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Wednesday, September 16, 2020

Chp 831. Contact Tracing in Mizoram

In my previous post, I wrote about my surreal experience of walking through my locality Chaltlang to get a permit from the Local Council office, when I saw most of the houses on the way slapped with a "Home Quarantine" notice.

Yesterday, we received the wonderful news that all 214 people under HQ (Home Quarantine) in my locality had been tested and their results were all negative. Wooohoooo!

Even though this is such a joyous news for our entire locality, especially those who were under HQ, I realized there is another entity that must be extremely glad with this good news, and that is the Contact Tracing department of Mizoram :D Imagine their relief because now they don't need to trace the travel and contact history of all those 214 people!

Party party! :D :P

And so, that is what I would like to write about on today's blog update. The Contact Tracing unit of Mizoram, about the importance of their work and how exactly do they go around doing their job.

Now to get a clear understanding of this, I spoke to my good friend Mazirtira, aka Maxeer, who used to work in this unit.

First of all, what do they do, and why? Well, Contact Tracing is the method of tracing and identifying all the people a CoVid-19 positive patient came in contact with. The main aim of this procedure is to prevent further community spread of the virus within our state.

In Mizoram, the unit that is responsible for this crucial task is known as the "State Contact Tracing Management Unit", and it comes under the Department of Health and Family Welfare.

Different health dept staff members are assigned to this unit. Like for example, Mazirtira was working in this unit back when Mizos were returning to Mizoram on those special Shramik trains, but now he is assigned to a different unit.

And even when Mazirtira was working in this unit, there was no need for him and his teammates to meet up every day, until there was an actual positive case. Hence, they were all working in their respective dept offices, doing their usual tasks like filing paper, data entry, managing logistics, coordinating supplies, taking selfies (in the case of Mazirtira), and were only "activated" when Mizoram got its first CoVid-19 patient (March 25th - Chp 799. Day 1 of 21 days Lockdown).

Once activated, they all met up at a designated office dedicated to this unit, and they started their work of tracing all the people the positive person came in contact with.

They did a fine job of collecting all the information, like the taxi driver who drove the patient from the airport, and so on. And once there were no other new positive cases, they all disbanded temporarily and continued working at their respective offices again.

After all, if there is no work, why waste resources? There's no point in the team meeting up every day when there is no "contact" to trace.

This reminds me of my friend and former colleague "SP" at a games development company. SP was a brilliant 3D model rigger, a perfectionist, and his 3D animations were top notch. Except, the problem was, we were working on a lot of 2D games for a very long time, and so, he didn't have any proper tasks for months. Initially, we tried to utilize him by keeping him in Market Research or Quality Assurance, but those were not his core skill sets. Eventually, we had to let him go as there was no work for him. Indeed it was a very sad moment to see him go.

I think from my experience above, you'll understand why they all headed back to their regular tasks.

We had zero positive case for a long time after our first case. When the first Shramik train arrived in Mizoram from Chennai (May 15th - Chp 815. The Long Train Home), it was expected that there would soon be positive patients too, and Mazirtira's team once again started prepping up, ready to be summoned to their unit's office any time. Eventually, we did indeed lose our unique status of being the only Indian state with no positive patient (June 2nd - Chp 818. Mizoram - 12 positive) and Mazirtira's team got into action once again.


Mazirtira mentioned that the way his team used to work back then and the way the current team works now, also known as SOP (Standard Operating Procedure), is very different. Here are 10 points on how Mazirtira's team used to function back then (without revealing any confidential information):

1. Since the infected people they had to deal with were all recent returnees, the source of the contagion was automatically assumed to be the place where they returned from (as they were all red zones). Hence, the headache of trying to trace where they got the virus from was not required.

2. Everybody who returned were all taken to various QCs (Quarantines Centers), and so their community contact was minimal. It was still not an easy task to trace all their movements, but this made their task relatively much easier.

3. The people they traced included the patient's train and bus travel companions (who were also all residing in one of the QCs), name of the drivers, places where they stopped on their way to the QC (which was again kept to a minimum) and so on.

4. They had a lot of help from the police, who also has a team dedicated to contact tracing. For instance, if a positive patient couldn't remember which bus he or she was travelling in or the name of the driver, the police stepped in and it was easy for them to retrieve those details and give it to them.

5. Apart from coordinating with the police, they also coordinated with all the districts of Mizoram. There are District units at every district doing the same work of contact tracing, and they share feed and information continuously with the main State unit.

6. Now comes the boring part. If you're expecting this Contact Tracing team to go all detective and private-eye ish, like Sherlock Holmes or Hercule Poirot (or even the Hardy Boys or Nancy Drew for that matter), then you're in for a disappointment. They didn't go out there putting on their sleuth cape or monocle and grilling people at different locations. Nopes. They got all their information, simply by speaking to them on the phone.

Don't get me wrong, I'm not criticising their method, maybe I've watched too many "Criminal Minds" or police shows and courtroom dramas, I was expecting a little bit more action and mystery, you know. I was imagining something like, Mazirtira is all suited up in leather jacket and rayban glasses, he jumps over a fence as he chases a positive suspect, and finally catches him. Mazirtira grabs him by the throat and pulls out a glock semi-automatic pistol and shouts, "Who else did you come in contact with? Who else!!?? Tell me right now or I'll blow your brains out!" and the other person meekly replies, "You, just now." :D

And so, they spoke to these positive patients over the phone, asking them a standard list of questions. If one patient was unreachable, they would call up another positive patient staying in the same hospital ward (all those details were with them) and asked him or her to give the phone to that person. It was also of utmost priority to speak to a patient before he or she was admitted to the ICU, because communication was difficult once the person became critical.

7. There were no fixed amount of cases they had to solve on a daily basis, they just had to solve ALL of them, and so on many nights they stayed in their office working till 3-4 AM. However, they didn't call up any patients after 11 PM as they could be sleeping. I really like how they sacrificed their sleep and yet had so much concern for others who were sleeping.

8. Surprisingly, they weren't using any dedicated software or apps to do their job. Being a techno-geek and all, I was expecting them to use some specialized tool compatible with their mobile phones that would automatically allow them to sync data on a centralized cloud server or something like that. Nah, they used the good old pen and paper, and sometimes Word document and Excel sheet to write down all the data they collected.

9. Once they had collected all the required information, they uploaded their data to a separate Data Management unit known as the IDSP - the Integrated Disease Surveillance Programme, which is under the central Ministry of Health and Family Welfare. There are various protocols and formats to follow too while doing that, which Mazirtira could not reveal because they are confidential information.

10. Apparently, every Indian state Contact Tracing unit uploads their findings to this IDSP portal. According to a quick Google search, this has been a norm for not just CoVid-19 related contact tracing but even for other diseases like Chicken Pox, Dengue, Cholera, Acute Diarrheal Disease and even Food Poisoning. Interesting...

And so these 10 points above more or less covered what Mazirtira used to do, without revealing any sensitive and confidential information. Like I mentioned earlier, he was lucky because the people he had to trace were just the recent returnees. Before I proceed further, let us take a short break and look at Mazirtira in various action poses as he gets on with his job of Contact Tracing. :)

Here's Mazirtira getting ready for work once again, making sure everybody who came in contact with a positive person is accounted for.

Mazirtira promising to trace the contact back to the very root and snip it off before it can spread further within our community.

Mazirtira working hard to connect all the dots and relations that a positive patient may have come in contact with.

Mazirtira saying, "If we do our job well, then this Corona virus is like a scooty with no wheels, as it cannot go anywhere else".

Mazirtira looking into every nook and corner, including all available holes too, trying to trace the contacted people.

The above image kinda reminds me of Nietzsche's quote, "If you stare into an abyss long enough, the abyss will stare back at you." Lolz.

Here's Mazirtira promising the people of Mizoram that he will sweep away the virus, protecting us all to the best of his ability.

And if all the methods above fail, Mazirtira said there is still one last resort he is willing to apply, and that is...

And so, coming back to this post, the way the current Contact Tracing team works now is very different from the time Mazirtira was in the unit.

Unfortunately, I don't know anybody who is currently working in the unit to ask about their current SOP, and since this is still an ongoing process, I don't think it would be wise or ethical either to write about it on a public domain like my personal blog.

But one thing I do know is that, the current team has a much more difficult task at hand. For instance, due to community spread, they must now determine from whom and where the person contracted the virus from, unlike before when they could just assume that they contracted it from a hotspot region before returning home to Mizoram.

And trying to determine now where the person must have contracted the virus from, must be a big pain in the ass..ymptomatic.

Do know that this CoVid-19 infection does not come with a "time-stamp" that registers the exact time it invades your body.

Suppose somebody wrote incriminating lies about you or shared a scandalous photo of you on social media, like revenge-porn, and that started going viral as more people forwarded it to different groups. If you want to file a police complaint, it is quite easy for the Cyber crime unit to do a reverse tracing and get back to the root. Eliminate each node, point by point, working backwards, until you reach the very source.

However, in the case of CoVid-19 community transmission, it is not as easy as that. Suppose a person A went to location X, and later location X turned out to be a contaminated area and he tested positive, it is quite easy to determine that he got the virus from X. Short and simple.

But life ain't always like that, innit?

It's like when you're sitting for a math exam and you read a set of questions. The first question carrying "2 marks" is very easy to answer, and you're like, "Damn, that was a cakewalk, I'm gonna become a neurosurgeon when I grow up!" And then, the very next question carrying "5 marks" has a few complexities added to it, and suddenly you're dumbstruck, now you're like, "Damn, what the hell am I gonna do with my life when I grow up?"

Similarly, imagine if that same person A went to not just location X, but locations Y and Z as well, that too not just in order of X-Y-Z but multiple times, like X-Y-X-Z-Y-X-Z, and all three places turned out to be contaminated. Now where did A contract the virus from? Even if the first place he visited turned out to be a contaminated, there is no real guarantee that he got the virus from there. He could get it from Y or Z instead too, he could even be the spreader when he returned to X, and so on.

And that's just the "5 marks" question. Now for the "10 marks" question: There were two other people B and C as well, who also moved around in those same 3 locations during the same time as A. Now, who contracted from which location, who infected whom, when did that happen, and how do you find the solution to all this without banging your head on the desk and passing out from the pain?  Not so simple now, huh?

Now multiply the number of people above by thousands, and location by hundreds. What you have here now is a complete cess pool of convoluted confusion and chaos. Welcome to Dante's 10th Circle of Hell. No marks will be awarded for answering the last question because we would all be marked for extinction by then.

Sorry to sound so grim, but that's just a small taste of reality. My friend Dr. Doris Zualtei recently wrote a good article about how contact tracing will no longer be possible to do at the rate in which we're moving, and she's completely right. Instead, she suggests we all focus on ourselves and respective well being, as that is the best preventive remedy we have for now.

Meanwhile, our LLTF, the Local Level Task Force, is doing an incredible job helping the Contact Tracing unit. Every day we receive new messages, like, "Those who had been to so and so place on so and so date, report to your LLTF immediately" and so on. Though Contact Tracing is a difficult task as I've mentioned above, the LLTF is definitely lifting a lot of the burden.

Imagine there is no LLTF or YMA, no semi-government body around to help with the coordination, we could very be living in a post apocalyptic world as of now, and not the cool steam-punk kind. Just pain and misery everywhere. So here's a big shout out to all our warriors still fighting this pandemic, both front-line and back-line, even the down-lines, from the doctors and nurses to lab technicians and contact tracing units, to the police force and LLTF and other authorities risking their lives every day to make Mizoram a better place to live for all of us.

Cheers to you all.

Ending this post, do let me know if I've made any mistake in some of the details I've written about our Contact Tracing unit. There may be a lot of other information I didn't include too, like whether they're also doing contact pattern analysis or not, whether they're studying the present scenario to strategize on future contact minimization or not etc. This is just the basic detail and a big thanks to Mazirtira once again for the info. By the way, Mazirtira's RT-PCR Swab Test result came out this morning, and he was Negative, so a big congrats to him as well.

To celebrate the good news, here is a picture of Mazirtira, assuring the good people of Mizoram that you can always lean on him.

A great lean indeed.

And of course, here are some pics to make you laugh as you complete reading this blog update. Thanks for reading once again, cheers. :D


Saturday, September 12, 2020

Chp 830. Lockdown... again.

Today, the streets were empty once again, reviving memories of a ghost town not too long ago, of the Ides of March when this pandemic first reached Mizoram. Starting today, 11th September, 2020, a lockdown had been declared across Aizawl again, as Mizoram saw its highest infection in a single day - 141 new cases!

Eerie, empty and desolate, not a single soul or vehicle on the road, not even a stray cat in sight, except for a few solitary individuals quickly walking past our house in vigilant but nervous steps, on their way to the Local Council office to get a permit to travel outside our locality.

I too went to the LC office earlier today to get a permit for my niece, who's appearing for an entrance exam tomorrow. The sight that greeted me on my way was discomforting.

As I walked on the empty road alone towards the LC office, all the houses adjacent to the road were locked up, just like the previous lockdowns. But what made today very different was that, at most of the houses, there was this prominent notice stuck on the gate or door in large, bold letters: "HOME QUARANTINE. Visitors strictly forbidden. By Order, Chaltlang Local Level Task Force."

House after house, the notice was displayed! This was apparently for those household members who had come in contact with the new positive cases, pending tests.

Suddenly, it hit me, these weren't just the people I had read about on the news, these weren't numbers or statistics I received on a WhatsApp forward message, these were actual people I know personally. My dear friend Jerusha's house, Uncle Kaia's shop, Nu BSi's medical store, the recently opened "Desi Choka" restaurant, the kind-hearted carpenter who used to repair our furniture, KTP leader Robert's house, and so on, just to name a few. All of them had this sign displayed outside their respective houses.

As I stood there still stupefied at what was happening around me, I tried to peep inside their house from where I was standing in the middle of the road without breathing (not sure why I was so damn curious or why I was even holding my breath), but I could see that even their windows were bolted shut from inside, curtains down, voices silenced. No signs of life from the outside world. It was like that scene straight out of a zombie apocalypse movie.

I continued walking towards the LC office, precariously.

After I explained the reason why I needed the permit and showed the LC officials the required documents, my request was granted and I collected the permit (thank you, Tlantea and Faka). I walked back to my house, passing by all those Quarantined houses once more. The surreal experience continued.

141 new positive cases in one day may not be a huge number for my friends outside Mizoram, especially when most Indian states are registering new cases in thousands and ten thousands (23K in Maharashtra and 10K in Andhra Pradesh on the same day Mizoram got 141). But for a tiny state like Mizoram where we are a close-knitted community and people had been very careful since the beginning of the pandemic, 141 is a very huge number.

For perspective, let me explain it this way. I have more friends in Pune than I do here in Aizawl. In Maharashtra, there are already more than a 10,00,000 infected, whereas in Mizoram the total so far as of today is less than 1,400. And yet, my friends in Pune hardly know anybody personally (a friend, a relative, a colleague etc) who is infected, whereas almost all my friends here in Aizawl now know somebody who is infected or quarantined.

And that is why this lockdown feels so different from the earlier lockdowns. When you know such people personally, it hits much close to home, literally speaking.

From the looks of it, most of the new infections and community transmissions seem to be from the recent Local Body election, which I blogged about here. Many of the new cases were those officials on election duty. Did they contract the virus from the voters? Did they spread the virus to other voters? We don't know all that right now, with contact tracing still in progress, but I'm planning to write about contact tracing in Mizoram on my next blog update, so do stay tuned for that.

As of now, the opposition party members are blaming the ruling party for conducting the election against their objections, which is expected of them to do. But I will not be political in my blog updates, at least for now. I'm not blaming the government, and at the same time I'm not not blaming the government, is what I'm trying to say. Other people of course have the right to criticize.

Meanwhile, let's continue to pray for all our friends and family who are infected or under quarantine so that we can flatten this curve once again. Love and prayers. Take care for now.

(Ps. I wrote this blog post last night but there was no internet in my locality, both WiFi and phone data were down, so I am updating it today, without changing any of the dates or tenses, hope you understand).