COVID, community and challenges ahead

With the country stepping up efforts to deal with the COVID-19 pandemic, and Prime Minister Narendra Modi calling for a nationwide lockdown, it has become imperative that the ramifications of not practicing self-quarantine is made clear to everyone.

Tuesday marked the first full day of the state-wide partial lockdown that was invoked by the Arunachal Pradesh state government. And while the government had advised the public to exercise caution, those appeals have landed on deaf ears with hordes of people choosing the mostly-empty roads of the capital to go on joy rides.

Most businesses in the capital did stay close but with government offices still officially remaining open, police and security personnel had a difficult time trying to convince people to put on their masks and stay home.

At the naka point at Ganga near the non-functioning clock tower, police had to stop several people (mostly young men and women in two-wheelers) and actually advise them to wear their masks even as all of them apparently had some urgent work somewhere or the other.

IMG_20200324_142539

In fact, in the morning hours, there were actually traffic jams across various places in the Capital Complex as people made a beeline to buy groceries and other commodities despite assurances from the government that they should refrain from hoarding. One source said that a prominent businessman from the capital had bought enough rice and other items to last an entire year.

The question to ask at this time is, are we as a state ready to deal with an invisible adversary?

INFRASTRUCTURAL CHALLENGES

Let’s face it, as far as our health infrastructure goes, the state is simply not equipped to deal with a possible outbreak. Given the fact that there has not been a single positive case reported from the state, we are not even dealing with the issue of containment of an outbreak but rather the reporting of a possibility of an outbreak.

From reports from the ground, at the various check gates, a normal temperature reading is enough to enter the state and go home. Although the state has been placed under a lockdown, i.e. no new ILPs are being issued, students and those who were travelling before the announcement have been allowed to return.

Given the fact that many students studying outside the state have been told to vacate their hostels and rented accommodation, it would be harsh to turn them away too. But given that young students are more likely to have stronger immune systems and be asymptomatic, a simple thermal reading of their temperature does not necessarily mean that they are not carrying the SARS-COV-2 virus that is responsible for the disease.

It is a very real possibility that even those not showing any visible symptoms may very well be carrying the virus. Even if those returning are responsible citizens and exercise self-quarantine, they are putting their family members at risk of being exposed to the virus, especially the elderly who have been found to be most prone to fatalities from the disease.

The ideal course of action in such scenarios will be to put everyone coming back under quarantine in isolation wards/centres and put under observation for 14 to 21 days- the incubation period of the disease.

However, is that a possibility in the real world?

Speaking with doctors and health department officials reveals that the state is definitely not equipped to cater to such demands.

Since screening began, over 21,000 people have entered or returned to the state. It’s a figure that state health machinery is simply not equipped to deal with.

So far, since people have been asked to exercise home-quarantine, isolation centres that have been identified by the state government have no dedicated staff to look after the possible inmates.

We have been fortunate that there have no positive cases yet. But in the case that even one person is tested positive, how will they be treated?

In the wake of this pandemic, a shocking revelation to come out was the fact that the state does not have a single functioning intensive care unit in any of its hospitals.

One senior doctor said that although the Tomo Riba Institute of Health & Medical Sciences does have a unit, it is devoid of any useful equipment.

CONFUSION IN COMMUNITY

One of the key steps that the state government had taken following the Janata Curfew of March 22 was to announce a partial lockdown to curb the unnecessary movement of people.

In a functioning democracy like India’s, invoking a full-on lockdown can never be a real possibility. At the end of the day, we have to rely on common sense. Unfortunately, common sense is a commodity hard to come by.

The morning after the state government issued the notification about the partial lockdown, the expected panic-purchasing began.

Even though it was stated that essential commodities including groceries and fuel will be available, it did little to deter residents from flocking to shops and piling up on a year’s supply of food. By Monday evening, the petrol stations had been exhausted.

IMG_20200324_141618

This happened despite a specific plea from the chief minister to not rush to petrol stations and the fact that people have been advised not to venture out of their homes. Even after being actively told not to go out, people still thought it necessary to fuel up their cars. It is unclear as to where they plan on travelling.

However, it must be pointed out that the government order left things a little ambiguous as well.

While it said that no public transportation will be permitted, the directive on the movement of private vehicles was unclear.

Since security personnel were asked to restrict the movement of private vehicles, they did as they had been told to. And as government offices remained open, it meant that several government employees had to stop and explain that they had to report to work.

The order had only said that commuting to hospitals and entry points would be permitted but was not clear on other vehicular movement.

More clarity on this front is required.

SEEKING SOLUTIONS

In the face of these challenges, it is important that all stakeholders are consulted by the government and all efforts are made to work out steps to ensure the disease does not have an outbreak in the state.

The first step that needs to be taken is for the government to allocate at least two sites in each district for isolation to place all those who are returning to the state, regardless of whether they show symptoms or not.

The samples of the people need to be taken and sent for testing; it’s a task easier said than done though.

For one, there simply aren’t enough kits available in the state to take 21,000 tongue swabs.

Secondly, health workers who are working putting themselves on the line need proper protection.

It has already been reported that there is a major scarcity of Personal Protection Equipments across hospitals in the state and it must be ensured that the gap is met sooner rather than later. After all, if we are asking doctors and nurses to protect us, they should be provided with a fighting chance to do so.

The identifying of isolation centres and providing protective equipment go hand-in-hand.

It must be ensured that doctors, nurses, and all auxiliary staff working in these isolation centres will also have to remain in quarantine to avert the risk of them returning to their homes and possibly infecting their families. For them, the quarantine will remain in effect long after the pandemic has died down.

Another area that the government has to look into is ensuring that the state does not fall into a state of complete chaos. Unfortunately, if past experiences are anything to go by, that is an eventuality we must all be prepared for.

So, how does the government ensure that people are able to buy their groceries without a riot-like situation arising outside of grocery stores?

Regulating the timing of markets will only mean that more people will gather for limited periods of time to stock up on supplies that they do not require.

In the absence of household data even inserting a provision that only one person per household will be permitted to step out of their homes, will not help.

Again, one can only hope that civic sense prevails.

Apart from these challenges, what happens to the daily wage-earners who are dependent on hard cash for their day-to-day survival? Of course, they can be provided with a stipend but that will only benefit those registered with the labour board. What happens to the thousands who are not?

They will probably die of hunger alone.