Manipur should not allow Home Quarantine to stop community spread

Dr Th Suresh Singh *

Quarantine Centre at Oriental College, Imphal on 05th June 2020 :: Pix - Lamdamba Oinam

In my previous Opinion Maker article published in this paper on 23rd May, I have stated that all returnees be kept in a quarantine centre for 14 days and be tested as per latest ICMR guidelines. Unfortunately the state is allowing home quarantine.

Let us see as below:

State's present testing procedure: All the returnees are kept at designated quarantine centres and tested. Once a person is found -ve, the person is sent to home quarantine for 14 days quarantine. I know that many states are also doing the same. Those in home quarantine are also not tested further. Please correct me if I am wrong. This is fraud with dangers. The reader can find the reason in succeeding paras below.

What is latest ICMR testing guidelines? ICMR Covid testing strategy dt 18/05/2020, sl 5 says - "asymptomatic direct and high risk contacts of a confirmed case be tested once between day 5 and day 10 of coming into contact.

Sl 8 says- All symptomatic ILI (Influenza like illness) among returnees and migrants should be tested within 7 days of illness". By this very definition, all returnees be treated as contacts as almost all returnees are back from high risk red zones like Delhi, Mumbai, Bengaluru and what not.

In every train, flights buses etc., there are many +ve Corona cases; that's why all returnees be treated as contacts. Please again read the above highlighted guidelines and one will be clear what it actually means.

Home quarantine: It can never be implemented properly, not only in Manipur but in any part of India because of congested rooms/houses, unhygienic condition etc. For a well-to-do family, it is alright as they will have separate bathrooms and other hygienic conditions.

But what about other middle class and poor families who don't have these facilities? If the 14 day quarantine is not implemented in a designated centre, the +ve cases are bound to increase many-folds. The virus is highly infectious and can spread quickly. Many states have reported many-fold increase after return of migrants.

Background of tests for contacts: Though the above ICMR guideline don't explain the reason where to test between 5th & 10th day for asymptomatic contacts and and within 7 days for symptomatic ILI within 7 days of illness, the guideline is not clear where to test.

Presently Manipur has around 100 cases only. Even if around 40,000 + returnees arrive, they can be easily distributed in every Assembly segment with around 666 returnees. With + and - here and there, it can be easily managed under the Honourable local MLA with the help of many local clubs/ volunteers.

I have put this suggestion in the previous article. MLAs also can contribute from their local area fund in case of shortage of fund.

We have one 200-beded hospital at CCPur, 100-beded one at Thoubal, 50-beded 5 district hospitals and many 30-beded CHCs. All these can be converted into emergency quarantine and treatment centres seeing manpower specialist doctors available.

India's many-fold increase due to wrong Control Strategy: The basic principle of infectious disease control is - a) case detection by house to house survey and lab testing b) treatment and c) preventive measures.

This is done in our National control Programmes - Malaria, TB, Leprosy, Immunization etc. In case of Corona, any +ve area be declared as red or hot spot and 14 day containment be declared and enforced strictly.

Survey - in the containment area, house to house survey be done and all population be tested for the virus. This is to be done twice. Treatment - any +ve one having mild symptoms be treated in a designated quarantine centre or hospital and for severe ones be treated in hospitals having ventilators.

No patient be treated at home in view of congested unhygienic huts/small rooms etc. as physical distancing of 6 feet can't be enforced as the virus is very infectious quickly. Treatment regime is best left to the experts.

Preventive measures - best is the shutdown (lockdown is complicated urbanite word), but it can't be continued forever. Others are - use of any kind of mask, physical distance of 6 feet in head to head count, frequent hand washing, sensitisation of area and other hygienic conditions.

In early stage, India has not implemented it. Delhi and Maharashtra did house to house survey and testing to a limited scale from around last week of March. Many states followed it later on. But it was implemented in piece-meal and not completely. Whole red zones were not quarantined properly; local spread did occur in the so called quarantine zones and enamouring areas.

Also home treatment of mild cases contributed to local spread. Further, as testing is not done twice in the 14 day quarantine, those who became +ve in late stage did also spread the disease in the same zone. One can imagine home treatment in Dharavi. No doubt, Maharashtra Govt, will continue to struggle.

This piece meal implementation of basic principle of communicable disease control is still applying throughout India thereby contributing more and more +ve cases. Now add many more due to migrant's return to respective home states. One can't keep lakhs in quarantine centres. India will have many more lakhs cases in coming days/months.

In my many letters to PMO, I have pointed out these deficiencies and requested to implement the above stated Control Strategy fully. It is still not done, though peace-meal implementation did occur. These are in PMO website. One can go through it. Hope PM will listen to it.

Manipur should learn from it: Your writer is saddened it with this piece-meal control strategy. I go on writing giving sound advice and on live telecasts of many local TV channels, but never heard by authorities. Still, I continue writing as a responsible public Health specialist in public interest. The state has no sound control strategy.

To me, it seems that Hon'ble CM and the Cabinet have not been advised properly. There seems to be confusion in the medical team and bureaucrats overtaking medical advice. I hope I am proved wrong. As our testing capacity is increased to about a 1000 per day, there will be no difficulty in testing all returnees quickly within the period of 14 days.

Conclusion: All returnees who were sent for home quarantine due to their -ve tests be brought back to quarantine centres and discharged after becoming -ve and completing 14 days quarantine. There should be no home quarantine.

We have to convince them that the same is required for their own family and their relatives as well. 14 day can be shortened to 10-12 days for train returnees considering their train journey as quarantine period.

It is a question of application of sound mind and good control strategy. It is not too late; we have only about 100 cases. Everybody should not be in a fear-psychosis. However, if community spread does occur, it will become uncontrollable and can't manage by our limited resources.

There are reports of returnees going to home 1st and coming back to quarantine centre later. It be prevented strictly for our own safety.

I will end in a +ve note. We have no community spread at present. We can still control Corona. Also hope authorities will listen to it.