Battling hassles, hate, & finding hope

Amidst the nationwide lockdown and in the aftermath of the news of the first positive case of the COVID-19 from a person residing in the Northeast Indian state of Arunachal Pradesh, a slew of concerns and questions began arising from healthcare workers and citizens alike.
A 31-year-old man was put in isolation at the zonal hospital in Lohit district’s headquarters of Tezu after he had tested positive for the disease. The man, a migrant manual labourer, had attended a religious event at Delhi’s Nizamuddin which has become an epicentre for the disease.
At least 28 people across Northeast India who had attended the Nizamuddin Markaz had tested positive for the novel coronavirus .
Apart from the first positive case from the state, six more people from the neighbouring Namsai district have tested negative. While the man and his family have been quarantined, he remains asymptomatic.
However, the work for healthcare workers and administrative and police officials is far from over.
PERENNIAL PPE PROBLEM
Dr Tumge Loyi, the media spokesperson for the State Task Force for COVID-19, said that apart from the shortage of Personal Protective Equipments (PPEs), there is also a shortage of staff in the field survey teams.
“Since one person has tested positive, we need to conduct contact tracing to find out who has come in contact with him,” he said, adding that logistical challenges outside of the state capital is another issue.
While a new consignment of PPEs has arrived that will be distributed across the state, it still remains a formidable task for doctors, nurses, and others.
One source said that the PPEs that arrived are not in sufficient numbers and more will be required.
Loyi said that one major issue is the absence of a testing facility in the state.
Samples of suspected cases are collected and sent to either the Regional Medical Research Centre in Dibrugarh or Gauhati Medical College in Assam.
Even collecting samples is another challenge as the state’s stock of Virus Transport Media (VTM), where cotton swab samples are collected and shipped, is limited. At last count, the total number of VTMs was at around 700.

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Dr Tumge Loyi of the State Task Force

Medical guidelines dictate that a person has to be tested at least twice and Loyi said that the man who tested positive has come in contact with at least 40 people.
If the samples of each of those 40 people are to be collected, 80 VTMs will be used for just that one case.
He and other health experts say that the priority should be on testing as many people as possible to control its spread by identifying and quarantining them.
Till recently, the Tomo Riba Institute of Health & Medical Sciences (TRIHMS) in Naharlagun near the state capital, Itanagar, had no ventilators in its intensive care unit. The TRIHMS has been assigned as a COVID-19 hospital and will exclusively deal with all cases related to the disease.
One senior doctor said that ventilators are for the final stages and that the government’s priority should be on preventing the spread of the virus.
A doctor in Namsai district on quarantine duty, who has been in close contact with the suspected cases who had travelled to Nizamuddin and others who came in contact with them, said that they have been working without PPEs.
“I just have my gloves and an N95 mask,” the doctor said.
A nurse on quarantine duty in Naharlagun said that “frontline health workers have not been provided with N95 masks either”.
With the news of the state’s first positive case, came the eventual stigmatisation.
Even before an official announcement was made by the state health department, the test result of the man had been leaked which revealed his identity.
Dr Raja Dodum of the State Task Force for COVID-19 said that this is a breach of patient privacy.
“How are the testing centres releasing this information without officially sending it to us first,” he said.
CONTROLLING VIRUS & HATE
While healthcare workers remain concerned about the spread of the virus and information, residents in and around the state capital began to panic over the pandemic spilling over from outside quarantine centres to their residential colonies.
On Thursday evening, at the entrance of Polo Colony in Naharlagun, residents engaged in a ‘lively’ conversation with the Additional District Magistrate (ADM) and Chief Estate Officer (CEO), Talo Potom, asking him to move those housed in the quarantine facility in their locality.
Fearing for their safety, the residents claimed that they are not safe if the people quarantined are not moved to a different location.
“Our water supply comes from near the quarantine centre…what if they contaminate it,” said one man in the crowd, his mask doing little to hide his anger.
Potom had to eventually assure them that they will be moved to another centre.
Across the state, at the gates of residential colonies in urban centres and villages, barricades have been placed by good-intentioned people but in the process, disrupting the entry of government inspecting groups including doctors in some cases.
The issue has such a hindrance that the Itanagar deputy commissioner had to issue an official order asking them to dismantle and allow the movement of essential services or regulate their movement.
Rumours about the disease and how it spreads have caused panic and led to fears amongst sections of the public. While some landlords have exempted their tenants from a month’s rent, many who continue to work are reportedly being subjected to suspicion.
President of the state chapter of the Indian Medical Association, Dr Lobsang Tsetim, said that several healthcare workers are being told by landlords and neighbours to not venture out to work.
Many have allegedly even asked nurses staying in rented accommodations to vacate their apartments.
PETTING PROBLEM
As people turn on each other and hostilities begin to surface, pets and stray animals have become unlikely victims as a result of the pandemic.
With the lockdown changing people’s consumption patterns, stray animals that often-scavenged food that was thrown out as garbage are finding it difficult to scrape by. The problem was noticed by a number of young animal-lovers who have since mobilised and taken it upon themselves that the furry four-legged friends do not go hungry.
Kobyum Zirdo has been on a daily round covering at least 60 km of the capital and its adjacent areas looking for strays for almost a week.
Tending to a puppy outside of a privately-run veterinary clinic, Zirdo said that some pet owners are abandoning their dogs if they appear to show signs of illness.
On Friday afternoon, she picked up the puppy with a collar around its neck that had developed a form of a severe rash.
She said that because treatment is difficult during the lockdown period, she’s had to euthanize four dogs in five days.
Not an easy task for someone who has over a dozen cats and dogs at home.

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Kobyum Zirdo and others like her are on a mission to ensure stray animals stay safe during the Covid crisis

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.

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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.

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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.