Though initially declared a “state-specific health emergency’’ after three positive Coronavirus cases were reported in the state, the state’s health ministry, which withdrew the declaration a few days later, is reassuring people that there is no reason to panic. “The decision to withdraw the emergency call was taken since the situation is not alarming as of now,” said health minister K K Shailaja. “But the possibility of community spread of the virus is far from over”.
When the country’s first three cases which tested positive for the new virus were reported from Kerala, the state’s public health machinery acted quickly to contain the spread of the deadly COVID19. The first patient was confirmed by the Union health ministry on January 30th. The patient had voluntarily got admitted to the district hospital in Thrissur. Immediately the state machinery initiated ‘contact tracing’ to find all those the patient had mingled with in the past couple of weeks, as the virus’ incubation period is about two weeks. Another suspected patient, who was isolated in Alappuzha Medical college on January 24th, was confirmed positive on February 2nd. By that time, her ‘contacts’ had been traced and all were either isolated or brought under observation.
The learnings from fighting the spread of the 2018 NIPAH virus, which had claimed 17 lives in the state’s northern districts, were put to good use. For instance, at the time of the NIPAH outbreak, the government had not been able to trace all those who had come into contact with those who had tested positive. This time, thanks to the awareness campaign launched in media, people took notice of the disease spread and opted not to come in contact with those who had returned from China. Also, the health department, besides ensuring that all stakeholders were put on extra alert, quickly set up a war room under the leadership of Principal Secretary Health Department.
The team, which also included the Director of Health Services (DHS), Additional DHS and MD and the state run Medical Service Corporation, held daily meetings, assessed the situation and stressed the need for joint efforts to create awareness and detect and isolate new cases. The Medical Service Corporation was asked to ensure the procurement of essential medicines, masks, gloves and other items. Also, as it took three days for samples to be tested in Pune, the state set up a testing centre in Alappuzha, so that results could be obtained the same day itself.
The health department also put together a team of dedicated doctors, nurses and paramedical staff to limit the spread of the infection. Under the direct leadership of health minister Shylaja, the state health department was able to ensure that those infected and those they had come in contact with were identified and isolated; fear and panic among the public over a possible pandemic was thus contained. “All the primary contacts with the three positive cases have tested negative for coronavirus,” Shailaja said. “The persons who had had direct contact with these three positive people were identified and quarantined. There is nothing to fear”.
At present, 3447 people are under close observation in the state of which 22 people are admitted in isolation wards of different hospitals. Of the 72 people who had returned from Wuhan to Kerala, only three have tested positive so far. Meanwhile, 1152 people have completed their 28-day quarantine and display no symptoms of infection. The rest would complete their 28-day quarantine period by February 26.
The minister also pointed out that the second positive case reported from the state and admitted at the Goverment Medical College Hospital, Alappuzha had also tested negative in repeat test of samples. “This is a matter of relief as one patient has come out of this deadly viral infection.” The other two cases which tested positive were from Kasargod and Thrissur districts. All three were students pursing MBBS in a medical university at Wuhan, the epicentre of virus outbreak in China.
Though districts like Thiruvananthapuram and Ernakulam have not reported any positive cases, the health department, with the support of the police, immigration department and local organisations, identified those who had arrived from China and are working on preparing a more comprehensive list of such people. “Besides regular appeals to people to disclose their visit to or return from disease-affected areas, the governments hint at penal action against those who did not, made people voluntarily contact the health workers,” said V V Shirley, DMO Kollam. As of now, normalcy prevails and no fresh case has been reported from any part of the state for over a week.
Preparations on a war footing
The state, which effectively implemented WHO guidelines and protocols to prevent spreading of NIPAH virus in 2018, urgently initiated preventive measures and put in place the requisite infrastructure in consultation with the union health ministry.
Headed by the minister herself, a high-level Emergency Rapid Response Team (ERRT) was constituted to decide on protocols on observation and isolation of suspected cases, treatment guidelines, training for paramedics, drivers and support staff. A campaign was launched directing people who had returned from China to report to district medical officers. Health professionals were roped in to constantly monitor suspected cases. Isolation wards were set up in all districts, and private sector roped in to prepare isolation wards to deal with emergencies.
All passengers passing through airports and sea ports are presently being thoroughly screened by health officers and any suspected cases are directly sent to isolation wards. Those allowed to go home are being monitored by health workers for four weeks. All people who came in contact with the suspected cases are being traced and brought under observation. Wide publicity has been given on precautions to be taken, with a toll-free number for the public to call to report suspected cases.
People have been advised to cover the mouth and nose during cough and sneezing. In all districts, the local administration in association with the Health department conducted a mass rally to impart awareness about the significance of using kerchief while sneezing and during cough.
The virus can spread even during its incubation period and can even recur in the same patient. Lifestyle diseases, lack of immunity and old age also contribute to the spread of the virus. Three repetitive serum tests of throat samples are needed to confirm that the patient is free of the virus, health workers explain. The disease can also spread through droplet infection and not through aerosol infection like in TB.
Medical experts say that broad spectrum anti-viral drugs have been found to be effective against the Coronavirus. None of the three Kerala cases that tested positive for n-corona viral infection have developed acute states like viral pneumonia, Acute Respiratory Distress Syndrome (ARDS). But India is among the 20 countries listed as high-risk countries.
Protocol revised
The Health department also recently revised the guidelines in connection with maintaining vigil for corona infection. Only those who fall in the high-risk category will now be monitored and put under surveillance at their residences for 28 days. Those categorised as low-risk may seek medical attention only if they start showing symptoms of infection.
Also, besides people arriving from countries like China, Korea, Japan, Hong Kong, Singapore, Vietnam, Thailand and Malaysia, people from USA, UK, France and Germany are among those who will be monitored. Those who have been in contact with or been in close proximity with the patients from these countries are included in the high-risk category. Those who had travelled with these people and come within three feet of them are also considered high risk.
As of now, things are stable in Kerala. Patients need to follow the guidelines and treatment protocol given by doctors. However, there are reports that some students who returned from China were hesitant to visit the health department. Though advised to remain at home, normal life was not disrupted to any great extent as people continued to attend public events and family functions.
Health department officials can be heard making announcements at railway stations too, asking those who have come to Kerala from other states to contact the help desk so that it may be ascertained whether they have any symptoms. Thomas Nainan and family from Kadavanthra, who arrived at Ernakulam Town railway station with their mouths and noses covered with clinical masks, said they were taking the precaution in view of the Corona scare. “During the journey we cannot stop any one from coming near us, but what we can do is to take maximum precautions,” said Nainan who works in an MNC in Hyderabad. But they seemed the exception, rather than the rule.