THIRUVANANTHAPURAM: They remain the oldest couple to recover from COVID-19 in India and their story best encapsulates Kerala's fight against the deadly coronavirus pandemic.
On March 30, the state touted to have one of the best health indices in the country, rescued an elderly couple from the jaws of COVID-19. The couple were aged 93 and 88 respectively and had age-related comorbidities. But the good news came at a price as one of the healthcare professionals engaged in treating the couple contracted SARS-CoV-2. However, the state health department underscores that such setbacks don’t deter them from attending to the patients and providing them with quality healthcare.
“When the aged couple tested positive for COVID-19 on March 8, we knew we had a fight on our hands as they were from the high-risk category. But we decided to try our level best to save their lives. Health Minister KK Shailaja herself took the lead role and she constantly monitored their health progress,” said an officer of the health department.
The officer said what also helped was that they had a meticulous plan in place.
According to him, for dealing with COVID-19 and related emergencies, the health department prepared a well-thought-out plan and the same was sought by the Union Health Ministry, who wanted to share it with other states. He drew attention the fact that the state was the first to stipulate a 28-day quarantine period, whereas at the international- and national-level it was only 14 days.
Plan A is running... but there is a Plan B and C too
Said the officer, “It was on January 30 that the first COVID-19 positive case was reported in the country from Kerala. It was in Thrissur. At that time itself, the state had readied a Plan A and B for dealing with emergencies. The third level of the plan got chalked out when three Italy returnees and two persons whom they came in contact with tested positive on March 8. Despite the three plans, Kerala is now moving ahead as per Plan A.”
As per plan A, fifty government hospitals and two private hospitals were identified and a total of 1,216 isolation beds were also arranged.
Under Plan B, 71 government hospitals and 55 private hospitals were identified and 1,425 isolation beds were also arranged. If an emergency evolves like that of a community transmission the state could shift to plan B and if needed even to Plan C.
Under Plan C, 3028 beds have been identified at 81 government hospitals and 41 private hospitals. The ICU beds that have been ensured is 218.
The first case was followed by two other cases on February 2 and February 3. These three cases happened to be the first three cases in the country too. By then, the state government machinery was put on alert. A state-level rapid response team chaired by the health minister got constituted at the Directorate of Health Services and interdepartmental coordination was put in place.
Once the second wave of COVID-19 cases were reported in the state from Pathanamthitta on March 8, Chief Minister Pinarayi Vijayan himself started to monitor the situation and for better coordination, a minister was put in charge of each district.
Novel initiatives for bolstering the fight
The Kerala model of COVID-19 management didn't end there. The state also came out with some novel initiatives like the ‘break the chain’ campaign and COVID Care Centers (CCC).
“The first wave of the COVID-19 ended with the three positive cases and their recovery. The second wave started with the Italy returnees and their contacts. Considering the possibility of more such cases and the mass return of expats from COVID-19 affected countries, it was first decided to launch the break the chain campaign. It is for generating awareness among the masses on the need to take up hand washing. It received an overwhelming response from within and outside the country,” said an officer of the Directorate of Health Services.
Another major initiative was the CCC established in all districts to accommodate people who have been advised home isolation but have do not home in Kerala, like tourists, people in transit and others. It is also meant to accommodate any person in home isolation but not following the home isolation guidelines and for the Keralite returning from various states in India.
Who is put under home isolation?
As per the advisory issued by the health department, any person with travel history to COVID-19 affected countries or a person coming in contact with such a traveller, whether they are having symptoms or not, must remain in home isolation for 28 days. Home isolation is ensured with the help of squads at Local Self Government level including health staff, police and volunteers.
Clinical categorization
Kerala mandates that patients with mild symptoms are advised not to come to hospitals for testing and treatment. The state also came out with a clinical categorization in which those with low-grade fever/mild sore throat/cough/diarrhoea were included in category A, those with high-grade fever and or severe sore throat or cough in category B and those with breathlessness, chest pain, fall in blood pressure in category C. While those under category A don't need testing, for both category B and C testing is required.
Who needs hospital isolation?
For category A, strict home isolation is recommended. Those who came under category B should have to come to a designated COVID-19 treatment center after informing DISHA. Based on clinical assessment, a decision on testing will be taken. Patients belonging to category C will be admitted to the treatment centre.
What if a person tests positive?
Different types of swabs are taken. One is the nasopharyngeal swab and the other is a specimen from inside the nostril. The swabs are then processed and sent to the laboratory for testing. There PCR and RT-PCR tests are performed. Once a sample tests positive, the health department starts the contact tracing exercise.
Contact tracing is the process of identifying, assessing, and managing people who have been exposed to a disease to prevent onward transmission. It basically involves a three-pronged process - contact identification, contact listing and contact follow-up. If the contact tracing can't bring the suspected contacts in the net, then the route map of the particular positive case is publicized. It will have the details of the positive case’s contacts, the places they visited and other details in chronological order.
How is the positive case treated?
There is no vaccine for COVID-19 and this treatment is for the symptoms. For most, it may include pain relievers (ibuprofen or acetaminophen), cough syrup or medication, rest and fluid intake. The protocol for serious and critical cases are different.
When will one get discharged?
If repeated samples test negative within 24 hours, then the person is discharged. But they will have to remain in isolation for 28 days.