Novel Corona virus and Kerala – Continuing vigilance.

Suppose a young man or woman, completes a difficult task successfully in the first attempt, we may call it ‘beginner’s luck’. But what if he or she is able to do it again? Then we may have to give the person due credit.

This is similar to what happened in Kerala, with regard to recent epidemics.

We were able to manage the NIPAH outbreak very effectively, last year and the year before last. A major flood, the worst in almost a century hit us, and we may not realize it, but it was miraculous that no major disease outbreak followed this natural disaster.

With the recent novel corona outbreak too, we are coping quite well. The success of any difficult operation depends on three factors:
?Planning
?Implementation
?Resources at your command.

Let us look at how Kerala dealt with this menace.

Corona infection and Kerala:

The moment the outbreak in Wu- Han, China, was announced, the health authorities were on alert. This is because there are expatriate Keralites working in most parts of the world. Many students are pursuing various courses, especially medicine, in China. Many businessmen from here are regular visitors there.

All the social media groups of health workers were abuzz with the possible implications. Even before a single case was reported outside China, the possibility was anticipated. The media gave prime importance to the news and asked the Health Department to give suggestions. Authorities started discussions.

It was after this, that the outbreak in China turned really serious. Reports started coming out, of instances detected outside that country. The Indian Government came out with guidelines regarding this, and the Kerala government released the local language version.

The State Health Department of Kerala gave directions to all institutions, both Public and Private.
The most important thing was to educate the public about the disease, symptoms and precautionary measures to be taken. The possible flow of infected patients from China was clearly anticipated. It was decided to start procedures centered on airports.

From the airport officials, names and addresses of people coming were collected. A special counter of the Health Department opened at all the airports. Passengers coming with fever could be intercepted. Screening was started in this regard. Everyone who arrived from affected areas was entered in Google sheets.

The moment a passenger thus arrived from these areas, the nearest public health centre, the Medical officer in charge there, and the local health inspector were alerted, and they were given responsibility for monitoring them.

A home quarantine of 28 days was enforced on these incoming people. The possible symptoms were publicised through all media outlets. The phone numbers to be contacted, and the centers to which they had to go in case of any symptoms were made known widely through the Media.

Most of the Districts had isolation wards kept ready for mild cases. For severe ones, Medical Colleges were assigned to isolate and treat patients. Blood samples could be sent for testing from these centers. Even when they were tested negative, isolation was continued.

Confirmed cases in Kerala:
The first case was confirmed. It would be useful to look at this patient to understand the way the system worked. This person had come to Kerala, from China, via far-off Calcutta. There were no symptoms when this person alighted in Kerala. She was in home quarantine, when the symptoms developed. Mild sore throat and cough, prompted her to seek help. After two days, the blood test confirmed Corona infection.

Apart from the period of travel, she was in full isolation throughout. After the onset of symptoms, she had a mask on, even when briefly interacting with close relatives. She came out of isolation only after the disease had run its course and two rounds of tests confirmed that she was totally virus-free. She spent a month in isolation.

The confirmation of this case galvanised everyone into action. All processes were further streamlined.
Ultimately, we had three confirmed cases, and all recovered.

The setting up of proper isolation facilities with total aseptic nursing was a real challenge in busy public sector facilities that were available. The real challenge was to prevent the infection of health care workers.

Places like Thrissur , Alappuzha and Kanjangad were new to this process. Isolation wards were set up even in these places in a matter of hours. Thousands of health workers had to be given training. It is a real triumph that not even one worker got infected.

The Health Minister directly co-ordinated the efforts. She personally came to Thrissur where the first case was admitted, co-ordinated the team. A ‘state emergency’ was declared.

In each District, District chief, District Medical officer, nodal officers, and others regularly met for discussing strategy. The list of people in quarantine, isolation, and their contacts were updated every day. All the people in quarantine were contacted by phone from the respective health center on a frequent basis. This was monitored at the District level, and phone calls from the district level occasionally cross checked the status themselves.
All news were updated and given through media to the public every day. This helped allay fears of the general populace.

Good isolation facilities, quarantine, and regular monitoring were the key pillars of the effort.
Kerala- Health infrastructure and human resources:
The situation was far from perfect. We were able to utilize minimum resources effectively. There was no permanent system to isolate patients. Perfect asepsis was really difficult to achieve. Most of the staff was not adequately trained. The number of staff was less.

Most of the employees worked overtime to overcome the deficiencies. Doctors and staff were well-coordinated, and most took on additional responsibilities voluntarily.

The general Public was very cooperating. Most of them listened to, and followed instructions properly. There was trust in the system, and that was important.

Special mention are due, to those people who returned from China and had to undergo quarantine. Some had to put up with hostility at the local village level from the local people. But none became major issues.

The future of preventive care:
We do need a permanent system to deal with emergencies like these. They have to be anticipated. Isolation wards, trained staff, adequate equipments and lab facilities should always be there.
This doesn’t mean that the Corona story in the state is over. Right now, there is a grave concern that the Corona Virus may become a global pandemic. Many cases have surfaced in various parts of India. There could be lessons to be learned from the experience of the State in combating this menace.