In the beginning of May, when the country was entering the third phase of the lockdown, the colour-coded classification set by the central government put almost all of Northeast entirely in the green zone, reflecting only a handful of reported cases: 43 in Assam, 12 in Meghalaya, 2 in Manipur, 2 in Tripura, 1 in Mizoram, 1 in Arunachal Pradesh and none in Nagaland.
Cut to June, the region accounts for more than 5,000 cases — with Assam taking the lead, followed by Tripura, with Manipur not far behind. A significant chunk of this surge can be traced back entirely to returnees, or those who have come back to their home states after the opening up of inter-state borders on May 17. While Assam has reported cases since April 1 and is now the most affected state with its current tally at 3,693 (2,098 active), the other states, too, are witnessing a considerable rise every day. A look at Nagaland, Manipur, Mizoram, Meghalaya, Arunachal Pradesh and Tripura, the surge and how they are coping.
Nagaland confirmed its first three positive cases — all returnees to the state — on May 25 (an earlier case in April had migrated to Assam). In ten days, by June 6, the number reached 107. “Like in other parts of the Northeast, the spike coincided with people coming back home,” said Adviser IT, Science & Technology, NRE, Mmhonlumo Kikon, who is also the spokesperson for Covid-19. The opening up of inter-state borders has led around 10,000 residents to return to the state — via state organised transports as well as their own means. At least 4,000 more are expected. “We wanted to organise the return trip in a phased manner so that we would be able to receive them with proper arrangements,” said Kikon.
In mid-May, the Nagaland government offered a one-time assistance of Rs 10,000 to those stranded residents who opted not to return. In the interim, the state tried its best to ramp up facilities including prepping a network of community-level quarantine centres. “We had to use the two-three months of lockdown to ramp up health infrastructure for Covid,” said Kikon, “If you look at investment of private sector and the government both into healthcare in the Northeast since independence, it has not been proportionate when compared to big cities— say, Delhi, Chennai, Mumbai. It is only in the recent past that we got so many medical colleges sanctioned in the Northeast.”
While Nagaland was earlier sending it samples to Assam and Manipur, it was only a few days ahead of the arrival of the first special train bringing back migrants on May 25, that the state inaugurated its first Biosafety Level (BSL)-3 lab for testing at Naga Hospital Authority Kohima (NHAK). Another BSL-2 lab is in the process of construction in Dimapur and the state has announced that it will be enlisting private laboratories to conduct tests too. “Though it is not that stage yet, community spread is the real threat we should all be worried about — many in the quarantine centres are not following protocols of social distancing etc,” he said. Currently, there are 163 cases out of which 114 are active.
Manipur was the first northeastern state to report a coronavirus infection when a 23-year-old student, who had travel history in the UK, tested positive in late March. Again, like the other states, the count has gone up only a month and a half later as people returned home. On May 8, Manipur recorded the highest single-day spike with 100 persons testing positive. Currently, the state has 279 active cases. Out of this, all are returnees, except a frontline nurse from Churachandpur district who was working in the district hospital. The health department anticipates this number to increase with more testing left to be done. Health Commissioner Vunglunmang Vualnam attributes a part of the spike to quarantine centres. “Many have failed to realise the importance of social distance inside the quarantine centres,” he said.
Despite that, the commissioner is confident that the state is prepared to deal with the prevailing situation. In addition to the 100 bedded isolation wards at Jawaharlal Nehru Institute of Medical Sciences (JNIMS) and Regional Institute of Medical Sciences (RIMS), Covid care facilities are also set up in almost all the district hospitals. For asymptomatic cases, work is on to convert a school in Imphal West district into a 100-bedded special quarantine center with a ventilator facility. Manipur at present has two testing labs at JNIMS and RIMS.
Tripura, which reported its first COVID-19 case in April, has shot up over a 1,000 cases till date, out of which 686 are active patients. While 163 of these patients came from Border Security Force (BSF) jawans, the rest are returnees from Chennai, Bangalore, Delhi, Kolkata, Guwahati and other places, where they were stranded for two months during the lockdown.
Earlier this month, Chief Minister Biplab Kumar Deb cited a National Centre for Disease Control (NCDC) report and said that the virus spread aggressively among BSF barracks since the border guards failed to maintain social distancing and quarantine norms in their battalions.
The state government has extended its healthcare apparatus to handle COVID-19 patients. Govind Ballabh Panth Hospital at Agartala, which is also the only authorised coronavirus testing facility in Tripura, initially had 40 beds but was later beefed up to accommodate 100. Twelve Covid Care Centres (CCC) have come up later, four of them at Agartala and the rest across eight districts of the state with a cumulative strength of 1,315 isolation beds. Tripura’s various quarantine centres have a cumulative capacity to hold 1,800 patients. However, the total number of people placed under surveillance in the state is far higher. Naturally, the government has opted to focus more on home quarantine. As per latest reports, 9,795 persons are currently under surveillance, of whom 93 per cent are under home quarantine. Tripura’s high numbers can also be attributed to its testing rate — the highest rate proportionate to the population in the NE region. The state government claims to have tested 42,841 persons till date at the rate of 9,359 tests per million.
In April, all of Meghalaya’s 13 cases were traced to its index patient — a 69-year-old physician in Shillong, who subsequently succumbed to the virus. Following that, a number of returnees — from Tamil Nadu, Delhi, Haryana, Maharashtra etc — have tested positive, although the state currently has the lowest number of active cases in the Northeast. “We have had about 15,000 people who have come back and adopted a testing strategy to consciously slow the virus,” said Meghalaya Health Secretary Sampath Kumar, adding that they are pool testing their returnees. Nearly 6,000 of the total have travelled from Assam. “We carry out both rapid antibody tests and RT-CPR testing on all its returnees. This helps us treat the patient better as the antibody test lets us know how recent the exposure is,” said Kumar, adding that the state has over 1,900 quarantine centres across villages.
Visited the community quarantine facility at Songsak Agalgre, #EastGaroHills district and had an interaction with the individual under quarantine. Told him not to worry and to duly follow safety precautions. Also presented the assistance through CM’s Relief Fund to the Nokma. pic.twitter.com/BNYsMSC9DC
— Conrad Sangma (@SangmaConrad) June 3, 2020
Currently, the North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS) in Shillong is the state’s biggest testing facility and has the capacity to carry out 2,000 tests per day. “Apart from that, we have testing facilities in Tura and another one in Shillong, and this [testing] is something we want to take to the district level,” he said, adding that the state was using a mathematical model to build its health infrastructure for Covid. “This model helped us estimate what kind of infrastructure we need,” he said. The state has 44 hospitals for all categories of COVID19 patients — asymptomatic and mildly symptomatic, severe symptomatic cases that require oxygen support and critical cases that require ventilators and ICU facilities. “Six out of the 44 are for the third category,” said Kumar.
For long, Arunachal Pradesh reported just one case of Covid-19. The 31-year-old, who had travelled back from Delhi, has now recovered. However, since the beginning of June, the state has reported a spurt of cases — with 18 cases reported in a single day on June 1, and 20 on June 12. Currently, the state’s tally is at 87. “These are concentrated on a few districts (eg. Changlang) which have reported a number of people returning,” said Dr L Jampa, State Surveillance Officer. “They are reported from quarantine centres and are not in the community,” he said. Among them, three are military personnel who returned from Bihar. “Most of these cases are mild or asymptomatic,” said Dr Jampa, adding that most returnees would be back by June end. The returnees are mostly students and professionals, he said. The state has two hospitals — in Pasighat and Naharlagun — to deal with positive, symptomatic cases. “So far the beds there are yet to be occupied,” he said.
While the rest of the country was going into Unlock mode, the Mizoram government announced that it would be imposing a total lockdown for two weeks from June 8 in a bid to arrest the spread of the virus. The state, which had zero corona cases after its only Covid patient was discharged after full recovery on May 9, now has 107 cases. 106 among them are active. “The returnees are testing positive and that is why we decided to go for a lockdown,” said State Nodal officer of Integrated Disease Surveillance Programme (IDSP) Dr Pachuau Lalmalsawma, adding, “Not everything is shut — a few shops are open, there is limited movement and there is a night curfew, attendance in government offices are at 50 per cent. This is helping us.” As per Mizoram Health Secretary, H. Lalengmawia, around 10,000 people have returned to the state. “Around 1,500 more are expected to return,” he said.
As of now, the Zoram Medical College and Hospital is the only testing facility in the state. “It is also where the symptomatic cases are being treated,” said Lalengmawia, adding that the state was confident and ready to handle the increase in cases. “We are trying to boost testing as much as we can,” he said. For that, procurement of four more RT-PCR machines is underway and two TruNAT machines were installed in Lunglei district to cater to the testing needs of the southern parts of Mizoram. “Currently, two RT-PCR machines are running,” he said, “Earlier our daily testing capacity was around 100, now it’s more than 400.”
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