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Too many to test & too few to lead the Covid fight — Assam struggles after early success

Assam has managed to keep its coronavirus cases from spiralling out of control. But logistics are getting in the way now.

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Guwahati: In all his 15 years as a disease surveillance worker in Guwahati, Trailokya Sharma, 50, never thought there would be a time when he would be surveying nearly 100 people a day.

“It has been a real challenge. Surveillance takes time, but there is no time now. We have to keep at it,” he said, as he waited for a team of lab technicians in the city’s G.S. Colony Friday morning.

A Covid-19 case had been detected at a building here the day before, and Sharma was in the area with his colleague, Nur Islam Saikia, to gather details of its 23 residents before their samples were collected by lab technicians.

The last month has been relentless for healthcare workers like Sharma and Saikia, two footsoldiers of a massive statewide exercise aimed at tracking and nipping the Covid-19 pandemic.

Until 4 May, when the Union Ministry of Home Affairs (MHA) allowed inter-state travel, Assam had all of 42 Covid-19 cases, one of India’s lowest at the time. But as the floodgates opened and thousands of passengers returned, the number of cases spiked, prompting the state government to adopt a “ruthless quarantine” and testing policy.

As a result, the state’s healthcare staff found itself grappling with a mammoth exercise that strained the state’s existing resources. 

While Assam is constantly working to equip itself to meet the scale of the challenge, its efforts have been stalked by complaints of delayed test reports and an inadequate staff strength.

For workers like Saikia and Sharma, the scale of the exercise translates to a suspension of the concept of fixed shifts.

“We usually work for eight hours but now we’re working overtime on our own, sometimes, choosing to do this. We have to help people so we sacrifice our personal time,” Sharma added.


Also read: First flush gone in lockdown, Bengal and Assam tea industries face Rs 2,100 cr loss


Test backlog builds up

Since inter-state travel was allowed again, the state’s Covid-19 tally has grown manifold.

As of Tuesday, Assam had recorded 4,319 Covid-19 cases. Of these, 1,897 are active, 2,411 are cured/discharged or migrated, and eight have died. The state, which has a population of over 3.11 crore according to the 2011 Census, had collected nearly 1.9 lakh samples by 12 June, as reported in the health bulletin issued that day. The bulletin issued 12 June is the last so far that included details of samples collected.

Under the state government’s policy for returning residents, every Assam-bound passenger is to be tested, and quarantined for a period of 14 days, even if found to be negative. This policy, say authorities, has helped control transmission.

“By and large we have been able to contain the disease… whereas crores could have been affected. The plan is if you don’t continue like this, and if you do not contain… we will lose many,” director of National Health Mission (NHM) of Assam, Dr Lakshmanan S., said.

While the state appears to be doing well, challenges remain. For example, in Kamrup Metro, the district under which Guwahati falls, the administration has been inundated with complaints about delays in test results.

A Covid-19 patient admitted at Mahendra Mohan Choudhury Hospital (MMCH) said she had yet to receive the results for at least “10 swab samples” collected since she tested positive. 

“They come and take my blood samples, take swab samples as well, but I have no idea what the reports are because these people don’t tell me anything. I think as a patient it’s my right to know how my body is recovering,” she said.

In Guwahati’s Bishnupur, Krishnanagar area, which was declared a containment zone nearly a week ago, Tinku Biswas, a 30-year-old photographer, got his test results a week after his swab was collected.  

Tinku had tested negative. However, four others in the area who were sent to a hospital Sunday after they tested positive had received their reports earlier. Swabs from one of them, Tinku said, had been taken after him.

Dr Runu Das, district officer of the government’s Integrated Disease Surveillance Programme (IDSP) in Kamrup Metro, acknowledged concerns about delayed testing, saying she consistently gets calls in this regard. 

Dr Runu Das, Kamrup Metro's IDSP district officer, Assam | Angana Chakrabarti | ThePrint
Dr Runu Das, Kamrup Metro’s IDSP district officer | Angana Chakrabarti | ThePrint

According to her, the problem is linked to a backlog build-up at Covid-19 labs on account of the state’s contact-tracing efforts. “There’s a lot of load in the virology department. There weren’t as many cases before, but when the number of cases increased, then with each case, we had to trace 100-150 contacts and the samples of other districts also came here.”

It typically takes five to six hours to test one sample for Covid-19 by using the RT-PCR method, which is currently the gold standard for diagnosis. 

Until 22 March, only two labs in the state — the Guwahati Medical College and Hospital (GMCH), and the Regional Medical Research Centre (RMRC) in Dibrugarh — could conduct tests for Covid-19. Since then, the government has set up 11 more facilities.

A few of these labs, including the ones at GMCH and RMRC, now conduct around 1,500-2,000 tests per day. The health bulletin issued 12 June indicated that reports were pending for 6,603 of 1,88,090 samples collected so far.  

However, Dr Runu suggested that labs prioritise issuing reports for positive diagnoses, as also borne out by Tunku’s account.

“When a positive result comes out, they immediately send the report, when it is negative, it seems that they don’t give it as much importance,” said Dr Runu.

Dr Manoj Choudhury of the Assam National Health Mission (NHM), who oversees testing in the state, said negative and positive reports are uploaded by labs to a portal of the Indian Council of Medical Research (ICMR) in a “disciplined manner”.

“Any test, whether negative or positive, is uploaded by the lab in the ICMR portal… They make the list, get it signed and then upload it on the portal. That is the procedure,” he said. “It was not maintained some days ago, but now it has been maintained. And as soon as it goes onto the ICMR portal, everyone will get their result on their phones.”

NHM director Dr Lakshmanan accepted there were gaps, and said medical colleges are trying to ramp up their testing capacity to address them.

“Our medical colleges have put their best foot forward in the last four to five days. We would have updated no less than 30,000 tests (in the four-five days),” he said, adding that plans are now underway to set up another lab at MMCH.


Also read: In Assam, you can be charged with a non-bailable offence for jumping quarantine


Staff shortage faced too

For health officials in Assam, staff shortage is also proving a challenge. For example, the doctor-population ratio in Assam is nowhere close to the standard specified by the World Health Organization (WHO). 

According to the 2018 National Health Profile issued by the Central Bureau of Health Intelligence, overseen by the Union health ministry, Assam has one doctor for every 5,395 patients. The WHO pegs the ideal ratio at 1:1,000.

The state government protocol for containment zones requires teams comprising Accredited Health Workers (ASHA), Auxiliary Midwife Nurses (ANM), surveillance workers, and lab technicians, among others, to visit the areas, survey the residents and collect swabs.

ASHA and ANM workers survey an area in Guwahati were positive cases were detected | Angana Chakrabarti | ThePrint
ASHA and ANM workers survey an area in Guwahati where positive cases were detected | Angana Chakrabarti | ThePrint

“If a positive case is found in an area, it is declared a containment zone and, after that, our medical team does the contact-tracing. We make a list and collect their samples, following which the area is sealed,” said Dr Runu Das of IDSP.

ThePrint learnt that, as of Saturday, only 400 data-entry operators, who collate data regarding tests, containment zones and patients, had been engaged in the state for Covid work. Apart from this, 8,370 ANMs, as many as 1,007 lab technicians, 1,496 surveillance workers, 4,724 doctors, 649 Community Health Officers (CHO) and 32,850 ASHA workers are engaged in Covid management duties across the state other than those at medical colleges. 

The numbers are set to rise as the state has begun recruiting more people, but, until then, the staff often find their hands tied on their rounds around town.

At G.S. Colony, disease surveillance workers Trailokya Sarma and Nur Islam Saikia had already waited three hours before they were told that there would be no swab collection there that day.

“We were supposed to have a swab test today here but we lack manpower here. Work is going on at a different place. Swab tests will be done here tomorrow,” said Saikia before the two headed off to another containment zone.

‘Ruthless quarantine’

With over 170 cases, Kamrup Metro district has been a major cause of concern for state officials. As of last Thursday, the district had 48 containment zones, of which 26 had active cases.

Assam Health Minister Himanta Biswa Sarma has raised concerns of community transmission in Guwahati over cases that had no travel or contact history. The government said it might reimpose a lockdown, and stressed the need to strictly follow containment protocols. It also launched a second round of community surveillance, as part of which over 28,000 villages in the state will be monitored. 

Meanwhile, a strict vigil continues at Assam’s ports of entry to mitigate any scope of the returnees fuelling an uncontrolled spurt in the state. According to the state health bulletin issued Tuesday, Assam had screened a total of 2,59,621 people who had arrived in the state by flight, train or road (the bulletin stated that this figure doesn’t include road arrivals from Sikkim).

Last Thursday, the Guwahati Railway Station was teeming with police officers and surveillance workers ahead of the arrival of the Rajdhani Express, scheduled for 8.15 pm.

Sanjib Dutta of the Directorate of Health Services in Kamrup Metro, who was overseeing the screening exercise at the station, said the passenger arrivals had shrunk. 

A surveillance worker screens a policeman at Guwahati railway station | Angana Chakrabarti | ThePrint
A surveillance worker screens a policeman at Guwahati railway station | Angana Chakrabarti | ThePrint

“Before, there were a lot of passengers, not as much now. Even then, in one day, we screen about 3,500-4,000 people. We work in three shifts, through 24 hours in a day,” he said.

“Earlier, there was a lot of fear as the passengers would wonder what would happen … it’s alright now. Till now, we have sent seven to eight passengers to test (at the medical college) because their temperature was found to be high,” he added.

When the train arrived, Dutta got busy screening the passengers. Around him, police personnel were checking if the passengers were maintaining distance, occasionally announcing that the markings on the floor had to be followed. Outside the station, helpdesks guided passengers to the right buses.

Those who were headed for either Hojai, a nearby district, or Kamrup Metro, were taken to Sarusajai stadium, where swabs were collected before the passengers were sent off to institutional quarantine in one of the 37 hotels engaged by the government.

A similar screening centre has been created at Kiranshree Grand hotel, a few kilometres from the airport, for passengers returning by flights.

“A ruthless quarantine with a humane heart” is how Health Minister Sarma described the state’s policy for returnees on 22 May. And the passengers all seem to be on board with the mandatory quarantine. 

“If we are kept in quarantine, well, then it’s good for us and for others as well,” said Daman Singh, an Army officer returning from Haryana who spoke to ThePrint at the Guwahati railway station.

Raj Karan Rawat, who works at a construction company in Guwahati, echoed the claim. “I don’t have a problem with the rule…” he said. “We will have to follow the government guidelines.”

(With inputs from Yimkumla Longkumer)


Also read: Assam is losing Rs 1,000 crore everyday because of lockdown: Chief Minister


 

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