No panic, only planning: Here is how Kerala's Kasargod successfully fought COVID-19

Even when the Covid graph was rising in Kasaragod -- 0 to 155 in 25 days -- the district administration was always ahead of the curve.
Children drawing graffiti to create awareness on Covid in Kasaragod town
Children drawing graffiti to create awareness on Covid in Kasaragod town

KASARGOD: Even when the COVID graph was rising in Kasaragod -- 0 to 155 in 25 days -- the district administration was always ahead of the curve. It never pressed the panic button though half of the infected patients in Kerala were from Kasaragod.

With people's participation and the carrot and stick policy of the police, it was just a matter of time, the rising graph stopped and then stooped. Here's how Kasaragod beat, or almost beat, COVID-19.

On March 21, Kasaragod's collector D Sajith Babu got a phone call from a senior advocate. The lawyer asked the top district official to immediately send in cops to his house. "My son is flouting the quarantine and is chatting away with my other children and wife. Take him away," the advocate told the collector.

Soon, the erring son -- who had returned from the UAE -- was picked and put up in a lodge, which the district administration turned into a quarantined facility. "I was amazed at the involvement of the public in fighting COVID," Sajith Babu said.

One cannot fight an epidemic of COVID's proportion without people's support, he said.

The district had raced from zero positive cases on March 15 to 155 cases in 25 days on April 9. On that day, the district accounted for 60% of the 257 active cases in the state. 

There was panic in the rest of Kerala, but by then the government had mobilised its entire machinery and the district administration was on top of its game. The numbers were rising as per the script, said the district surveillance officer Dr A T Manoj.

"We knew where the cases were coming from and where the graph was headed for," he said.

Spotting the Naif connection early

On March 20 evening, collector Sajith Babu put out a press note. "All those who arrived from Naif in Dubai should immediately report to their nearest primary health centre or community health centre," it said. Anybody with symptoms of COVID would be tested.

Before the note, not many in Kasaragod or Kerala have heard of Naif, a commercial hub and a densely populated area in the historic Deira district of Dubai.

Sajith Babu's note was a 'super saver' in the battle against COVID in Kasaragod. 

Of the 172 confirmed cases in the district, all but three were linked to Dubai, and specifically, Naif, said Dr Manoj, the surveillance officer.

When he put out the note, Kasaragod had only two active cases, both linked to Naif. "I was informed by a source in Naif about the situation there. He even WhatsApped me the passport details of those arriving from Naif," the collector said, explaining the reason.

To be sure, the Dubai administration put Naif under lockdown only on March 31, eleven days after Kasaragod flagged Naif.

Acting on the tipoff

Kasaragod saw an influx of NRIs from Dubai on March 19, 20, 21, and March 22, the last day before all flights were grounded.

The district administration kept a tab on the people arriving at the four airports in Kerala. But the international airport in Mangaluru was a weak link. 

The district administration posted an official there on March 20, and ran six buses for three days -- three in the morning and three in the evening -- to bring passengers to the district. "In the three days, we managed to bring in around 750 passengers from Dubai without them coming in contact with the public," said Dr Manoj. The 750 persons were immediately put in quarantine.

Considering a COVID patient can infect three persons, the move potentially saved 2,250 people from the contagion.

Made Wuhan Experience Count

These small acts in infection control and contact tracing came with the early experience of treating the first COVID patient from Wuhan.

The medical student from Wuhan tested positive on February 3 and recovered on February 16. The disease surveillance team traced 189 primary contacts of the students.

"The first case prepared us well," said Dr Manoj.

The District Health Service trained the surveillance teams in the primary health centres -- every panchayat has at least one -- to trace contacts of suspects. The team comprises accredited social health activists (ASHA) and health inspectors who are good at asking needling questions.

Helpdesks were set up right at the entrance of all primary health centres, community health centres, government, and primary health centres.

Patients could go to the out-patient (OP) wing only after a round of rigorous questioning: whether they came from abroad, whether any relative of their came from abroad, or if they came in contact with anyone from abroad.

"We had to do it to ensure hospitals did not become an infection-point," he said.

Nurses and doctors in private hospitals were also trained to spot a potential COVID patient, considering that the symptoms are too common and could be missed, said Dr Manoj.

All the training and preparation helped. Exactly one month after the patient from Wuhan recovered, Mohammed Farras arrived from Dubai. He went straight to a private hospital in Kasaragod.

"All he had was a runny nose but we referred him to the General Hospital to test for COVID," said a nurse.

He tested positive on March 16. The district administration immediately quarantined the doctor and 10 nurses of the private hospital as a precaution. 

The second job was to trace the contacts of Farras.

"Since the virus is virulent, we had quite a task at hand. We nosed around and quarantined 46 members of his family," said collector Sajith Babu.

Twenty-three of them tested positive, possibly the highest number of infections from a single source in Kerala.

"But we had it covered as all of them were in quarantine," he said.

No community spread

Of the 172 cases in the district, 107 are imported cases and the remaining 65 are cases of local transmission.

Of the 65, nine persons are the source for 50 cases, said the surveillance officer. Of the nine, the first patient was the source for 23 cases and all of them were immediate family members, and all of them were in quarantine.

"So at no point was there a threat of community spread," said Dr Manoj.

The collector also formed Awareness Committees in every ward in all the 41 local bodies in the district. They were responsible for ensuring people who came from abroad and their relatives remain in quarantine.

"We dropped the word home quarantine and started using room quarantine. The ward-level committees helped build enormous social pressure to ensure compliance," he said.

At the peak, 11,087 persons were in quarantine in the district.

Twelve patients, who recovered from Covid on April 13, pose for a photograph at the
District Hospital at Kanhangad in Kasaragod

Aggressive containment and policing

Along with the social and health strategies, the police too came in with their effective 'carrot and stick' policy. 

On March 20, when six persons tested positive for COVID, the district collector imposed Section 144 of the Code of Criminal Procedure (CrPC) to restrict mingling and movement of people. Kasaragod was the first district to go into lockdown.

"By May 3, Kasaragod will be in lockdown for 42 days," said the collector.

On March 23, when 19 cases were reported, the government sent a police team of four officers led by Kochi police commissioner Vijay Sakhare to strictly implement the lockdown.

On March 27, when 34 cases were reported, the government sent in the principal secretary of industries and Kochi Metro MD Alkesh Kumar Sharma as a special officer.

Together, they identified seven hotspots where most of the cases are reported from -- Kasaragod municipality; Madhur, Chemnad, Pallikkara, Chengala, Mogral Puthur, Muliyar gram panchayat. 20,000 houses were in quarantine.

"At any point of time, only 150 persons were allowed in Kasaragod town," said district police chief P S Sabu.

Those from the hotspots were not allowed to venture out of the zone. "Police launched cash on delivery scheme to deliver food provision and medicines in these areas," he said.

Vijay Sakhare ordered the installation of COVID Safety, a tracking app on the phones of all those in quarantine. Those violating quarantine were picked up and lodged in isolation facilities.

"We were asked to harass even people who were out for genuine reasons. It was a deliberate ploy to keep people in," said a sub-inspector. "We got some bad press but its ok," he said.

In the meantime, the police made the lockdown rules more stringent. One officer was posted to monitor 10 houses in hotspot areas. Drones were deployed to capture images of those violating lockdown and quarantine.

Alongside the "ruthless policing", panchayats and municipalities ran community kitchen, delivering food at home. Most of their beneficiaries were migrant workers, palliative patients, the elderly living alone. 

Ramping up the infrastructure

At the same time, a virology lab was started in the Central University of Kerala, which could test up to 87 samples a day.

The General Hospital was turned to a COVID Care Centre (CCC) with 222 beds. Another full-fledged CCC was started in under-construction medical college building at Ukkinadka in record four days.

"When the second case was reported, we had 903 beds ready," said the collector. Now, it has been ramped up. Tata is building a 540-bed CCC at Thekkil

Ruling out community transmission

Though the number of active cases has dropped to 27, the administration is not pausing a bit. 
The District Health Service said it has launched a door to door survey in the hotspots to find if there are any persons with symptoms of COVID.

The health officials have visited 16,000 houses, met 90,000 persons in six panchayats and a part of Kasaragod town.

"We found 320 persons with symptoms and took their swabs. It could be common cold but we do not want to leave anything to chance," said an official in the survey team.

Preparing for the next round of influx

The district administration has also launched a door to door survey to find out how many persons were now abroad and how many were likely to return once the lockdown was lifted.

According to the Economic Survey, 67,000 persons from the district are abroad.

"But the reality could be more than 1 lakh," said an official. "At least a quarter of them may return," he said.

The district administration is arranging rooms to quarantine them as soon as they arrive. 

Related Stories

No stories found.
The New Indian Express
www.newindianexpress.com