All the North-Eastern states seem to be well prepared to take on this challenge and by the standards of their efforts till date, it will not be a surprise if the region remains the most protected in India from the deadly virus. The combination of good governance and community responsibility is a tough collaboration for even COVID-19 to breach
-Rami N Desai & Rohit Kumar
An official checking the temperature of a passenger
using an infrared thermometer at Dimapur railway station, Nagaland
In the collective imagination of India the North-East region of India has often in the past had the disadvantage of being overlooked for a multitude of reasons. But in the past six years, with the present government in India making the North East a priority, we have seen the states in the region optimise their potential through not only good governance but also through great individual responsibility.
There was a time in late April when 5 out of 8 North-Eastern states were COVID-free. However, with the opening of borders and migrants returning from harder-hit states like Maharashtra and Delhi, the numbers of COVID positive patients in these states may have changed but only marginally. As of June 1, the number of COVID positive patients stood at Mizoram 1, Sikkim 1, Arunachal Pradesh 4, Tripura 268, Manipur 62, Nagaland 37, Meghalaya 27 and Assam the most populous state in the North East and also the gateway to the region at 1,185 infected persons.
The response of these states has been nothing short of commendable and while there has been some focus on their success story, it is the Kerala Model that has most often been in the limelight. Though what is important to consider here is that Kerala has been known for its excellence in healthcare as well as its pre-existing infrastructure. The North-Eastern states, on the other hand, are not known for either their healthcare, their infrastructure or their connectivity. Besides, the threat of the spread of COVID-19 in the North-East is also more serious because of the comparatively less availability of high-end treatment facilities and geographical bottlenecks. Despite all their apparent limitations, it is not just a story of success but a story of good governance, community partnership as well as resilience. The region undoubtedly has followed the guidelines of Government of India in letter and spirit.
To begin with, what was common to all the states in the region was their timely and strict enforcement of lockdown in adherence to the Government of India norms. Many states had imposed a lockdown even before the initial announcement of a national lockdown by the Hon’ble Prime Minister. The states also revisited continuously and revised their lockdown strategies to keep up with the changing circumstances around the outbreak.
Interestingly, the lockdown was enforced not just by law enforcement agencies but also was managed with community support. This was the novel concept of community quarantine and surveillance seen throughout the North-Eastern states, where a high-risk contact is isolated in the village, in his home and is strictly tracked and supported by the community at large. Due to a predominant tribal population in this region and closely resembling general population, the customary laws in the villages and smaller urban areas ensure registration of the in-migrants with the village headman. This practice ensured limiting the spread of infection as well as successful enforcement of social distancing and quarantine requirements, for instance, in Assam, when a mammoth programme called ‘Assam Community Surveillance’ was undertaken. The surveillance task involved all the villages of the state (around 28,000) to look for SARI (Severe Acute Respiratory Infections) and ILI (Influenza-like Illness) and fever cases with an aim to test all such cases.
Further, the government as per the findings of the testing (be it COVID, JE, Dengue, malaria) decided as a part of its aggressive action plan to not only isolate such patients but also follow up such cases with contact tracing and appropriate treatment. This extensive programme was started in the first week of May and within the first 12 days, health officials had already completed their ambitious survey of 18,000 villages. Further, a staggering 5,84,145 persons were surveyed, 57,436 Gram Sabha meetings were conducted, 12,901 persons who came in contact with COVID-19 positive cases were identified and tested for COVID-19 and 35 people were found positive. Without the involvement of the community at every level their efforts would have failed.
In Manipur too, the State Health Department in collaboration with various community organisations prohibited spitting in public places along with the use and chewing of smokeless tobacco products, pan masala and areca nut in public places and made it a punishable offence. Communities also created shelter huts outside their villages to function as quarantine facilities for people coming from outside the state. Similar initiatives and heartwarming stories of villagers regulating people coming in were many across the region. Mizoram also activated a Local Level Task Force or a Village Level Task Force to monitor the situation as well as to help local villagers with the distribution of food, medical aid and information. Communities across these states in a seamless effort came together with their respective governments to communicate the importance of proper sanitisation, medical tests, quarantine and contact tracing. Many villages made it mandatory to wash hands and feet and follow adequate safety norms before entering the boundaries of the village.
What is also very surprising is that most of the migrants in these states did not request to leave, unlike larger and wealthier states like Maharashtra. For example, in the case of Sikkim, not only were the residents being looked after by ample distribution of food and relief material but not one migrant left the state. There are an estimated 25,000 migrant labour in Sikkim. But due to equal distribution of basic necessities, migrant workers felt safe and their needs were looked after preventing them from moving. This too was in accordance with the request made by the Prime Minister to all the states across the country to take responsibility and to look after their migrant workers.
Assam Health Minister Himanta Biswa Sarma inspecting facilities at a COVID-19 hospital
Additionally, the North-Eastern states also very quickly identified the gaps in the facilities that would need to be filled. For instance, due to relatively weak healthcare facilities in the region, only Assam had a few BSL2 laboratories to test for COVID-19. This hampered their ability to increase testing. It also meant that all the other states had to depend on sending their samples to Assam. To increase testing and to save time, many states quickly developed their laboratories and repurposed TB testing facilities (CBNAAT and TrueNAAT) for COVID-19 testing. By April 6 Mizoram, by April 30 Arunachal Pradesh and by the May 14 Nagaland had inaugurated their own labs. Once the other states had their labs, Assam began testing at full capacity. Only last week Health Minister Dr Himanta Biswa Sarma announced that the state had surpassed Kerala for testing for COVID-19. Assam has carried out 55,862 tests so far, surpassing Kerala’s testing count of 52,771. Kerala may be a state with an edge over other states as it is known for its excellent healthcare, but Assam has been a proverbial dark horse in this race to overcome this pandemic.
Many states also began screening as soon as they realised the gravity of the situation across the world. For instance, Manipur started screening people arriving at the Imphal airport from 18-01-2020, well before any other state. It also was the first state to seal its international borders on 09-03-2020. Assam too sealed its international borders with Bhutan and Bangladesh immediately following the instructions of Government of India. While Sikkim closed its doors to domestic tourists on March 17, 2020, this was a callous decision as the state is tourist revenue dependent. However, their doors were closed to even their residents wanting to enter the state. Equal restrictions were accorded to the families of even Judicial personal, bureaucrats, public representatives and entrepreneurs. This was not an exception in the North-Eastern states but this was the norm. All the states managed the lockdown with absolute seriousness even though many depended on tourist revenue.
Though the situation is set to change with many North-East origin migrant workers and students returning to their home states, Nagaland was the last state to record COVID positive cases with all cases having come from outside the state. Arunachal too recorded its single-day spike this week with all cases from migrants that had returned to the state recently. Tripura CM Biplab Deb recently announced that he would be recruiting more doctors and nurses to the state health department to combat the possible increase in cases.
Interestingly, the lockdown was enforced not just by law enforcement agencies but also was managed with community support. This was the novel concept of community quarantine and surveillance seen throughout the North-Eastern states, where a high-risk contact is isolated in the village, in his home and is strictly tracked and supported by the community at large
Assam too is preparing on a war footing with the knowledge that there are still over 2000 people that are expected back in the coming week. Assam being the gateway to other states in the North-East finds itself in a precarious position. But the state has planned by creating a very comprehensive quarantine infrastructure. With over 30,000 quarantine and mass isolation beds, and nearly 600 ICU beds, the state has booked 1000 rooms in hotels around Guwahati and further identified schools, colleges and Bhawans for quarantine purposes. The final aim is to identify and create facilities to accommodate over 5000 people.
Sadly, if only other states had looked after their migrants the way the North-Eastern states have, the region may still have been COVID-19 free. However, all the states in the region seem to be well prepared to take on this challenge and by the standards of their efforts till date, it will not be a surprise if the region remains the most protected in India from the deadly virus. The combination of good governance and community responsibility is a tough collaboration for even COVID-19 to breach.
(Rami N Desai is an author & North East analyst and Rohit Kumar is a writer and Research Fellow, India Foundation)