Biggest challenge to the state's reputation of being a role model in curbing spread of infectious diseases
Kerala’s fight against Covid-19 had been exceptional so far, but even this benchmark set by the state could be in for a serious challenge after the first ever instance of man to man transmission in the country was reported at Ranni taluk in Pathanamthitta district in the state.
Three people who had travelled from Italy carrying the virus, infected two of their relatives back home and on Wednesday the number of those infected stood at 12 apart from 3 others that include a child and her parents who also arrived at Kochi from Italy, taking the total number to 15.
It was the first case of a local transmission in the country and health experts believe this could just be the beginning.
The case involving five members of a family hailing from Ranni, a hill town in Pathanamthitta district is now throwing at the state’s health department a herculean challenge that, experts say, could very well get bigger as the days go by.
Kerala’s success story in the last few weeks were based on its robust system of surveillance which could track down the students who returned from Wuhan in quick time leading to timely quarantine and ensuring that the virus does not spread to the local populace.
In the present scenario the Italy returned family of three have locally transmitted the virus to two others initially, which over the last 48 hours has swelled into a dozen confirmed cases and more than a thousand being warned to remain in home isolation.
Understandably on Tuesday, Chief Minister Pinarayi Vijayan while addressing the media persons at the state capital made it very clear that Kerala is in a state of heightened alert following the latest outbreak.
He also put the blame right on the patients who returned from Italy and failed to follow the government’s directions.
“It is the negligence on the part of the patients that has caused the situation to be so precarious in the state leading to a local transmission. We are no doubt facing a very serious situation where a number of steps have to be put in place to ensure that spread of the virus is curtailed at all costs,’’Pinarayi Vijayan told media persons on Tuesday.
But health experts say the state will have to brace itself for the worst in days to come and are apprehensive that many others might have entered the state escaping the surveillance system at airports as this family from Italy did.
“We honestly believe that there will be much more than this. There could be a lot of other patients also who given the authorities a slip and escaped the surveillance system. They may have gone to other places which means more hidden cases. However we are very confident that we will track them down. But we do need a lot of support from the general public which means people should report any symptoms at the earliest,’’ Dr. N Sulphi, vice president Indian Medical Association (IMA) told the Lede.
The trio from Italy reported to a private hospital in Ranni initially with fever and sore throat but did not reveal that they had returned from Italy.
It was after their relatives got admitted at the government Taluk hospital with Covid like symptoms that the trio were confronted by the health department.
But by this time they had been busy travelling frequently across the district and even outside to meet relatives and friends.
This has now thrown the spanner in the works for the state health department since getting the right information on time is absolutely crucial to preventing the spread of a virus like the Corona.
The Pathanamthitta distict Collector PB Nooh, under whose administration comes Ranni, the epicentre of the present outbreak clearly outlines how the local transmission would have taken place.
“It is very clear that the patients failed to inform the district administration or the health officials regarding their return from Italy. Even at local hospital they did not reveal much. The local health official had to confront them on why they bought paracetamol from the hospital following which they agreed that they have fever and sore throat. By that time they had visited a number of people and even attended some functions,’’ PB Nooh told The Lede.
If the health officials are to be believed the family even refused to be quarantined and had to be forced into doing so.
But the patient who did speak to a few media outlets deny such reports completely.
“We did not hide anything. We had told very clearly at the airport in Kochi that we are coming from Italy. But we were not given any directions by the officials there and what do you expect us to do,’’ asks the 26 years old patient whose father and mother are the other two who travelled with him from Italy carrying the virus.
While sheer negligence is at the core of the present imbroglio the blame certainly is a shared one.
With a Government of India directive existing dated February 26 th asking officials at all airports to take steps to quarantine travellers from a few countries including Italy for 14 days it is baffling how the officials at Kochi International Airport allowed three travellers to get out without even a proper health check.
Secondly the patients, despite being aware of having Covid-19 like symptoms which include fever and sore throat failed to report their travel history or their medical condition to the local health officials even though they visited the hospital. Instead they mixed with the local population as if all had been well.
“It is very clear that the people at the Airport just did not follow the much laid down protocols which could have prevented this outbreak to a large extent. But there is a huge responsibility on civil society too without which we cannot fight such viruses. Only if they had reported on time when they had symptoms this may not have happened,’’ Member of Parliament from Pathanamthitta Anto Antony told The Lede.
It is here that the health officials too are reiterating that the fight against Covid-19 cannot be taken to a successful end with out the active participation of the people at large.
“We cannot do anything unless people fully cooperate with us. Just look at the case of the patients who returned from Italy. They went to so many places to visit friends and relatives after they came here but they did not tell us in spite of repeatedly asking them. We had others calling us and telling us that this family visited them after landing in Kerala. See people need to understand that we are fighting a very serious virus that has taken the world by storm. There is a limit to which any government can do. People need to help themselves too,’’ Health Minister KK Shailaja told The Lede.
When this report was being filed 1,495 people have been put under the scanner in the state. A total of 259 people in isolation wards in different hospitals and 1,236 people have been asked to be in home quarantine for 28 days.
While the state’s efforts in the first outbreak had set a benchmark for others to follow, all eyes will be now on Kerala on how it deals with the present outbreak which due to its local nature is incomparable with the first one in terms of its potential to spread.
Health experts say that while containing the first outbreak was clearly an easy task the second one is a much tougher one because not only one needs to track the primary and secondary contact persons with whom the index patients would have come into contact, but also ensure that they do not spread it to a vast number beyond control. This is exactly what happened in China and what is now happening in Italy.
“The local bodies are now doing the contact tracing very well but the problem with contact tracing is that in such scenarios in rural areas it’s a real challenge. To be very frank we do not know how this will go. It’s a waiting game since the incubation period of the virus is also prolonged. We will have to atleast wait a week or more to clearly understand where this outbreak will take us,’’ Dr. PS Shareek, who is an expert in infectious diseases told The Lede.
When this report was being filed a seven-kilometre buffer zone had been set up around Ranni the epicentre where contact tracing is happening on a war footing. But what spoils this effort is the fact that the family which arrived from Italy Covid-19 had travelled to places far from Ranni even as far as Kottayam town to meet relatives.
Pathanamthitta district administration is also planning to use GPS technology to track the whereabouts of those taking home quarantine in order to ensure that none leaves their home till the quarantine period is over.
Recently one person had jumped out of quarantine from the Pathanamthitta General Hospital and the government now does not want to take a chance even with people in home quarantine.
A team of counsellors have also been put in place to call up those people in home quarantine over phone and ensure that they get emotional support too.
“It is very easy to ask people to stay at home for ever. But it is very difficult for several of them to do so. Mots of them are used to being out of home for work or for other things throughout the day. So we need to convince them over long period of time to do this,’’ added Raju Abraham, MLA from Ranni.
What sets the district of Pathanamthitta apart from many others is the presence of the huge NRI crowd in the district especially in Ranni Taluk.
Several homes in Pathanamthitta has one of their relatives working or settled in one of the European countries, the United States, Canada or Australia. It also explains the fear that many citizens are expressing here.
“We all know that almost 50 people travel to and from Pathanamthitta to different destinations in the Europe and elsewhere. That is why people are apprehensive what will happen when school vacations begin and a lot of them will come home. Easter is also around the corner. Now we cannot stop Indians from returning and it will not be feasible to quarantine everyone,’’ added Anto Antony.
But Dr. Shareek expresses one more concern. “There is a local transmission happening in UAE too, which is the other major threat for Kerala. That will be a real challenge. Like Tamilians go to Malaysia in huge number Keralites go to Dubai. Also such people coming back from UAE to Kerala might disembark in other south Indian airports too. Hence tracking them will be very difficult. It could affect the entire south India and then using quarantine will become nightmare,’’ added Shareek.
While the state seems to be doing all it can to curb the spread of Coronavirus, it is also bringing in some stringent controls, the authorities said.
Chief Minister Pinarayi Vijayan conducted a media briefing on Tuesday to announce the controls that the state is putting in place.
“We are in a state of heightened alert and so it is very important that we put in place certain measures at the earliest. Classes right from nurseries to standard seven would remain shut right away and will not have their annual examinations right now. All professional colleges have also been asked to wind up their classes immediately. Even madrasas and other educational institutions will also remain shut,’’ Vijayan told media persons.
Apart from this the state government has shut down all tourist centres in Pathanamthitta and Idukki and would be soon extending it to the rest of the state. Online booking to all tourist destinations have also been stopped and hotels across such places have been asked not to accept reservations till further notice.
Many of the religious organisations in the state have also come forward to either minimise or stop major functions that see a lot of people devotes gathering. The Kerala Catholic Bishops Council (KCBC) has asked the bishops of every diocese in Kerala not to hold any celebrations, conventions or mass pilgrimage till further notice.
Though Pongala festival at the famous Attukal Temple in the capital city where lakhs of women congregate annually went on as planned this week, many other temples across the state are curbing their festivities.
While the renowned Guruvayur Temple has put its festivities on hold till further notice, the government has appealed to devotees to stay away from the Sabarimala shrine which is all set to open in a few says time for its monthly poojas. The Chief Minister appealed to the devotees and reiterated that rituals at the hill shrine will go on as planned with minimal participation.
The Chief Minister has also announced that all entry into government institutions across the state using biometric facilities have been stopped till March 31 st.
The Novel Coronavirus has also hit Mollywood hard. Theatre Owners Association met on Tuesday and decided to shut all theatres across the state. Even the shooting of a number of films have also been put on hold till further notice.
Meanwhile the state police has also registered eight cases for spreading fake news and rumours and three persons have also been arrested in connection with the same.
“It has also come to the notice that there is an artificially created shortage as well as exorbitant prices being charged for masks as well as sanitizers. Government will take very stern action if anyone is found doing this,’’ the Health Minister reiterated on Tuesday.