung into action spraying disinfectants on streets leading to major markets, including the Ima Keithel, in Imphal. They also cleaned and sterilised the streets, footpaths and railings in the public areas as well as removed waste dumped on roads, said reports.

Similar work were also reported from various localities where locals sanitised their surroundings, including cleaning of drainage, maintaining hygiene in their home premises.

While cases from Tablighi Jamaat congregation began to emerge across the country, Manipur identified 14 attendees before another case comes to the fore. And a day later, an attendee was tested positive for the virus.

The state sealed its borders with Myanmar at eight points, and Lilong area in Imphal was completely sealed off.

Likewise, in Assam on March 31, when a Tablighi Jamaat attendee was tested positive, becoming the first case in the state, a non-stop operation was carried out to trace nearly 500 people who took part in the religious congregation in New Delhi. Though 33 of the 34 cases in the state are directly or indirectly related to Jamaat, its swift action bore fruits as the Assam successful managed to sever the chain, with all the positive patients in quarantine and no contact between the society and positive patient.

Two containment zones were identified in Guwahati and sealed off, restricting entry and exit from those places. Constant sanitisation is underway in the state.

On April 6, when Tripura reported its first case, area of 1-km radius around the patient’s residence was sealed. Also, the district administration sealed another 1-km area on either side as per protocol. The standard spraying and disinfecting procedures were put to action.

The person’s travel history was revisited and 108 contacts were quarantined and tested.

Further, the state became the second in the country to invoke Essential Services Management Act (ESMA) to contain the spread of novel coronavirus, after Madhya Pradesh.

Meanwhile, when a renowned doctor from Bethany Hospital, Shillong in Meghalaya became the first person to test positive for the virus in the state on April 13, a 48-hour curfew was immediately imposed in Shillong Agglomeration area.

Soon after, the entire corona task forces of the state sprang into action and within 18 hours of the report of the first case, 90 samples were tested. The government was also been able to establish 2,000 contacts, besides listed down the primary contacts of the patient.

Similarly, the other states quickly took action and have managed to so far contain the spread of the virus. Meanwhile, Sikkim remains the only state in the country to be free from COVID-19 pandemic.

Hospital infrastructure

The fight against coronavirus essentially comes down to the availability of hospital beds, ventilators and Personal Protection Equipment (PPEs) for doctors, nurses and medical teams. With a large section belonging to the financially weaker section of the society it leaves public healthcare facilities as the only available option for them. As per National Health Profile, Northeast has a total of 35,296 bed in 1,946 government hospitals that leaves 1 bed for approximately 1,275 people if we go by the 2011 census.

Table showing the number of public health care facilities and number of beds across Northeast

Patients found to be COVID-19 positive were sent to isolation wards creating a demand for more quarantine zones. Additionally, for critical cases, intensive care is needed. Currently, almost all suspected cases of coronavirus are referred to government hospitals and quarantine centres.

Scenario in the Northeast

Wasting no time, the Assam government set up two quarantine centres with capacity of nearly 1,000 persons each in Guwahati. While one was set up at Sarusajai Stadium, the other came up at Nehru Stadium. However, patients who are worst affected by the infection will require critical care in form of ventilator support. Among northeastern states, Assam is equipped with 303 ventilators followed by Meghalaya with 163 ventilators, Manipur with 90, Arunachal Pradesh with 23 and Nagaland with 17.

Meghalaya that is still battling to bring down the number of Coronavirus cases has freed up 64 ventilators dedicated for COVID-19 cases and has procured around 20 from other hospitals such as NEIGRIHMS for critical patients.

“Around 80-85 per cent patients are either identified as asymptomatic or with mild symptom, so these don’t require hospitalisation. To ease out the pressure on existing health infrastructure, government of Meghalaya has created additional facilities in the form of temporary medical facilities called Corona Care Centres equipped with isolation and independent room. So from Corona Care Centre they will be taken to hospitals, dedicated for Covid-19, having oxygen support and if critical patient they would require ventilator support,” said P Sampath Kumar, commissioner & secretary, Meghalaya health and family welfare.

“In a worst case scenario at any given point of time we would require 70 ventilators in the state. Each ventilator can take about 10-14 days. To be on the safe side we have also procured around 100 non-invasive ventilators called BiPAP (Bilevel Positive Airway Pressure). Majority of the hospitals would require ventilator but they would require just oxygen support. So all hospitals, including community health centres have been asked to keep oxygen support ready,” Kumar added.

Meanwhile, in Assam, health minister Himanta Biswa Sarma had informed during a press conference that 82% of the 34 patients who tested positive for the virus were “silent carriers”, that is, they were asymptomatic.

Why are ventilators important?

For those who develop trouble breathing, medical care outside of the home is needed. This may be in the form of supplemental oxygen and/or breathing treatments. These may be given in an urgent care or emergency room setting that is equipped with a ventilator and experts to operate the machine. Ventilators are used to manage and treat individuals with severe lung infections, commonly used in patients with chronic lung disease, severe asthma, chronic bronchitis, emphysema, or lung scarring in situations where patients are not able to maintain blood oxygen levels.

The contradiction

Meanwhile, a global debate has surfaced on the use of ventilators to treat patients with COVID-19. Latest reports suggest that doctors are now moving away from the use of ventilators.

“Mechanical ventilation always comes with risks: a tube must be placed into a patient’s airway to deliver oxygen to their body when their lungs no longer can. It’s an invasive form of support, and most doctors view it as a last resort. Under the best of circumstances, up to half of patients sick enough to require this type of ventilation won’t make it,” stated a report in Time.

The report further stated that for COVID-19, the numbers are even worse. Only a small portion of COVID-19 patients get sick enough to require ventilation—but for the unlucky few who do, data out of China and New York City suggest upward of 80% do not recover. A UK report put the number only slightly lower, at 66%.

Economic preparedness

In order to battle the pandemic, the centre so far allocated an economic package of Rs 1.7 trillion (equivalent to 0.8 percent of India’s GDP). This, according to experts, means that states have to dole out more funds for relief.

The Centre earlier this month relaxed State Disaster Response Fund (SDRF) utilisation norms for one year given the outbreak of the pandemic, permitting expenditure as the 2015-16 guidelines. Out of the 28,983 crore to SDRF, Centre recently released the first instalment of Rs 11,092 crore for 2020-21. This fund can be utilised for cluster containment, quarantine and purchase of personal protective equipment for health, municipal, police and fire authorities, said a report.

While the Centre’s contribution is 75% of SDRF in general category states, but for special category states like Himachal Pradesh, Northeast including Sikkim, etc., this goes up to 90%.

But is this enough to battle the unprecedented virus which has put mankind behind the four walls of their home?

States are constantly churning out relief for those stranded outside due to the lockdown, but future of smaller states like those of Northeastern region remains in limbo. Meeting budgetary promises, providing relief funds, distributing free ration and paying salaries during a lockdown when a large chunk of economic activities remain closed is taking a toll.

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