COVID-19 and Institutional Response in Assam

By Raju Mandal

Introduction

The role of institutions in times of a public health and economic crisis has come to a test like never before during the COVID-19 pandemic. To bring people’s health, their livelihoods and the economy out of the crisis, a proper institutional mechanism and its effective implementation have no alternative. In the absence of any cure or vaccine, the institutional responses at the national and sub-national levels have attempted to slow down the spread of the infection, cure the infected, provide financial assistance and other supports to the needy, and adopt measures to revive the economy from this exogenous shock. Since the timing and intensity of exposure to the pandemic vary across countries and even within the same country the responses by the respective governments have been different; this along with differences in the demographic composition, human mobility, level of awareness within the communities, cooperation by the people etc. have been the reason behind variations in the spread of the disease across states and/or countries.

Assam, the gateway to northeast India, is one of the states that witnessed a delayed outbreak of COVID-19 compared to most other states of the country. The first positive case in the state was reported on March 31, 2020. After that, it has seen a smaller number of persons testing positive for COVID-19 for a longer period of time before taking a jump after May 22 (see Fig.). As on June 16, 2020, there are 4320 confirmed cases in the state which is 1.23% of the national total.

The timing and pattern of spread of the virus in the state are different from other parts of the country. While the delayed infection in the state helped its government by providing time to carry on preparation in advance, the active involvement of the government machinery throughout is another factor behind the slow spread of the virus, although there has been a sharp increase in the number of confirmed cases in recent weeks due to a sudden increase in the number of people coming from outside, mostly from the highly infected areas. This article highlights the institutional response from the state government to the corona pandemic.

Source: https://www.covid19india.org/state/AS. accessed on June 16, 2020

The Early phase: Before the national lockdown

The Government of Assam (GoA) has been pro-active since the beginning in its efforts to fight against COVID-19. The Ministry of Health and Family Welfare left no stone unturned with untiring involvement of the Health Minister himself leading from the front day and night visiting the length and breadth of the state along with his team in the preparation against the pandemic. In the early phase, before any confirmed case in the state was reported, the government efforts were on to create the physical infrastructure, such as quarantine centres and increase in hospital beds by involving private hospitals on a war-footing; increasing the strength of manpower in medical teams by involving more doctors, nurses, paramedics etc.; and creating awareness among people and educating them about the pandemic through media and government employees. The state Health Minister repeatedly talked to the doctors, nurses, health officials keep their morale high. He continuously held meetings and video conferences with DCs, SPs, doctors, and professionals to take stock of the situation and preparedness.

The GoA framed regulations called, ‘The Assam COVID-19 Regulations, 2020’ and brought out an official notification on the same on March 18, 2020. It further notified the framing of ‘The Assam COVID-19 Containment Regulations, 2020’ on March 21. These regulations emphasized the strategy of testing all suspected cases, isolating them, treating the COVID-19 patients, tracing their contacts and quarantining them meticulously. These would be facilitated by geographic quarantine, social distancing measures, and enhanced active surveillance through a house-to-house survey. Anybody who had a travel history to the affected areas in the last 14 days but was asymptomatic was required to go for home quarantine or institutional quarantine created by the government. But those having a travel history and showing symptoms, were isolated at a hospital.

The District Disaster Management Authority headed by District Magistrate was authorized for planning and implementation of containment measures for COVID-19 in their respective districts within the framework of instructions issued by the state government from time to time. Any person/institution/organization found violating any provision of the regulations would be deemed to have committed an offence punishable under section 188 of Indian Panel Code (IPC). Under these regulations, all government and private hospitals are required to have separate space for screening of suspected cases of COVID-19 and provide treatment facilities to any confirmed case.

All schools, colleges and other educational institutions in the state were closed on March 16 and teachers were sent to the villages neighbouring their institutions to create awareness among the people about the disease, how it spreads, and what people should do to contain the spread of the virus. They were told the importance of social distancing, use of masks, hand washing and sanitizers. The government also continually disseminated awareness among people through print, electronic and social media.

From March 19, all museums, libraries, coaching centres, beauty parlours and barber shops in the state were closed. The government started screening of people coming from outside the state at airports and railway stations. There were preliminary screening and health examination and they were advised for home quarantine. In order to eliminate the risk of community spread of the virus, the government issued an advisory on March 20 asking the health officials to use ‘home quarantine’ stamp, with date, on the wrists of suspected persons to be kept under home quarantine. On March 21, the State Level Task Force was notified to supervise the implementation of ‘The Assam COVID-19 Regulations, 2020’ and other regulations notified by the GoA with regard to the containment of COVID-19 in the state.

Given the importance of masks, gloves and sanitizers when there was a sudden shortage of these items in the market and many sellers charged exorbitant prices, the state government warned against selling them above maximum retail price and prohibited hoarding, black marketing and profiteering on these items.

As a precaution to contain the outbreak, the GoA prohibited all inter-state passenger vehicles to and from the state on March 22. The government held a meeting on the same day with suppliers of medicines and essential medical materials to ensure enough supply of these items and augment infrastructure and supply chain.

Given the limited number of government hospitals in the state, the GoA signed a memorandum of understanding (MoU) so that these could be exclusively used for the treatment of COVID-19 patients and the general patients could be sent to the private hospitals. Many private hospitals in the state were roped in to provide cashless treatment to beneficiaries under AAA and PMJAY. Patients can directly approach private clinics for treatment and the government will pay back the private hospitals as per Ayushman Bharat rates.

The final year MBBS students were given seven-days intensive training on treatment of COVID patients so that they can be utilized as a back-up in case the situation worsens, and scarcity of doctors arises. To enhance manpower of the medical teams the final year nurses were also deployed.

The seriousness of Assam government in fighting COVID-19 is evident from the fact that even without any positive case in the state, it announced a state-wide lockdown for a week with effect from the evening of March 24.

Lockdown and after

Measures to contain the spread of COVID-19
The GoA announced a state-wide lockdown for a week from the evening of March 24 which was followed by announcement by the central government for a national lockdown from March 25. The state was under complete lockdown except for essential services and all DCs and SPs were instructed to ensure 100% compliance of the lockdown. When some people in a few places did not seem to take it seriously and came out on the streets, the police was quick to enforce restrictions.

The first case of COVID-19 in the state was confirmed on March 31, 2020, when a returnee from Delhi’s Tablighi Jamat congregation tested positive for the same. The next day saw an increase with 15 new positive cases, all linked to the congregation. At the beginning of the outbreak in the state, except one case in Guwahati, all had either travel history to the congregation or were their contacts. In order to trace and isolate them, the state government made appeals to all the returnees from the congregation and their neighbours to cooperate with the administration by disclosing their information. Despite repeated appeals by the government when many returnees did not come out and cooperate with the health department, all DCs and SPs were directed to take swift and strict measures. As and when, information was made available to the administration, without any delay the family members of the Tablighi Jamat congregation returnees were brought to quarantine centres and the Health Minister himself was himself present to ward off any fear among them.

The Chief Minister of Assam held a meeting on April 9 with the leaders of different religious organizations and urged them to appeal to their followers to remain indoors considering the highly infectious nature of the virus. He asked them to take responsibility to create awareness among their followers and educate them about the urgency of avoiding any kind of religious or social gathering. He appealed to all the people of the state to perform their religious activities, if any, within their housing premises.

The strict enforcement of the lockdown helped contain the spread of the virus as a result of which it took 37 days to take the tally of confirmed positive cases to 50, during which, 20 days saw no new positive case.  During this period, the cases were confined to the Tablighi Jamat returnees and their contacts. Though there was flattening of the daily cases, relaxation of the lockdown and incoming of stranded people from outside the state saw a sharp increase in the number of positive cases since May 23. But the good news is that the average growth rate per day has fallen from 37% during the week May 20-26 to 10% during June1-7 and to 6% during June 9-16.¹

As far as the doubling rate of infection in the state is concerned, it took 47 days for the number of COVID-19 positive cases to reach 100, but only 4 days from there to reach 200 and 400, and 3 days to 800 before improving to 6 days to double the figure to 1600 and 7 days to 3200.  However, the silver lining is that more than 90% of all confirmed cases came from the quarantine centres. But one thing to be noted is that as there was an increasing flow of people into the state there was a sharp rise in the number of tests also. The state government has repeatedly emphasized the need for increasing the number of tests. As on June 16, 2020, there were 6,330 tests per million population in the state which is higher than that in many other states. Given the positive correlation between the number of tests conducted and number of confirmed positive cases, the relatively better status of Assam can be visualized from the fact that the confirmed cases in the state is 2% of total tests conducted compared to the national figure of 5.92%.

Since there was a sharp rise in the number of positive cases of COVID-19 after a huge inflow of people from outside, the GoA adopted a strategy of ‘Ruthless Quarantine with a Human Heart’. It means everyone coming from rest of India by road, train and air will be compulsorily sent for quarantine for 14 days – either 14 days institutional quarantine or home and institutional quarantine of equal period during which they will be provided with all essential requirements. For the people going for home quarantine, the government would provide all essential items like food supply, hygiene, security, and medical arrangement etc. at their home for the period. As per government estimates around Rs 13,000/- would be spent on average per person during the quarantine period for the same.

There is increasing pressure on the institutional quarantine facilities because of a sudden surge in the number of people coming from outside the state. Therefore, the government has given importance to home quarantine for people not showing preliminary symptoms. But the entire household of the person going in for home quarantine would become a containment zone and all residents of that house are required to follow the quarantine norms. To enforce this, the government has involved the local communities by setting up Village Level Home Quarantine Management Committees and Ward Level Home Quarantine Committees which would, under the supervision of Constituency Wise Quarantine Management Committees, monitor the strict compliance with the home quarantine norms.

The GoA also adopted a ‘Community Surveillance’ measure whereby doctors and health workers visited villages to check any possible spread of COVID-19 in the villages. The first phase of the program covered 29,771 villages in which around 26,000 people were found to have fever and 6,000 had influenza-like illness. But fortunately, none of them tested positive for COVID-19. This is indicative that because of the ruthless quarantine policy the virus has not spread to the villages and local communities so far. Further, on May 8, the Assam government made it compulsory for people of the state to wear masks or cover faces in public places. Anybody failing to comply with this will be liable to punishment under section 188 of IPC and would be required to pay a fine of Rs 500/- on violating up to three times and Rs 1000/- for subsequent violations.

In the coming days, the number of positive cases in Assam is expected to increase manifold with an increase in the number of people coming from areas which are exposed to COVID-19. To face this crisis, the state government is diligently making use of its limited resources. As per the Press Release by the Health Minister, Dr Himanta Biswa Sarma on May 24, 2020, the existing health infrastructure in terms of hospital beds, doctors, nurses, paramedics etc. is capable of treating 5000 COVID-19 patients.

The government has also created a portal for doctors, nurses and paramedical staff working in the private sector to register themselves if they wish to volunteer to serve during this pandemic. As a response to the appeal, some additional 200 plus doctors have volunteered to serve the patients. But unlike other states, the GoA has adopted a unique strategy of not opening all COVID hospitals at the same time. Rather the hospitals are to be opened sequentially as their capacity exhausts with an increase in the number of patients. This is to reduce the speed of infection by the virus.

The state health department has unveiled a three-tier system of COVID-19 treatment. The symptomatic patients will be treated at medical colleges, while the vulnerable patients will be admitted to district hospitals. Moreover, 50 model hospitals with 50-bed facilities in different parts of the state have been converted into a COVID-19 treatment facility. These model hospitals will treat COVID-19 patients who are asymptotic or have mild symptoms. Concerned Deputy Commissioner and Joint Director of Health Services will monitor the functioning of the model hospitals and ensure that all necessary logistical support is provided to the doctors and staff.

Like every other year, Assam has already been affected by floods twice in less than a month. To prevent the spread of COVID-19 among the people taking shelter in the relief camps, the state government has taken some special measures. To give safeguard to the vulnerable people there would be separate relief camps for or segregation of persons below and above 60 years of age. Face masks, soaps and sanitizers would be distributed among people in the relief camps. Moreover, random swab samples would be collected for testing.

The state government decided to carry out in all districts a targeted surveillance drive named the Assam Targeted Surveillance Program (ATSP) on June 15. Under this drive, around 50,000 random samples were collected from people working in locations such as truck parking, loading and unloading centres, godown areas, weigh bridges, dhabas etc.; frontline district officials, staffs of hotels used as institutional quarantine, and family members or co-residents of persons released from institutional quarantine.

Measures for general public and ‘corona warriors’
The motive behind the lockdown was to slow down the rate of infection of COVID-19 and have some time for preparation against it. But making people stay at home is not easy, particularly, because they have the compulsion of coming out for work or to buy daily supplies. Therefore, during the lockdown, to minimize the hardships of people in general and give security and motivation to the ‘corona warriors’ the GoA has taken several steps some of which are mentioned below.

In order to ensure supply of essential food items, grocery stores were allowed to open for a stipulated time maintaining social distancing norms. Fruits and vegetables were also made available at the doorsteps of households with the help of some government-designated vendors.

The GoA established ‘Assam Arogya Nidhi Trust’ to provide financial assistance and medical services to the needy and those suffering from various diseases, including COVID-19. The government urged people to donate to the trust.

During the national lockdown, many migrant workers had to suffer due to loss of livelihoods. When their employers declined to provide them with any assistance, the state came forward to help those who were stranded outside the state. The state cabinet decided to transfer Rs 2000/- to the bank accounts of 3.61 lakh people who decided to stay back in their places of work till June (after disbursing the same amount for April and May).

The GoA launched a new scheme called ‘Dhanwantari Scheme’ under which locally unavailable medicines have been delivered to patients at their homes with the help of ASHA and multi-purpose workers. The medicines below Rs 200 have been delivered to the patients free. So far 7500 persons have been served under this scheme. Moreover, the state government provided financial assistance to the patients stranded outside the state too.

To lessen the hardships of the parents, the state government directed all private schools to waive off 50% of monthly fees for the month of April. They were also advised not to increase the fee structure or curtail salary of teaching and non-teaching staff of private schools.

The local communities played a great role during the pandemic by standing beside the people and state government. The state government employees contributed one day’s salary for the month of March voluntarily after an appeal by the government. The lockdown severely hit the livelihoods of the poor and those engaged in unorganized sectors. The state government decided not to make any cut in the salary of state government employees and appealed to them to help a few of their poor neighbours in this time of hardship. Responding to this, not only the government employees but also many other people and social organizations came forward and helped up to 50 poor households in their localities with food items.

In addition to the Rs 50 lakh insurance coverage announced by Prime Minister for health sector workers, the Assam government decided to bring the policemen and frontline officials of all other departments directly engaged in the fight against COVID-19 in the state, under the insurance coverage. The government also took a very important decision to bring the108 ambulance and 104 health helpline employees under Rs 50 lakh health insurance. Further, an additional amount of Rs 1000/- for 108 employees was announced for next the nest months which is in addition to their regular salaries.

In the wake of COVID-19, the GoA decided to make admission for higher education, right from higher secondary to post-graduation, for the session 2020-21 free with a view to providing relief to guardians.

Challenges ahead

Despite the risk of infection, the government has allowed inter-state movement of people on humanitarian grounds. Assam has managed to quarantine people coming from outside, thereby, reducing the risk of the spread. But the testing and quarantine facilities and hospital beds will be stressed if a very large number of people come within a very short span of time. Therefore, the government has been requesting people who want to come back to the state to not come in one go but in batches. Towards this end, people stranded outside are given financial assistance by the state government and they are encouraged not to come back if not extremely necessary.

Amidst the COVID-19 pandemic, there is the fear of floods looming in Assam, which is a regular phenomenon in the state, causing extensive damages to life, property, and crops every year. Floods have already hit several districts of the state twice and multiple waves throughout the state are expected in the coming weeks. This is going to make the fight against COVID-19 more difficult for the state government and its people not only in terms of compromise of social distancing norms but also diversion of monetary, physical infrastructure and human resources to fight the flood-induced damage. Therefore, the state government has asked the people stranded outside to come back by June 10 so that government machinery can be engaged to cope with the possible damages by floods too. If there is no community spread of the virus and all incoming people strictly abide by the quarantine norms the situation is expected to improve in the state by the end of June.

Conclusion

Assam is one of the states of India that got affected by COVID-19 late compared to most other states and where the initial rate of infection was low. The main reasons for this could be – geographically remote area without a regular inflow of large-scale people from outside, no international flight landing from the infected countries, preparations in advance, timely lockdown and its enforcement, and local condition like anti-CAA movement since December last year that led to a decline in the number of tourists from rest of India and abroad. Moreover, the people of Assam, by and large, cooperated by adhering to the government guidelines. For example, responding to government’s call, people refrained from celebrating their week-long festival, Rongali Bihu, in the traditional way, and avoided social and religious functions in public.

Assam is known as one of the economically backward states of India and so the health infrastructure cannot be increased drastically overnight. Despite the existing resource constraints, the government of Assam is putting in its best efforts. At the same time, we must not forget that everyone has a social responsibility, and this time this responsibly is much bigger because our irresponsible behaviour can bring greater damage to the society at an exponential rate in terms of the spread of the virus. Those in the quarantine centres and/or sent for home quarantine should follow the quarantine norms. They must keep in mind that the entire state and nation is in crisis and everyone, across society, has been making sacrifices to fight this pandemic. The public should also cooperate with the government by adhering to its advisories about social distancing and hygiene norms.

AUTHOR
Raju Mandal, Assistant Professor, Department of Economics. Assam University, Silchar, Assam

Disclaimer: The views and opinions expressed in this article are those of the author/s and do not necessarily reflect the official policy or position of Azim Premji University or Foundation.