Is Kerala a hot spot of viral attacks?

Health department officials say the high number of detection of viral diseases is the result of the robust screening mechanisms in Kerala

THIRUVANANTHAPURAM: Dengue, Chikungunya, Kyasanur forest disease, West Nile Fever, H1N1, Nipah. And now novel coronavirus. For the past many years, Kerala has been facing the brunt of major epidemic prompting many to ask “is the state turning out to be a hot spot of viral attacks?”

While some say that the state is becoming vulnerable to viral attacks including the ones that attain genetic variations, the health department say that state’s robust screening and surveillance mechanism is the reason for detecting these many viral diseases.

“The state is very much concerned about so many viral attacks. But we are not scared of detecting these cases. The state’s public health system is strong and is ready to accept the challenges. We have established a robust mechanism to screen viruses,” said Dr Anish T S, Community Medicine Department, Thiruvananthapuram Government Medical College.

Unlike other states in the country, Kerala has established detection facilities for virus outbreaks, he said.
“Post-Nipah, the state has established outbreak monitoring units at all major hospitals and it has been stipulated that all fever cases should be screened. If a fever case is not diagnosed, samples including throat swab are collected and are subjected to multiplex polymerase chain reaction (multiplex PCR) analysis,” he added. Since Keralites are spread across the globe, the state is well-connected to various parts of the world. This makes Kerala vulnerable to viral attacks. “A large number of doctors and nurses from Kerala work in various countries. There are students who pursue medical courses abroad. These three categories face the occupational hazard of viral attacks,” said Anish.

He cited a case where a nurse working abroad had to seek treatment for the Crimean-Congo haemorrhagic fever (CCHF). She contracted the viral disease while on the work. At the same time, the absence of BSL-3 or BSL-4 labs in the state is being pointed out to be a major handicap in the fight against viruses. BSL stand for biosafety level. “At present, the state relies mainly on test results from labs of Rajiv Gandhi Centre for Biotechnology and National Institute of Virus in Alappuzha. But they are BSL-2 labs. Considering the emerging viral attacks, Kerala needs BSL-3 lab like Manipal Institute of Virology or BSL-4 lab similar to that of NIV, Pune,” said a health department official.

Meanwhile, it is being pointed out that the Institute of Advanced Virology at Thonnakal, which is being readied to function from June, will have a BSL-3 lab. “A major handicap with our health system is that we are yet to concentrate on research. Thorough research on viral outbreaks is yet to get attention in the state,” said former health secretary Rajeev Sadanandan.

Why is it called coronavirus?
The name coronavirus comes from the Latin word corona, meaning crown or halo. Under an 
the electron microscope, the image of the virus looks like a solar corona.

Guidelines to tackle nCoV

• nCoV surveillance deals with three types of case definitions – asymptomatic travellers, suspected ones and confirmed ones
• Asymptomatic travellers – those who reached the state from nCoV-notified places – are recommended with a strict home quarantine of 28 days with fever surveillance
• They are asked to remain shut in a room. For meeting their needs one member of the family
•  is assigned
• That member is also not supposed to maintain close communication with the home isolated person
• The member should at least maintain a two-metre distance from the isolated person
• The health department follows up the home isolated cases two times a day. If needed they are also provided with medical assistance
• Suspected ones – those with severe acute respiratory illness or those who had travelled to any of the nCoV-notified places 14 days before the onset of the symptom – are admitted to the designated isolation ward in the identified hospital with ICU facility
• Suspected persons are discharged only if two recommended tests turn negative
• For confirmed cases, the treatment is for the complications caused by nCoV

January 18
The department commences preventive and control measures. Alerts district medical offices to look out for persons with symptoms

January 26
Department publishes guidelines on nCoV surveillance

 January 30
The first positive case in the country is confirmed in a medical student who was quarantined at the Thrissur General Hospital

February 1
A revised guideline on nCoV surveillance is published

February 2
The second positive case is reported from Alappuzha

February 3
Kasaragod reports the third positive case. All three are Wuhan returnees. They are medical students there and are known to each other

February 3
State declares nCoV a state-specific disaster. Health advisories are released for animal husbandry, education and tourism departments

February 7
With no more new cases detected, the declaration is withdrawn