Negatives turning positive, Is catastrophe lying in wait?

SK Singh *

This July 15, the Deputy Commissioner of Imphal West district issued orders de-notifying as many as 26 locations, in the very heart of Imphal, most of which are quarantine centres as specific Containment Zones. The order also lifted the inherent restrictions after all the positive patients had been shifted to Covid-19 Care facilities.

The sequences of events of a particular person who tested positive in one Leikai, while in 'Home Quarantine' are rather intriguing. This particular person I am referring to, on return from Delhi tested positive and had undergone treatment in one of the designated treatment specialty. His condition improved, tested negative and as per standard protocol sent home for 'Home Quarantine' for a obligatory period of 14 days.

Belonging to a, one could term, conscious family, the parents arranged for his home quarantine, totally isolated, on the top floor. It had separate bath and separate arrangement for everything from foods to tea; had his independent waste disposal facility, mostly setting on fire whatever can be disposed off. They even thought of isolation for 21 days, 7 days in excess of the mandatory 14 days.

This additional confinement of 7 more days was expected to add to the safety index for both the patient and the family members around. The person stayed confined to his flat on the top floor. He did his daily chores alone away from the members of the family. He had reportedly never been down the floor during the 21 days' isolation, having no instances of contact, let alone mixing up.

Excessive personal care was conceived by the family by voluntarily self-extending the period of isolation from the prescribed 2weeks to 3 weeks. Given the precautions, aspects of isolation followed by the patient and his parents, an excessively cautious family thought it safer still to go for a 'RETEST' from the appropriate authority.

On contacting the Medical Department for such a test, they were firmly advised to break the confinement, as a second test was not needed, given the protocol followed by the patient keeping note that this patient tested negative 21 days back. An adamant family, still apprehensive, contacted the local MLA who happened to be the Speaker and through his good offices, a test was conducted finally.

And, lo, the patient turned out 'POSITIVE', again. Imagine the scenario:- a negative patient, duly discharged, briefed comprehensively by the Medics and following the precautionary measures extra-religiously, as prescribed by the authority, completed home quarantine for 21 days, 7 days in excess of the mandatory 14, turned positive on retesting. How could this impossibility turned out to be a reality?

This development was on the face of the following ground scenario:

i) the patient turned negative after treatment in a designated hospital and therefore released;
ii) the patient had to complete home quarantine for 14 days and yet, he completed 21 days' isolation instead, as an added precaution;
iii) the Hospital was approached for a retest to make doubly sure that he in effect was finally free from the deadly virus;
iv) the Medical authorities reportedly took it easy, stressed that a second test was not necessary at all and rather encouraged the parents to let free the person from further isolation.

A concerned parent however overacting they could be, were not feeling safe despite complying with all these rigorous protocol. They hunted down influential people, finally landed at the Speaker's. A second test changed the course of events that could have led to 'Local Transmission' for sure had the family let free the boy, had foods together after all those 14+21= 35 days in isolation. Thank God, the parents insisted on retest.

Imagine the ground scenario in the house of the patient. The family members of the three houses, closely built, all brothers, had around 33 members including about 10 children, one hardly a year old. After the patient was picked up by the Medical Department for treatment, the next day all the adults were put to test. Fortunately all tested negative.

The big question now is what is the probability that not even 1% of 1235 persons i.e. 12, of those discharged, as on (19 July) would turn positive? One occurrence we have just noticed. Couldn't there be others who had not been influential enough to get a re- test on completion of home quarantine and therefore as per the medical authorities' advice came in contact with his or her family?

Couldn't there be possibilities of such persons spreading the virus in the locality unknowingly? Has the Medical Department been keeping close watch on such patients? One is not very sure as the proceedings are as they are.

Negatives turning positive even after strict enforcement of the fineries of standard protocol are quite a serious matter; cannot just be left to chances. The Medical Department needs to make public on their follow up action on such patients. They cannot shy away from working out this statistics, now that some semblance of 'community transmission' has set in already in parts of the state.

Mere pc of rate of recovery rate at 63 or around, better than those of other countries, like the USA or Brazil, is not enough. The Singjamei case we discussed here before is a strong reminder on the perilous issue to the GOM.

An equally perilous situation may be in the making. Are we sure that majority of those discharged for home quarantine have a 'safe' place to stay for two weeks? Are we also confident that most would have separate bathrooms, separate bedrooms, to start with? The answer could be easily, 'NO', and a big 'NO'. Wouldn't then this lead to local transmission?

India's position this day is totally precarious. Ranking below 10 half a month back, it ascended to 4th a week back. This day it hovers around 3 but all set to seize 2nd spot sooner than later. Its 'new cases' at 40,153 far exceeds that of USA at 30,641 and worry fully 39 times that of Brazil, the 2nd spot holder reporting only 1,389.

The Manipur situation in terms of personal hygiene, level of family consciousness, affordability of all the minimum care can equally be disastrous.

Now that 'Local transmission' has set in, rather such cases are on the rise, a comprehensive review of the present so- called 'protocol' is called for, that too urgently. News is around of such local transmission cases reaching 90 by evening of July 19. The lone case of Thoubal where five of a family testing positive is certainly a pointer to the impending peril in line.

And going by the degree of transmission, more are lying in wait around us. Of samples of 80 persons put to Rapid Antigen Test (RAT) in Thoubal Hospital, 10 turned out to be positive. These are confirmed as close contact cases only. Something serious is in the making.

Community Transmission, the next and the ultimate final stage or the dreaded phase, may be lurking around, given the ground realities we face. The country as a whole too is in the grip of community transmission, according to the Chairman of the Board of Directors of the IMA.

The GOI may be hesitant to admit to this apprehension, the facts are aplenty visible. We are not far behind. Some drastic containment measure, some intensive 3T (tracing, testing and treatment) measure is called for in our state too, before further worsening the situation.