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How Kerala contained the coronavirus threat

March 04, 2020 08:54 IST
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'We had three positive cases, but our success was the three not going up to 30 or 100.'
'Also, all the three survived the virus.'

IMAGE: Medical staff in protective suits dispose waste as they exit a coronavirus isolated ward at the Kochi Medical College in Kerala. Photograph: A S Satheesh/ANI Photo

It was in early February, soon after Wuhan was shut off from the rest of China, that the first three cases of coronavirus (Covid-19) were confirmed in India, and all the three were in Kerala.

But the state health machinery acted immediately and all the three people recovered from the attack. The most important aspect is that they could contain the spread of the virus.

When the Nipah virus attack occurred last year, Kerala's healthcare system responded admirably.

And the person whose role is appreciated and complimented is that of the health minister in the Left Democratic Front ministry, K K Shailaja -- Shailaja 'teacher' to the people of Kerala. So much so, 'Teacher' has become her surname now.

When Shobha Warrier/ reached her office late in the evening, several people were waiting in the lobby to meet her. It was after attending to the last person that Shailaja 'teacher' and Shobha sat down to talk about how Kerala's health department successfully contained the corona virus.

"I can confidently say that we have a system in place to fight any outbreaks," says Shailaja 'teacher', below.

It is well known that hundreds of students from Kerala study medicine in Wuhan. So, when the coronavirus outbreak started there, were you concerned?

Of course, we were very concerned. From the moment we read the news online about the coronavirus outbreak in Wuhan, we became very vigilant. Because we had an experience with the Nipah virus, we knew that any virus could appear anywhere in the world.

So, when we read about the spread of coronavirus in China, the first connection that came to my mind was, China, Wuhan, medical university and students from Kerala. I knew they would fly back immediately, and they might even come carrying the virus.

When I called the health secretary, Dr Rajan Khobragade, he also said that we had to be very vigilant, for the same reason that came to my kind; that the students from Wuhan would come back any moment. So, the chances of a virus outbreak might appear in Kerala first.

Even before anyone landed in Kerala, we decided to set up a rapid response team and the team met immediately. We then sent messages to all the district medical officers to be ready. We also contacted Preeti Sudan, the health secretary in Delhi.

Was it because you had the experience of fighting the Nipah virus that you started taking precautions even before the coronavirus came to India?

Yes, after the Nipah attack, we have been very vigilant, and we even conduct mock drills every year.

I became the health minister in 2016. At that time itself, I realised that one of the major challenges in front of us was infectious diseases like dengue fever, H1N1, etc. And we have diseases like leprosy, filariasis also. So, one of our targets was to fight all the infectious diseases and reduce deaths as much as possible.

Despite our continuous campaign, in 2017-2018, we had many outbreaks of infectious diseases like dengue fever. That was when we realised that what we were doing was not enough to contain these diseases.

Our next campaign was to involve grassroot level workers to spread awareness every day, personally meeting people.

The outbreaks were happening even though Kerala is quite advanced in the field of literacy and cleanliness...

Yes. But the number of deaths was far less than compared to the other states. Still, every year, we have had an outbreak of infectious diseases.

We could have stopped the outbreaks. For example, the dengue fever outbreak is due to mosquitoes. But however hard we try, people are a bit careless about stopping the breeding mosquitoes.

In fact, I wrote to all the MLAs asking for their help. I also wrote to all the panchayat presidents asking them to start a volunteer group to make people understand the need to stop the breeding of mosquitoes.

If this worked, I knew we could stop the outbreak of such infectious diseases completely. But then, you know how hard it is to achieve 100 per cent success in these matters. I was only hoping for a success rate of 50 per cent.

To my satisfaction, I found that in 2018-2019 and 2019-2020, the number of deaths due to infectious diseases came down drastically.

Today, if the health department hears about a dengue case, our workers reach the area immediately and see to it that the disease would not spread.

I can confidently say that we have a system in place to fight any outbreaks.

What kind of precautions did you take when you heard about the coronavirus outbreak in Wuhan?

We needed permission from the aviation department to have screening at the airport. Before we started the screening, a few students had come and they were taken home by their parents. Because we had instructed people to inform us about all those coming from Wuhan, we could track them down immediately.

You must understand that this was much before the Indian government brought students from Wuhan by chartered flights.

We had already set up isolation wards in two districts.

The first girl we contacted already had sore throat and fever. So, there was not much resistance from the parents about the idea to keep her under quarantine. But they asked, why they had to be quarantined when only the girl had fever.

But we insisted they also came with us. We kept the girl in an isolation ward at the Trissur Medical College and kept the parents under observation. We did this even before we got the test result from the virology department in Pune.

Then we caught hold of one of her friends who came with her, in Alappuzha, and he was also kept under quarantine there. The third person had gone to Kasargod, and she was kept in isolation there.

Were you worried about an outbreak because these three students came from Wuhan?

Yes, we were extremely worried. In fact, 72 people came from Wuhan itself. We traced the addresses of all the people who were on the flight, and contacted them through the local medical officers.

We isolated all those who came from Wuhan and had a slight fever. All of them were under our observation till they tested negative. We had sent the blood and sputum samples of all those who were isolated, to Pune.

When the results came from Pune, the three students tested positive. In fact, even before telling us, the virology department announced in the afternoon that the samples that came from Kerala were positive.

The moment we came to know the results, Rajan Khobargade and I went to meet the CM. When I told him that the situation was serious, he asked us about our plans.

We said, like what we did in the case of Nipah, it would be isolation, quarantine, and opening a control room in Trivandrum and organising teams to take charge of each work.

The health secretary wrote 18 guidelines to be followed, and we called for a meeting of all the head of departments in the medical colleges.

Then we went to Trissur to oversee the work. By the time we reached Ernakulam, it was 12.30 at night. I called for a meeting with the doctors in the periphery and also the HoDs in the medical colleges then itself. By the time the meeting got over, it was 2.30 in the morning.

I met the press after the meeting and told them that there was no need to panic, and everything was under control.

Why did you say there was no reason to panic when all of China had started panicking by then?

I said so because of the experience I had after the Nipah outbreak.

When we announced the Nipah outbreak, there was panic in the entire state. People from the village where there was the first outbreak, started leaving the village.

It was a panic reaction, and I didn't want such panic this time. If at all one of these people are carriers, they would be spreading the virus in another area.

It was like a war zone moving to another area.

That was why I said there was no need to panic. That was the only way we could contain the spread of the virus.

We had three positive cases, but our success was the three not going up to 30 or 100. Also, all the three survived the virus.

While you were planning all this, did you think of the magnitude of the situation in Wuhan?

Yes, I did. We only had three positive cases. There were hundreds of positive cases at that time in Wuhan.

What happened was they did not grasp the situation in the beginning. By the time they understood, the virus had spread like wildfire.

In those days, I could not sleep at all. I could not even imagine something like that happening here.

I cannot but applaud the support given by our entire team. If not for Rajan (Khobragade) and the team, we would not have been able to contain it so well.

There were many days when Rajan did not even sleep at night.

What about the students who were brought to India on special flights by the central government?

That was a week or so after the first three people were tested positive.

When I came to know that the government was going to bring people from Wuhan, I called (Union Health Minister) Harsh Vardhanji. I wanted to know whether they would send those people to their respective states soon after they landed.

He said they would isolate them first in Delhi and would send them only if they tested negative. It was a good idea. Otherwise, we would be putting the entire country at risk.

Even after the 14 days of quarantine in Delhi, we decided to ask them to be in isolation at home for another 14 days. We didn't want to take any chance.

Now that covid-19 is spreading to more and more countries, are you still vigilant?

Yes. We cannot relax now. I am still on mission mode. At night, I am still worried about the report that would be coming the next day.

The dangerous aspect of the coronavirus is that after it comes out of a human being, it can remain alive for two hours.

But the satisfying part is that we could take immediate action and save those three children.

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