Nobody should starve; for those who cannot cook for themselves, food will be prepared in community kitchens and delivered home. Even as the world grappled with the COVID 19 pandemic and stood shocked, these were the words of the Chief Minister of Kerala, addressing the COVID-19 induced situation in the state.
Thiruvananthapuram: As the State government stands by the people of Kerala with utmost care and caution, Kerala is all set to face and fight the deadly pandemic head-on, with all its might.
The world is stunned and overwhelmed by the spread of the deadly novel coronavirus pandemic which originated in Wuhan of China and went on to badly hit Iran, Italy, and Spain among others. Later, as the virus extended its spread to the South Asian countries, including India, through the Arab countries, Britain and the United States of America, which kept boasting of its power in controlling the whole world, were dismissive in their approach to COVID-19 pandemic. Britain surrendered to it sooner, even before the country could actually realise the gravity of the situation.
It was a month after the first positive case in Kerala was reported that America confirmed a COVID positive in its land. Kerala, which has a population of 3.34 crores, had its first case confirmed on January 30, 2020, while New York, with a population of 1.94 crore, had its first COVID positive reported on March 1, 2020.
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Despite reports that Kerala will see a community spread through February and March, the State did not surrender. With meticulous precautions and preventive measures, Kerala has been battling the virus with full vigour. There have been only two COVID-19 related deaths reported in the state so far and 265 are currently undergoing treatment.
But the situation is of grave concern in America. As many as 2,77,522 persons have been confirmed to have been infected by the novel coronavirus in the US. The report released by John Hopkins University says that the highest number of COVID-19 deaths were reported in America on April 3, 2020. As many as 1480 persons died of COVID on April 3. Even late at night, mass burials were being carried out in many places. There was no space in New York’s hospitals even for critical patients. American President Donald Trump said he will call on the army.
Tardy response to the spread of novel coronavirus has now left America in a state of helplessness. When the World Health Organisation indicates that the death toll in America may rise to more than 2 lakhs, Italy and Spain which lost control in ensuring preventive measures, will only trail behind the US.
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Meanwhile, Kerala started its diligent and flawless preparations foreseeing the worst crisis, while hoping to effectively contain the same and thus keeping the pandemic spread under control.
One of the leading national media in India said, ‘What Kerala thinks today, India must think tomorrow’, referring to the diligence and foresight in the precautionary measures taken by Kerala and the detailing involved in each aspect of it, while fighting COVID-19.
To learn these techniques from Kerala, many states in India including Telangana had sent their teams of health experts to Kerala, so that they could copy the Kerala model and start working on it, though a bit late.
Precise preventive measures and guidance, constant deliberations and discussions with health experts in many parts of the world, efforts to trace each and every person who had reached from abroad, the herculean task of bringing out a route map by tracing all places of travel and listing contacts of those persons, identifying any possible secondary contact left out, total isolation and quarantining of those with symptoms, regular meetings involving the government and the health officials to assess and analyse the situation, take the necessary actions accordingly and highly diligent preparations, have all culminated in forming an effective ‘Kerala model’ to fight the COVID spread.
The experience and strength gained in containing Nipah, another deadly epidemic, has tremendously helped Kerala’s health sector to prepare well in advance, promptly act and effectively control the virus spread.
First COVID positive case reported
Cut to 30 January 2020, the first case of coronavirus was confirmed in the State, as a female student from Thrissur who had returned from Wuhan in China tested positive. The health sector turned fully vigilant with this confirmation and started executing things as planned.
The state government declared that there must be more care and caution in the health precautions and preventive strategies. The case was confirmed by Pune Virology Institute and the Central Cabinet Secretary officially informed the State about it through video conferencing.
Read: Kerala police initiate 'Break the Chain' awareness campaign
Of the samples taken from 20 persons who had returned from Wuhan, only one had tested positive then. Kerala Health Minister K K Shailaja and Health Secretary Rajan Gobragade reached Thrissur Medical College and held a high-level meeting on the same day. The government sent out alerts to all the districts in the State immediately. As there were about 200 Keralites to be returning home from China, all the airports were under surveillance to screen these passengers.
As many as 1036 persons were to be on home quarantine and 15 were being observed in hospitals. Special COVID control room and helpline numbers were facilitated, all on day 1.
Contact tracing - the Kerala way
With the confirmation of the first positive case, preparations at the Thrissur Medical College were completed on a war footing. The pay ward block in the Medical College hospital was quickly made into an isolation ward. Twenty independent rooms were readied. In no time, the block was ready to isolate, observe and treat 24 persons at a time. Separate toilets were arranged for each individual patient.
Within 5 hours after the Wuhan student tested positive, the isolation ward was all set and she was shifted there. Five other students who had travelled with her were also isolated and observed at Thrissur General Hospital isolation ward.
One factor that has helped Kerala check the spread and keep it under control was its foolproof method of contact tracing. No other states had then thought about it or taken efforts in those lines.
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The herculean task of contact tracing involved finding out the contacts - whoever the patient could have mingled with in the past few days, where all he has been to – like shops, hotels and other public places visited, besides friends and relatives, contacts while travelling locally and the like. The health department took immediate action and the contact list was to be readied urgently, with a remarkable coordination between many departments and the staff working in teams. The District Collectors and the District Medical Officers led the contact tracing process. The list and the ‘route map’ of the patient were then published for the public.
The Health Minister urged the people seeking to report to the Health Department immediately, if anyone could have had direct contact with the patient as per the time and route map. She insisted that no one should hesitate to come forward and report to the health department as this could help save the society at large from the spread of the deadly virus, besides oneself and one’s own family.
Those who were already in hospitals and the hospital staff were strictly directed to wear masks. The need and the effective way to wear masks were clearly announced through speaker systems at the hospitals at regular intervals.
The Health Minister’s statement that whoever has returned from China in the immediate past, regardless of having symptoms or being asymptomatic, were to report immediately to the health department or at the nearest Government Hospital, failing which strict actions would be taken against them, saw good response.
Besides those who were under observation, all their family members were also told to strictly follow self-quarantine at home. The Government informed the family members of those in quarantine to completely avoid any public functions and gatherings and visiting relatives or neighbours. The Government demanded them to postpone any pre scheduled functions in such houses, like weddings or other ceremonies. This decision by the Government helped in checking the spread right from the beginning.
Break the Chain- Kerala model campaign
After 2 more positive cases were reported in Alappuzha and Kanhangad, the State Government declared COVID 19, a State-level disaster. This was the first such declaration on a health issue that the State encountered. All the three COVID positive patients than had returned to Kerala from Wuhan by the same flight.
The government machinery was put on high alert and worked days and nights. Then came a campaign titled ‘Break the Chain'. An initiative by the state’s health department to educate people about the importance of public and personal hygiene given the spread of COVID-19 has received widespread acceptance in the state capital.
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Social organisations and the general public joined hands with the Government’s Break the Chain campaign insisting on sanitising hands every now and then to ‘break the chain’ of novel coronavirus spread. Temporary handwash areas, provided with water and soap, were set up on the roadsides, government offices and public spaces where people usually gather. Sanitisers were made available where hand wash counters could not be facilitated. Private businesses followed suit.
In one day, more than 300 medical doctors and a larger number of nursing staff were appointed to the health department on a permanent basis by the State, considering the demanding situation.
Isolation wards were set up in all districts of Kerala in order to ensure that the situation does not slip out of control against expectations. Those who reported with mild symptoms were in hospital quarantine at district hospitals and those who presented with severe, complicated symptoms were to be isolated at the Medical College hospitals. Arrangements were made to send the samples collected from the suspected cases here presenting COVID specific symptoms. After testing, until the results were out indicating negative for COVID, those tested were also told to strictly avoid any social mingling.
Adapting best practices in awareness generation
Kerala succeeded in educating the people on how the infection spreads from one person to another, how to prevent that spread by maintaining a physical distance and by hand sanitisation methods. The State’s efforts in creating this awareness among the people has helped in still keeping the pandemic at a distance.
Read: Kerala elderly couple recovers from COVID-19, leaves for home
Kerala police even released a dance video on the State Police Media Centre's Facebook page promoting the washing of hands, here on Tuesday. In the video, the police officers were seen dancing to the tunes of Kalakkatha from the Malayalam action-drama thriller Ayyappanum Koshiyum while demonstrating the right technique for washing hands. The video gained over 27,000 likes and over 2,400 comments and more than 33,000 netizens shared the video.
‘Social unity and physical distancing’
When Kerala started practising on the government’s slogan ‘Samoohika orumayum shareerika akalchayum’, calling for maintaining ‘a physical distance and social unity’, the other states in India had not even given it a thought.
Through these awareness campaigns and call for physical distancing, the health department and the government were successful right from the start.
The health department worked anticipating that the virus will come in mainly through those who reach the State from foreign countries, including China. Stringent surveillance was carried out at the airports to ensure the probable virus carriers travelling from foreign countries do not get to mingle with the common public. The vigil was heightened at the state borders and railway stations; thermal screening and vehicle checking measures were enhanced.
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Strict orders were given to all who had travelled from abroad to remain on complete home quarantine for 14 days. They were banned from even stepping out to visit relatives and friends.
The list of persons who had travelled from COVID affected countries with their complete address and phone numbers were handed over to the health department workers.
Health department set up special COVID screening desks at the airports to screen and isolate all those who reached with fever and flu symptoms. A google sheet was prepared to list those who travelled to Kerala from the COVID affected countries.
Review meetings are being held every day, chaired by the District Collectors, to assess each and every aspect of COVID prevention works. This continues even today. The lists of those on home quarantine, in isolation at hospitals and their primary contacts under observation, are being updated every day.
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The health staff at the nearest Government Health facility contacts each and every person on home quarantine and checks on their health status. Asha workers were engaged for the door to door data collection in rural, remote areas. They directed whoever had returned from abroad to remain on strict home quarantine. Those who presented with symptoms were immediately shifted to hospitals by the health workers directly.
The government has been releasing updated official data on the number of COVID patients in each district, those on self-quarantine and hospital isolation, the status of the patients, besides the general guidelines and information for the general public, every day and that continues.
Despite being the first state in India to report COVID positive cases, Kerala could effectively check the spread of the pandemic and keep it well under control, unlike most other states in the country.
Care giving- the Kerala way
The State gave special attention to take care of the migrant labourers who belonged to various other states and had come to Kerala for work. The migrant labourers, who are now being called ‘Guest labourers’ in a more dignified manner by the State, even in all its official communications, are treated as guests as the name suggests. All arrangements were made to provide the guest labourers with good food, clean places to stay and medical treatments as required.
The government decided to provide free rice through PDS stores to all, irrespective of APL or BPL cardholders.
Kerala’s Chief Minister who said no one will starve and the Health Minister who said Kerala won’t be left to suffer from COVID, gave the State a relief from the COVID scare.
Kerala went on preparing by setting up community kitchens in every panchayath and by disbursing welfare pensions well in advance.
As part of the preparations, the State took over auditoriums, hotels, schools and vacant buildings in many places across Kerala to be converted as COVID centres, if there is a contingency situation. Anticipating a likely spread which may have slipped out of control, the State put 7 districts on high alert. In the selected districts, COVID special hospitals were set up, exclusively for COVID patients. Rest of the patients in those hospitals were shifted to other government health facilities.
Besides lockdown and curfew measures in Kasaragod, the most affected district in Kerala, the State provided special security and also deployed a dedicated health team.
Saving lives
As the oldest of the initially reported COVID cases in India, 93-year-old Thomas, a native of Ranni in Pathanamthitta, got discharged from the hospital after testing negative for COVID, Kerala stands proud before the whole world.
At a time when even the European nations hesitate to treat their elderly patients with COVID symptoms, Thomas and his wife Mariamma, who is 88 years old, left the hospital cured of COVID.
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True that death is certain and man cannot do anything about it. But Kerala’s health department and the people are all determined to save each and every life affected.
The seven foreign tourists who were affected, were in Kerala through their treatment, got discharged and returned to their home countries. Nurse Reshma, who had contracted COVID after dealing with many patients, also got cured and discharged. It was a moment of relief and pride for Kerala.
Time has proved that prevention is the best defence strategy. Kerala is battling COVID-19 with all its might. Kerala defeated Nipah, and is confident that it will overcome COVID-19 too.
