With Experience Drawn From Nipah Outbreak, Kerala Is Leading Fight Against Coronavirus

There have been three confirmed cases in the country, all from the southern state of Kerala. However, in a positive development on Friday, February 14, the government announced that all the patients have recovered.

The State Finance Minister, Thomas Isaac, in a tweet congratulated the health department and said, "Just as in the case of Nipah, Kerala has won battle with Corona Virus. All the 3 patients identified have been confirmed by Central authorities to have fully recovered. No case of secondary spread. Number under quarantine observation drastically coming down.Congats Health Dept."

On Thursday, the state reported that two of the patients from Thrissur and Alappuzha have fully recovered. In addition, one of the patients was discharged from the isolation ward of the Alappuzha Medical College hospital in the state.

As of now, a whopping 2,288 travellers from virus-affected countries have been identified and placed under surveillance in the state. Of this, 2,272 are under home quarantine and 16 admitted in select isolation facilities.

So, how is Kerala battling the deadly virus?

Early Preparations

With its experience in fighting the Nipah virus outbreak two years ago, Kerala is setting an example to the world in dealing with the novel coronavirus epidemic. In 2018, 17 out of the 18 affected by Nipah had died in the state. However, banking in on this experience, during Nipah's second outbreak in 2019, not a single death was reported in the state.

Today, it is this experience that is helping both the government and the public in dealing with the latest virus outbreak.

The state was battle-ready as soon as the Union Health Ministry issued an alert against the coronavirus on January 17. As students from Kerala accounted for a large section of the medical students in China's Wuhan, the epicentre of the virus outbreak, the health department officials in Kerala was alert about a possible outbreak in the state.

Moreover, the chances of a higher number of positive cases in the state are high due to its huge population.

"Kerala's density of population is high and people participate in many group functions. Hence, as the virus is airborne, it can spread easily. Also, the comorbidity in the state is high, that is, diseases like hypertension, diabetes, cancer, and heart diseases are more. People with such diseases have higher chances of getting infected," Dr B Ekbal, former Vice-chancellor of the University of Kerala, a public health activist, and currently a member of the Kerala State Planning Board tells The Logical Indian.

Immediately after WHO declared the severity of the virus, strict vigil began at airports in the state to screen passengers flying in from China. At the four international airports, preliminary screening procedures were set up. If anyone showed symptoms during the screening, they were taken to the nearest medical college in a sterilised ambulance.

Isolation wards were prepared in all districts. In addition, private hospitals were also informed about setting up isolation wards in case of an emergency. To decide on treatment, isolation, and quarantine of suspected patients, a Rapid Response Team (RRT), headed by the Health Minister herself, was set up. State and district level control rooms were also set up, that held daily meetings headed by the Principal Secretary of the State health department. Over 40,000 health official and staff have been mobilised in the state.

Adequate training was provided to paramedics, drivers, support staff and measures were taken to spread awareness among the public. The awareness drives focused on minimising the spread of fake news and fear among the public. State-run Kerala Medical Services Corporation (KMSCL) was also prepared to ensure the storage and supply of masks, gloves, medicines, safety suits, protective gears, medicines etc.

Contact Tracing, Quarantine, And Surveillance

"The Health Department is identifying those who are coming in from China and they are monitored. They also check who travelled in close proximity to the person - like the people sitting beside them on the flight and those in the seats in front and behind them. All are then quarantined for 28 days. If anyone is sick, they are treated in the hospital," says Dr Ekbal.

After the first case was confirmed, 'contact tracing' was promptly initiated to trace all those who had come in contact with the patient. The second and third case was confirmed n February 2 and February 4, respectively.

All the patients were interviewed in detail to contact any individual they may have come in contact with.

"Based on all the contacts we received, we quarantined the people and put them under surveillance," says Dr Ekbal.

After the third case was confirmed, Kerala declared a 'state calamity' to strengthen all surveillance measures. This was later withdrawn on February 7 as no new cases were reported.

"The announcement is not meant to scare people. It is to help take proactive steps to intensify the steps to contain the spread of the virus," the Health Minister had said.

The health department wasted no time in waiting for more positive cases to turn up to strengthen vigilance across the state.

"We are not waiting anymore for positive cases to come. We will be prepared to take containment action and will not have a lag time," health secretary Rajan Khobragade had told media.

The Leader At The Forefront

Soon after the Union Ministry's alert, through PSA's and press conferences, a calm and composed voice issued an alert against the spread of coronavirus and asked the listeners in Kerala to maintain caution. The voice belonged to Kerala's Health Minister KK Shailaja.

With her exemplary show of strength in dealing with calamities in the state, KK Shailaja, fondly called as Shailaja teacher, has won hearts all over. The 63-year-old former high school teacher's openness and caring nature is also a reason for her popularity.

Many attribute Kerala's continued success in combatting epidemics to the Health Minister.

"(Shailaja)Teacher's leadership is exemplary! What I'd say is that she has an 'infectious enthusiasm'. Just like how there is an index case for any disease, Teacher is the index case for enthusiasm in the entire health department. Her enthusiasm spreads to everyone. Her leadership is such that she can easily enthuse people," Dr Ekbal says with a laugh.

"We are countering the virus with this enthusiasm that Teacher has imparted in all of us," he adds.

In the days and weeks that followed, cases of the deadly virus grew, and the three confirmed cases were reported in Kerala.

On January 30, when the first confirmed case of the virus was detected in Thrissur district, a high-level meeting chaired by Shailaja was held at the Thrissur Government Medical College. As two more positive cases get confirmed from the state within the next five days, the Minister leads her team against the deadly virus with gumption.

"We overcame flood and Nipah. We will overcome coronavirus too," the Minister assured the citizens.

Communication From The Health Department

One of the most commendable aspects of the Kerala Health department is their efforts in regularly communicating to the people of the state. Be it day or night, press conferences, especially by the Health Minister herself, were held on a regular basis.

In addition, bulletins on the status of the quarantined individuals, patients under isolation, new people screened, etc, were shared on an almost daily basis. Through live streaming of the press meets and posts on precautions, social media was widely used by the top officials to reach out to the public.

Furthermore, the health department is providing mental health support to all those under quarantine. Twice daily, a special designated team of doctors and counsellors call all those who are under quarantine at homes or at hospitals to help them deal with trauma, anxiety, sleeplessness, worry, etc.

"Our health department has done an exceptional job of taking care of us. Every day they would call me to ensure that I was alright," Bharathi E S, a medical student who had returned to Kochi, Kerala, from China, tells The Logical Indian. Currently, she is on her 20th day of home quarantine.

"When I developed a slight throat pain a couple of days after coming here, they immediately asked me to get admitted to a hospital they mentioned. I was admitted for five days and tested for the virus. After the tests turned negative, they discharged me and asked me to continue home quarantine. All the doctors and nurses there took such good care of me. A doctor would give me counselling every day too. From food to all the health check-ups, everything was free too," she adds.

The onus of the effective control of the virus in the state lies on both the government and the public.

"In Kerala, we effectively followed the WHO protocol to contain the virus. The health-conscious community and all the political leaders came together in the state to fight the virus," says Dr Ekbal.

However, amidst the hysteria surrounding the outbreak, stigma and alienation are also rampant in the state. "Just because I came back from China, my sister was asked by her office to not turn up for work. Even though she showed them my negative test results, they were adamant that she stay at home till my quarantine period got over," says Bharathi.

Fake news spreading through social media is also creating unnecessary fear among the public. The health department is taking strict actions against those responsible.

As the death toll in China rises by the day, the Kerala government will have to maintain the vigil in the coming days.