When Dr S S Santhosh Kumar reached Kasargod at the northern edge of Kerala on April 5, the situation there was precarious. Already declared a Red Zone with the largest congregation of COVID-19 positive cases in the state, the district that shares a border with the South Canara region of Karnataka had looked almost like a ghost town with little or no hope of resilience.
Karnataka's decision to deny road access even for non-COVID medical emergency cases from Kasargod to hospitals in nearby metropolis Mangalore had already caused 13 deaths. Tension and anxiety were widely prevalent as some expatriates from the district who just returned from the COVID-19 hubs of the Persian Gulf countries had violated the quarantine and caused the spread of the pandemic. Uncertainty was looming large everywhere. The 115-bed district hospital had run out of capacity following a sudden surge in the number of COVID-19 cases.
Dr Santosh Kumar, Deputy Superintendent of Government Medical College Hospital in Thiruvananthapuram and Vice President of South Asian chapter of the medical humanitarian organisation, Doctors Without Borders (DWB), was leading a 26 member medical expert team to Kasargod with a unique mission: Turning the academic block of a new medical college under construction at Badiyadukka on the outskirts of Kasargod into a comprehensive COVID-19 treatment hospital.
"Although my team is experienced in setting up a corona care block at Thiruvananthapuram Medical College Hospital, turning an academic block under construction with classrooms, exam halls and laboratories into a special ward was quite challenging. We had very limited resources and very little time to complete the task. We had no option other than collecting used furniture from the neighbourhood, and for rearranging the block, we had to use ribbons,'' recalled Santhosh in an exclusive interaction with The Logical Indian.
Corona-care wards require many things unique to them and they include single entry-exit, facilities for biomedical waste management, sorting area and buffer zone. The floor, wall, and beds had to be disinfected every four hours.
"In a single day, a buffer zone was created using steel cots placed vertically to segregate the rooms of COVID-19 patients from others. The COVID-19 ward started functioning by the evening of April 6. On the first day, six positive people were admitted. The number of patients rose to around 19 at one point. We returned with the satisfaction that Kasargod is no more the COVID-19 hub of Kerala. Coronavirus did not cause any deaths in Kasargod though 13.
people died due to the denial of a medical emergency by Karnataka,'' he said. Other than treatment, the team had ensured two things to the people on quarantine: Proper mobile connectivity along with quality food on time.
Part of medical humanitarian efforts in the past in middle east, Africa, and in neighbouring countries of Afghanistan, Sri Lanka, Pakistan, Santhosh Kumar has a track record in arranging medical infrastructure in short duration. This was the first time this orthopaedic surgeon was using that skill in his native state.
"Kasargod has now turned into a global model in fighting virus pandemics. The district administration and the district medical unit which left no stone unturned in the fight against coronavirus deserve the credit," said Dr Santhosh Kumar.
A district with 178 positive cases in mid-April, Kasargod heaved a major sigh of relief on May 10 when the last case had tested negative. Even the union health ministry has lauded the health workers who made it possible. But the district continues to remain vigilant as people start reaching Kasargod from abroad and other parts of the state.
On May 10, violating all rules, a 50-year-old political activist, who happens to be an elected member of a local body and his 35-year-old wife clandestinely picked up a relative who arrived at state border Thalappady from Mumbai and dropped him at his home in their car. This has landed many people in Kasargod under the COVID-19 radar.
Now tested positive for the pandemic, the CPI (M) leader and his wife are facing police action for withholding information that they had come in contact with a high-risk person from Mumbai and exposing many others to the virus. They have also been charged for violating quarantine rules stipulated under the Epidemic Diseases Act.
Along with the couple, their two sons aged 11 and 8 years have also tested positive for the pandemic. After picking and dropping home the relative who arrived without any travel permit, the politician had brought a cancer patient to the district hospital. At the hospital, he visited the lab and cancer ward apart from meeting a nurse, and two ENT specialists. He had also attended a wedding, a funeral, and a cradle ceremony before the relative was tested positive. Now 50 people who came into contact with the couple during these days are in quarantine and their samples have been taken for testing.
"This incident has turned into a bigger lesson for us. The district is comparatively safe but we have escalated our vigil,'' the District Medical Officer Dr A V Ramadas told The Logical Indian. "If patients and caregivers do not make full disclosure about their contacts with high-risk persons, our efforts would turn meaningless. So the major effort is in convincing them and ensuring their cooperation,'' he said. According to the District Collector D Sajith Babu, the couple who caused the spread of fresh cases had forced the district administration to prevent unnecessary and avoidable visits of people to hospitals.
"We were able to contain the spread of the pandemic to a larger extent through people's participation and the carrot and stick policy of the police. A coordinated effort of doctors, health workers, district officials and police had helped stopping and stooping the rising graph,'' said the collector.
"A senior advocate telephoned me in the third week of March seeking police action against his gulf-returned son who was flouting quarantine. He was soon picked and put up in a quarantine facility. This is a classic case of involvement of the public in fighting COVID-19 in the district,'' he said.
Till March 15, there were no positive cases in Kasargod. But in the next 25 days, the figure rose to 178. The district had accounted for 64 per cent of active cases in the entire state. Chemnad Grama Panchayat had the largest congregation of positive cases in the state with 39 confirmed patients.
"Among the total 178 positive cases, 106 were gulf returnees. Sixty-nine people turned its victims due to contact. Among them, there was one 81-year-old lady and four people aged above 60. Sixteen children have also been tested positive. But they all have been cured now,'' said district surveillance officer Dr A T Manoj. The district had many expatriates who worked in Naif, the COVID-19 hotspot of Dubai. One among the expatriates who returned from Naif on March 19 had caused large scale spreading of the virus infection by violating quarantine and attending numerous public functions. Two MLAs and over 1000 people then went on quarantine.
"On February 3 when three students who returned from Wuhan in China tested positive for the first time in India, one among them was from Kasargod. Though he was cured completely, we were on high alert since then. As reports from Naif confirmed an increasing number of COVID-19 cases there, we started to focus on those who returned from there. On March 20 evening, I had issued an order directing all those who returned from Naif to immediately report to their nearest primary health centre or community health centre. Everybody with symptoms of COVID-19 had been tested,'' said the collector. Naif is a commercial hub and a densely populated area in the historic Deira district of Dubai. Of the 172 confirmed cases in Kasargod, all but three had clear links with Naif.
When the collector had issued the order, Kasargod had only two active cases and they both were linked to Naif. "A source there informed me about the situation there. I managed to get the passport details of those who were coming from there," the Collector explained. The situation in Kasargod turned worse between March 19 and 22, the four days before the flights were grounded. Though there was clear surveillance at the four airports in Kerala, monitoring at the international airport in Mangaluru was a huge challenge. During these days, the district administration was able to bring in 750 returnees from Dubai without any of them coming into contact with the public. They were then put in quarantine. As a single COVID positive person can infect three persons, the move had saved an estimated 2,250 people from the contagion.
According to Manoj, the health department had properly trained the surveillance teams and deployed them across the district with attachment to all primary health centres -- every panchayat has at least one -- to trace contacts of suspects. Accredited Social Health Activists (ASHA) and health inspectors were formed part of the teams.
In addition, helpdesks have been established at the entrance of all primary health centres, community health centres, government, and primary health centres. In each primary health centre, people were subjected to a round of rigorous questioning: whether they came from abroad, whether any relative of theirs came from abroad, or whether they came in contact with anyone from abroad. Through this, the authorities have ensured that the hospitals would not become infection-points.
Over 400 people who violated quarantine have been nabbed using a mobile app and they were put under isolation wards. Other than converting the academic block of medical college into a COVID-19 hospital, the general hospital in Kasargod too was converted into an exclusive COVID-19 vid hospital. Outpatient facilities there were shifted to other places. A private hospital with 64 beds, Paddannakkad had been attached and converted into COVID-19 hospital. A women's hostel with 30 beds at Udayagiri. And an educational institution with 40 beds at Kasargod town was also converted into a COVID-19 hospital.
The district which once lacked any major treatment facility has now 2800 isolation rooms and over 3000 hospital beds to handle any COVID-19 emergency. Door to door surveys have collected info of 92413 vulnerable people from 18810 houses so far.
"At no point was there, any threat of community spread. On March 20, when six persons tested positive for COVID-19, Section 144 of the Code of Criminal Procedure (CrPC) was clamped in the district to restrict people's mingling and movement. Kasargod was the first district in the country to go into lockdown,'' said the DistrictCollector.
Meanwhile, police had made the lockdown rules stringent. In hotspots, one officer was posted to monitor 10 houses. Drones were used widely to capture images of people violating lockdown and quarantine.
In the meantime, local bodies had operated community kitchens to delivering food at home. This had helped migrant workers, patients under palliative care and those living alone.
According to Manoj, a new virology lab had started functioning at the Central University of Kerala in Kasargod by the end of March and tested up to 87 samples a day. As a major solution to the lack of large scale healthcare infrastructure, the Tata group is constructing a 540-bed hospital in the district now, after learning about the ground-level reality of Kasargod.
As the district has over 1.25 lakh expatriates, the possibility of more returnees from gulf countries in the coming days remains a major challenge to Kasargod. Another worry is the illegal entry of people from other parts of the country. "People from other parts of the country are arriving even in vegetable and container trucks and on foot. Many are skipping the highways and using mud roads on the border to escape our tracing. Extra efforts are on to trace them,'' said the Collector.