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Thursday, April 09, 2020

How Kerala beat back one of the first hotspots in India in Pathanamthitta District

On 8th April, the health ministry recognised the containment efforts in coronavirus hotspots like Pune in Maharashtra and Pathanamthitta in Kerala as best practices adopted by states that were worthy of emulation.

On March 11, Pathanamthitta, a migration hotspot in Southeastern Kerala, became the district with the highest number of cases in the state.


Most of those who were infected had travelled widely across the district before they were diagnosed with the infection, it was later found.

But over nearly two weeks to March 23, the district managed to limit the cases to 10 (from then till April 8th, the number has slowly gone up to 16 - mostly people who returned from abroad or other States).

Through contact tracing, the team was able to track nearly 98% of all primary and secondary contacts, who have been advised home- or hospital-isolation.


An extraordinary video conference

It was 2 am on March 8, the day after the first set of diagnoses, when an extraordinary video conference was held at the collectorate between the collector, the district surveillance officer and the state health secretary. 

There was a reason for the panic: When swabs had been taken from a family of five for diagnosis, no one had expected every one of them to test positive.
“We were so taken aback that most of the team [was] here by 7 am the next morning. There was no time to lose,” said AL Sheeja, the district medical officer in charge of coordinating the efforts at the district level.


By 7 am on March 8, calls were already going out to doctors, medical staff, drivers and vehicles to gather by 8 am at the collectorate so that 10 teams could trace the travel history of the patients. Every contact of the infected family that had returned from Italy was to be traced from the time it landed in India on February 29, to the time of its isolation.
From then on, how the team worked on surveillance, gathering travel history, contact tracing, and ensuring quarantine by providing essential and psychological support offers an insight into how the district managed to control the spread of the virus.
On March 8, the teams went to locations visited by the affected family. “We did two things – got their travel history, and got the field teams to visit every location and check as many CCTV footages as possible to ascertain their primary and secondary contacts,” said Resmi, a Doctor who leads the surveillance team. 
As of April 7, 2,575 persons who came from abroad and 4,583 persons who came from other States are in home quarantine. This is besides 401 primary and secondary contacts of the infected persons in the district.

According to the District Medical Officer, all of them will have to remain in quarantine for 28 days.

The Teams at District Level
The district control cell includes multiple teams – surveillance, call centre, psychological support, training and awareness, community-level volunteers, media monitoring among others.
The district has mobilised a 1,000-strong field team of ASHAs (Accredited Social Health Activists), junior public health inspectors and nurses, to ensure widespread awareness about the disease and provide ground support. This is in addition to the surveillance team of 450 led by Dr. Resmi.

The field staff go from home to home, seeking travel details. These home surveillance squads make more than 2,300 home visits in a day, as per data from March 25.

Testing asymptomatic cases

On 7th Apr, two persons in Kerala, who earlier did not exhibit symptoms of the Covid-19 infection, tested positive for coronavirus in Pathanamthitta district. Out of the two cases, one is a 60-year-old man who recently travelled from Dubai to the district, while the other is a 19-year-old student who travelled from Delhi in March.
The 60-year-old man who tested positive was quarantined between March 19 and April 6. He had flown back from Sharjah to Thiruvananthapuram on March 19 and then travelled to Pathanamthitta by road. He was asymptomatic but was still tested as he had returned from a country with a number of Covid-19 cases.
Meanwhile, the college student, who recently travelled to Pathanamthitta, had also completed her mandatory 14-day quarantine at home. The student boarded a train from Delhi to Ernakulam on March 15 and reached her home on March 17. She was asymptomatic all this while. However, she was tested for the coronavirus after Delhi emerged as an infection hotspot.
The authorities in the district have started to test people with a history of travelling to high-risk zones, or those who fall in the vulnerable category even if they may be asymptomatic, Pathanamthitta District Medical Officer AN Sheeja said.
It was reported on 8th Apr that a home-quarantined youth who came from Dubai on March 21st, tested positive. With that, the number of cases rises to 16 in Pathanamthitta.

Wednesday, April 08, 2020

Why Kerala has a high rate of recovery from Covid-19

The records of Covid-19 patients who tested positive between March 9 and 20 show Kerala as having a high rate of recovery at 84 per cent.


In all, the rate stands at 17 per cent so far when one takes into account all cases in the state till date.

In comparison, Maharashtra has a recovery rate of 5.5 per cent, while the rate for Delhi is 4.04 per cent.

Healthcare experts have cited Kerala's early identification system and its specialised Covid-care wards as the main reasons behind the state's good recovery rate.

Along with Kerala, Maharashtra has also seen a decent rate of recovery, but it lags significantly behind Kerala in one parameter. As of Apr 6th, Kerala has managed to avert spikes in number of cases since the first spurt in March, but Maharashtra has not been able to do so.

Kerala's rate of sample collection  is higher than all major states, where it lags only behind Rajasthan.