A person suspected to be infected by COVID-19 enrolls himself at an isolation camp in Kannur, Kerala. Photo by S K Mohan.A person suspected to have COVID-19 enrolls himself at an isolation camp in Kannur, Kerala. Photo by S K Mohan.

An effective medical network built over decades

Kerala’s efforts are strengthened by an effective medical network. On March 4, a BBC talk show on COVID-19 had showered praise on Kerala for its effective and efficient handling of the cases reported in the state so far. According to eminent virologist Shahid Jameel, chief executive of DBT Wellcome India Alliance, what makes Kerala different is its health infrastructure. “Apart from hospitals, the state has a wide network of primary health centres which function as the first level of contact with the population. The state also has the capability to diagnose and track viruses and other infections,” he said in the BBC panel discussion on COVID-19 crisis.

The first phase of COVID-19 in the state started early February when the country’s first three confirmed COVID-19 cases were medical students that returned to Kerala from Wuhan in China (where the virus first emerged). All of them were cured in isolation wards.

The students were prompted to follow a rigid protocol, which included a 28-day quarantine to contain the spread of the infection. Quarantine is a treatment in isolation for suspected cases of COVID-19 depending on the seriousness. Those with serious symptoms are isolated at medical college hospitals with isolation wards, while those with minor symptoms are quarantined at home under regular observation of health officials and doctors.

The first phase ended at the beginning of March when new cases started being reported. More suspected cases of travellers from Italy (Indian and foreign nationals) were reported in the first week of March, the start of the second phase. The health department officials managed to trace all those who reached the state from countries with high cases of COVID-19 (particularly China, Iran and Italy) in this phase and isolated them, even if they had minor symptoms. According to the World Health Organisation, the most common symptoms of COVID-19 are fever, tiredness, and dry cough. Some patients may have aches and pains, nasal congestion, runny nose, sore throat or diarrhea. These symptoms are usually mild and begin gradually. Some people become infected but don’t develop any symptoms and don’t feel unwell. Most people (about 80%) recover from the disease without needing special treatment. Those who came in contact with the suspected patients were home quarantined.

A healthcare worker at the reception of an isolation ward at a government hospital in Kannur, Kerala. Photo by S K Mohan.
A healthcare worker at the reception of an isolation ward at a government hospital in Kannur, Kerala. Photo by S K Mohan.

When the Nipah outbreak was detected in Kerala in 2018, the health department had issued alerts for people diagnosed with pneumonia-like symptoms. Based on expert opinion that the virus was being spread through fruits eaten by bats, the government has advised people to reduce fruit consumption. Then the infection control measures were initiated which included isolating patients, using surgical masks and decontaminating surfaces.

“We are fighting COVID-19 in the same way we handled Nipah. That time we were poorly equipped and lack of previous exposure remained a major handicap. Now we are well-equipped with better experiences,’’ said Shailaja. “The Nipah virus outbreak has taught us that isolation is one of the most effective methods to control the spread of infection. We were also able to convince the people about the need to treat and isolate symptomatic patients. Strong public vigil has helped us to trace and deboard an Italian tourist infected with COVID-19 who escaped from isolation and monitoring to return to his home by a flight from Kochi international airport,” she said.

“What is worth applauding is the transparency and probity the Kerala government has shown in the case of fighting the virus threats. Chief Minister Pinarayi Vijayan and Minister Shailaja are conducting press conferences on a daily basis to keep people aware of the gravity of the issue and the steps taken by the government. It’s a Kerala model that began during the floods of 2018 and nowhere else you can see such an attempt which is highly educational. Apart from a roundup of the day, each press meet provides plenty of practical information to the ordinary people about the pandemic that sweeps the world,” Kozhikode-based public health expert Suresh Kumar told Mongabay-India.

Read more: Nipah infection in Kerala – Don’t blame the bats alone; improve public health

“Break the chain”

As of March 20, 2020, Kerala has 28 confirmed cases of people (Indian and foreign nationals) with COVID-19. A total of 10,994 people are under observation across the state and among them 289 are in isolation wards in different government hospitals. A total of 2,147 blood samples have been collected for testing and among them 1,514 turned out to be negative, according to data sourced from the health secretary on March 17, 2020.

Women members of self help and neighbourhood groups are assisting staff of primary health centres in tracking those who arrived from abroad, following reporting of cases on March 9 when a family from Kerala that returned from Italy was confirmed with COVID-19. In each of the 14 districts of Kerala, special cells have been formed to prepare route maps of each infected person. The map tracks every point from where the patient landed in India or came in contact with an infected person up to the moment when he or she was admitted to the hospital. The information comprising the place and time is then circulated through newspapers and social media with the request to all those who came in contact with the person in those places to be vigilant and access preventive care.

While the union government stipulated period of quarantine for those who have tested postive for COVID-19 is 14 days, Kerala is quarantining COVID-19 positive cases for about 28 days. In the isolation wards, the admitted patients are receiving their choice of meals, access to wi-fi and counselling sessions, according to the health secretary. Another step taken by the government is opening of multiple call centres to keep check on the mental health of those who are home quarantined. As of now 14 such call centres are opened at district headquarters.

The youth volunteer at the Break The Chain campaign organised by the Kerala health department to encourage hand sanitising and prevent the spread of the virus. Photo by S K Mohan.
A youth volunteer at the Break The Chain campaign organised by the Kerala health department to encourage hand sanitising for preventing the spread of the virus. Photo by S K Mohan.

“I spent 25 days in isolation and there were occasions when I felt depressed. A counsellor called me and comforted me regularly. I got better care and my favourite food including chicken biryani,”Kerala’s first coronavirus patient, who was discharged after completion of the treatment, told Mongabay-India.

To avoid possible breaking of quarantine, the government is using GPS tracking (tracking phones) and has tackled some cases where patients in quarantine have escaped. In another significant step, government has forced internet service providers to increase connectivity (network capacity and bandwidth) by 30-40% in the state to meet the surge in demand as people are placed in quarantine or forced to work from home. Women self help groups, prison inmates, youth organisations and social collectives have been prompted to prepare sanitisers for bulk buying and distribution among the needy.

Strict police action against those who spread fake news, home-delivery of mid-day meals to kids that used to attend anganwadi centres that closed in response to the pandemic and medical check-ups at 24 spots bordering Tamil Nadu and Karnataka for people entering the state by rail and road are the other major steps undertaken by Kerala. On March 15, the health department launched a “break the chain” campaign to encourage hand sanitising among people to prevent the spread of the virus.

Banner image: A state transport employee wearing a mark on duty in Kerala. Photo by S K Mohan.

Article published by Aditi Tandon

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