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In the North East, the pandemic is slowing down – but at a rate slower than the rest of India

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Even as the pandemic appears to be rapidly slowing down in most parts of India, the rate of decline in many of the smaller North Eastern states continues to be slow.

In some states such as Sikkim, Manipur and Meghalaya, the decline in the number of active cases has not resulted in the lowering of test positivity rates – the number of positive cases per 100 samples tested – suggesting that chains of transmissions have not been effectively terminated and the drop in absolute numbers is artificial and a result of low testing.

The test positivity rates in Nagaland, Arunachal Pradesh and Mizoram are on the decline, but much higher than the national average. Tripura’s graph has marginally inched upwards too last week, but its positivity rate is still much less than these states.

Assam’s trajectory reflects the broader national trend to a large extent.

Manipur’s woes

The situation in Manipur is particularly concerning. After a steady dip since the last last week of May, the state’s test positivity rate has seen a rise in the last two weeks. On June 30, the state’s average test positivity rate calculated over the last seven days reached a high of 12.8% from the 8.8 % two weeks ago.

To make matters worse, the daily growth of new confirmed cases has also seen a steady uptick in the last one week.

Manipur’s test positivity rate over time. Credit: covid19india.org

The trend has worried the state’s health officials. “We are also perplexed why the positive rate is still so high despite so many restrictions in place,” said a senior health official requesting anonymity as he was not authorised to speak to the media.

Manipur reached its peak thus far in the last week of May. Since then, the number of new cases steadily went down till about one week ago. “We thought we had peaked, but we are now puzzled as to why still so many cases and deaths,” said the official.

Manipur’s new cases over time. Credit: covid19india.org

Since May, the state which has seen just over 38,000 cases has reported around 740 Covid-19 deaths.

In the last couple of weeks, the virus has started rapidly spreading in the fairly remote tribal-dominated hill districts of the state. “Earlier the problem was in the two most populated districts of Imphal West and Imphal East,” said the official. “We have contained it there, but now it is increasing in the hill districts.”

In Tengnoupal district, bordering Myanmar, the weekly test positivity rate over the last seven days as of June 29 was in the high twenties, said the health official.

On June 29, the state government suspended the Free Movement Regime along the Indo-Myanmar border for a month.

Manipur’s principal secretary, heath and family welfare, V Vumlunmang acknowledged that the high positivity rate was a cause of concern. “We are tracking that and monitoring it on a day-to-day basis,” he said. “We are strengthening contact tracing and putting in place micro-containment measures in localities and villages.”

But the state’s struggles to contain the pandemic despite its spare population seem to be at least partly due to its limited testing. After reaching a peak of over 8,000 daily tests in the second week of June, the number has dropped to less than 5,000 in the last week of the month. Consequently, the positivity rate has shot up.

This suggests that some infections are going under the radar leading to continued transmission of the virus. After all, only when a person tests positive, they are isolated to prevent them from spreading the virus to other people.

The state has a daily capacity of 1,500 RT-PCR or reverse transcription-polymerase chain reaction tests that are recommended for diagnostic purposes, said Vumlunmang. However, the state has been doing less than 1,000 RT-PCR tests daily on an average, instead deploying the less reliable rapid antigen tests for the rest.

But health officials said the problem was not capacity as much as convincing people to get tested. “People are not coming out to test, we are going to their homes, but still they do not agree,” said a state health official. “We cannot force them beyond a point.”

Manipur’s daily tests over time. Credit: covid19india.org

Same story in Meghalaya

The hill state Meghalaya is also reporting a high positivity rate that has started to inch up again in the past week. On June 30, the average positivity rate of the state calculated over the last seven days shot up to 13%

Meghalaya’s test positivity rate over time. Credit: covid19india.org

However, unlike Manipur, this has not coincided with any notable daily growth in new cases.

Yet, that may not be a true reflection of the situation as the state’s daily tests have substantially decreased since the last week of May when it hit a peak of over 5,000 tests, which is roughly the state’s daily capacity. The average number of daily tests in the state in the week ending June 30 was around 4,000.

A vaccination problem

Apart from low testing, another thing ties Manipur and Meghalaya together: low vaccination coverage. The two states have the lowest vaccine coverage among the smaller states in not just the North East, but the entire country.

That, public health experts say, could also be one of the reasons behind the positivity rates continuing to be high. “We have had a very big hesitancy issue in Meghalaya,” said Sandra Albert, director of Shillong’s Indian Institute of Public Health, an affiliate organisation of the Public Health Foundation of India. “That is definitely one aspect of it.”

Not only Meghalaya, large parts of the North East, particularly areas dominated by ethnic tribes, have seen beset by vaccine hesitancy. Manipur’s hill districts have some of the lowest vaccination rates in the country.

Yet it is difficult to draw neat patterns. Despite its vaccination coverage – the second highest in the country – Sikkim’s positivity rate is the highest in the country.

While conceding that it was not ideal, the state’s health secretary K Sreenivasulu said an overwhelming number of them were asymptomatic. “We don’t have enough testing infrastructure but we have tried to make up for it by high vaccination,” he said.

Indeed, since May 1, Sikkim has seen 160 deaths with a case fatality rate that is almost half of both Meghalaya and Manipur in the same period – despite the small hill state seeing a surge in positivity rate in recent times owing to a small number of tests. Ditto with Tripura which boasts of one of the highest vaccination coverages in the country.

On the other hand, officials in Manipur and Meghalaya said a fairly high percentage of their positive patients were symptomatic.

A North East phenomenon

Irrespective of vaccination rates, the average rate of decline of cases in the smaller states of the North East is slower than most other parts of the country.

Ram Kumar, director of Meghalaya’s National Health Mission, said that was likely because people lived in less dense settings in most of these areas. “Unlike a place like Delhi where it spreads really quickly, it takes time for the virus to spread here,” he said.

What he meant was: In densely populated places, the virus infects a higher number of people in a shorter period of time – resulting in more explosive outbreaks that tend to burn out sooner.

That apart, as public health expert Albert pointed out, the second wave arrived later in the North than the rest of India.

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Covid-19

COVID-19 containment may derail if protocol is not followed, says Mansukh Mandaviya

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New Delhi: With the festive season approaching fast, COVID-19 containment can derail if they are not celebrated following protocols set by the Government.

Union Health Minister Mansukh Mandaviya has warned people on October 0, 2021 and exhorted 19 states to escalate their inoculation pace so that India can achieve administering 100 crore vaccine doses in the next few days. India has so far administered over 94 crore Covid vaccine doses.

Reviewing the progress of vaccination with principal secretaries and mission directors of the National Health Mission from all major states, the health minister underlined that administering 100 crore doses of COVID vaccine is the immediate milestone.

Mandaviya noted that if festivals, synonymous with auspiciousness, joy and large gatherings, are not observed as per COVID-19 guidelines, containment of COVID-19 can get derailed. “The two-pronged solution is to follow COVID-19 protocols very strictly and to speed up vaccination,” the minister said.

The minister cited results of experiments that pegged the number of first dose recipients not developing severe COVID-19 to be 96 per cent and further pointed out that the number increases to nearly 98 per cent for people who have taken both doses of the vaccine. Officials of Andhra Pradesh, Assam, Bihar, Chhattisgarh, Gujarat, Haryana, Jharkhand, Karnataka, Kerala, Madhya Pradesh, Maharashtra, Odisha, Punjab, Rajasthan, Tamil Nadu, Telangana, Uttarakhand, Uttar Pradesh and West Bengal took part in the meeting.

Observing that over eight crore balance vaccine doses are physically available with states, Mandaviya enquired about specific hurdles, if any, faced by them in increasing their pace of vaccination and vaccine coverage among the target population.

Many states are nearing saturation of coverage in urban areas and are catering to the floating population in the city. Labour and time-intensive door-to-door vaccination is being undertaken in some geographically aloof pockets where first dose coverage is nearing saturation.

Uttar Pradesh state that comparatively limited supply of Covaxin and its shorter span between the doses as a rate inhibiting factor.

“In consultation with the states, the minister exhorted each state to increase their target so that the administration of the last six crore doses for reaching the mark of 100 crore is achieved in the next few days,” the health ministry stated.

Union Health Secretary Rajesh Bhushan urged all the state health administrators to be strict with observance of COVID-appropriate behaviour during festivities to prevent a COVID-19 outbreak. He underlined the need to adhere to a detailed standard operating procedure issued through a ministry’s letter on September 21. It included no mass-gatherings in containment zones and in districts with over 5 per cent case positivity.

Gatherings with advance permissions and limited people to be allowed in districts with a positivity rate of 5 per cent and below. Relaxations and restrictions to be imposed based on weekly case positivity.

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WHO set to vaccinate 40% population of every nation by yr end

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Geneva, Oct 8: The World Health Organization (WHO) announced an initiative to vaccinate 40 per cent of the population of every country against Covid-19 by the end of 2021 and 70 per cent by mid-2022, by prioritising vaccine delivery to low-income countries, particularly those in Africa.

“Today, the WHO is launching the Strategy to Achieve Global Covid-19 Vaccination by mid-2022,” Xinhua news agency quoted WHO Director-General Tedros Adhanom Ghebreyesus as saying at a press briefing here on Thursday.

“The strategy outlines the road we must all take together to achieve our targets of vaccinating 40 per cent of the population of every country by the end of this year, and 70 percent by the middle of next year.”

According to Tedros, achieving these targets will require at least 11 billion vaccine doses, which is an allocation problem instead of a supply problem.

“With global vaccine production now at nearly 1.5 billion doses per month, there is enough supply to achieve our targets, provided they are distributed equitably,” he said.

According to the WHO’s records, more than 6.4 billion vaccine doses have now been administered globally, and almost one-third of the world’s population is fully vaccinated against the virus.

However, low-income countries have received less than half of one percent of the world’s vaccines.

In Africa, less than 5 per cent of people are fully vaccinated.

Earlier this year, the WHO had set a target for all countries to vaccinate 10 per cent of their populations by the end of September, but 56 countries didn’t make it.

UN Secretary-General Antonio Guterres, who joined the WHO chief at the initiatve’s launch, said: “Vaccine inequality is the best ally of the Covid-19 pandemic.

“But through dose sharing, swaps, technology transfers and other priority actions, it is possible to reduce deaths and minimize suffering, prevent health systems from being overwhelmed, resume social and economic activities, and reduce the risk of dangerous new variants.”

The UN chief also renewed his appeal to the G20 nations for help, adding that “their meeting later this month will be an opportunity to deliver”.

“I urge all global stakeholders to step up, mobilize their resources and turn this strategy into a reality,” he said.

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Global Covid-19 caseload tops 236.7 mn

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Washington, Oct 8: The global coronavirus caseload has topped 236.7 million, while the deaths have surged to more than 4.83 million and vaccinations soared to over 6.39 billion, according to the Johns Hopkins University.

In its latest update on Friday morning, the University’s Center for Systems Science and Engineering (CSSE) revealed that the current global caseload, death toll and the total number number of vaccine doses administered stood at 236,730,066, 4,833,592 and 6,394,485,945, respectively.

The US continues to be the worst-hit country with the world’s highest number of cases and deaths at 44,158,348 and 710,173, according to the CSSE.

In terms of infections, India follows in the second place with 33,894,312 cases.

The other worst countries with over 3 million cases are Brazil (21,532,558), the UK (8,084,275), Russia (7,575,825), Turkey (7,357,306), France (7,142,387), Iran (5,674,083), Argentina (5,264,305), Spain (4,971,310), Colombia (4,967,524), Italy (4,692,274), Germany (4,295,876), Indonesia (4,224,487) and Mexico (3,699,621), the CSSE figures showed.

Nations with a death toll of over 100,000 are Brazil (599,810), India (449,856), Mexico (280,610), Russia (209,752), Peru (199,581), Indonesia (142,494), the UK (137,818), Italy (131,198), Colombia (126,517), Iran (122,012), France (117,845) and Argentina (115,416).

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