On March 27, Kerala Chief Minister Pinarayi Vijayan began his daily media briefing on COVID-19 scenario with a warning.
“The situation in Kasaragod is turning out to be serious and the state has to further strengthen steps to contain the disease,” he had said.
That day 34 persons from Kasaragod, state's northernmost district bordering Karnataka, had tested positive for coronavirus, and the number of COVID-19 patients rose to 76. The total number of active patients in the state that day was 176.
Coronavirus infection continued unabated for the next 13 days in Kasaragod. On April 9, the district had 155 active COVID-19 patients, and things looked getting out of control.
A majority of the positive cases reported from Kasaragod had foreign connection. The first person to be tested positive was a medical student from Wuhan, the epicentre of the COVID-19 outbreak in China, on February 3. The patient was discharged from the District Hospital in Kanhangad on February 15. The second COVID-19 case emerged a month later, on March 16. The infected person this time was a person returned from the United Arab Emirates. The number increased with the arrival of more people from abroad.
With the disease spreading fast, many raised doubts about the district's ability to withstand the crisis.
Kasaragod, which was formed after splitting neighbouring Kannur in 1984, has been lagging behind other Kerala districts in health, education and infrastructure fronts.
A major health crisis had hit the district in 2000 because of endosulfan poisoning. More than 1,000 people were killed and 6,000 fell permanently sick because of the Kerala Plantation Corporation's indiscriminate aerial spraying of endosulfan - a highly potent neurotoxin banned in many countries - on its 12,000-acre cashew estates. The pesticide spraying was stopped in 2000 but the impact left by it was even bigger. Thousands of children were born with congenital disabilities, hydrocephalus, diseases of the nervous system, epilepsy, cerebral palsy, and severe physical and mental disabilities.
Despite being home to thousands of patients, the district never got adequate health facilities.
The construction of a medical college hospital is progressing at a snail’s pace since its foundation stone was laid in 2013.
The doctor-patient ratio in Kasaragod is 1:1,925 (one doctor for 1,925 patients), while this is 1:395 in other districts. This stands testimony to the district's backwardness in health sector.
In the absence of adequate health facilities, people have been depending on hospitals in Mangaluru, a medical hub in the neighbouring state of Karnataka. The COVID-19 outbreak, however, put an end to this access after Karnataka sealed its borders with Kerala and stopped patients from travelling to Mangaluru.
Kasaragod was literally in dire straits in the last week of March and first week of April because of the rapid rise in the COVID-19 cases.
The situation forced the government to act quickly.
On March 29, it appointed senior IAS officer Alkesh Kumar Sharma, principal secretary with the industries department, as the special officer to co-ordinate the activities against the disease.
Inspector General of Police (Kochi range) Vijaya Sakhare was brought in to strictly enforce lockdown.
In the first week of April, it set up a specialised COVID-19 Care Centre in the administrative block of the under-construction medical college at Ukkinadka in just four days and sanctioned 273 posts of medical and paramedical staff.
The results were there to see. Number of COVID-19 patients began to dwindle. Recoveries outnumbered new positive cases starting from April 10. As on April 22, the district has only 26 active patients.
In the process, Kasaragod became the first Indian district to cure 100 COVID-19 patients without a single death. The Union Health Ministry praised it 'for the detailed and effective implementation of containment measures despite facing various unique challenges'. It even termed this as 'Kasaragod model of surveillance'.
This series analyses Kasaragod's fight against COVID-19, focussing on the roles played by various stakeholders. The first part looks at the role of grassroot workers.
Grassroot workers: On duty, 24X7
M Radha begins her work early in the morning these days. The Accredited Social Health Activist (ASHA) in Chemnad gram panchayat trudged long distance on foot, visiting many households after COVID-19 scare gripped the panchayat. Since her Ward 23 (Paravanadukkam) has not reported any COVID-19 cases, she is helping her colleagues in other wards.
Chemnad is a COVID-19 hotspot in the district as it reported 37 positive cases. Thirty-two patients have been cured of the disease and the remaining five are being treated in various hospitals.
Radha's primary duty is to keep track of the persons coming from foreign countries and share their details with the health department. While visiting homes, she exhorts people about the importance of hand washing with soap water and social distancing to keep the coronavirus at bay.
Chemnad lies just four kilometres south of the district headquarters Kasaragod. It borders Kasaragod municipality on the north and Arabian sea on the west. With 23 wards, it is the biggest gram panchayat in the district. Of the 65,000 residents, around 4,000 work in various Gulf countries.
Radha is one of the 22 ASHA workers in Chemnad, who have been working day in and out to check the spread of the virus. “We have been working so hard these days. We are passing through a crucial period. We have to work hard to tame this virus,” she said.
District Medical Officer (DMO) Dr A V Ramdas hailed the efforts of ASHA workers. They played key roles in Kasaragod's COVID fight. They are our ground level warriors. We could not have contained COVID-19 without their help," he said.
On Wednesday, Chief Minister Pinarayi Vijayan announced an additional honorarium of Rs 1,000 to 24,465 ASHA workers across the state as a token of appreciation (They are entitled for a monthly honorarium of Rs 6,500). "ASHA workers have been preparing the list of people coming from abroad and other states. They ensure that senior citizens get their medicines regularly. I appreciate their efforts," he said.
Tracing the contact
Working with them closely are the health inspectors, public health nurses and members of the local self-governments to trace the contact and ensure quarantine for those who come from outside.
Kasaragod has a population of 13.1 lakh. According to conservative estimates, 10 per cent of the population live and work outside the country, mainly in the Gulf.
COVID-19's second wave started in the district with the arrival of persons from abroad. Hence it became crucial to trace contacts to check the virus.
"Finding primary contact was difficult in places where people live in joint families," said Junior Health Inspector P Raveendran, who works at Chemnad.
Being a committed health worker, Raveendran has made Chemnad his temporary home for the past 37 days. His home is in Madikkai village that lies 35km southeast of Kasaragod town.
"I have not gone home for more than a month. I am staying here because I can attend any health emergencies even at night," he said.
Apart from assisting ASHA workers to collect data from villages, health inspectors and public health nurses ensure proper quarantine and monitoring of people who came from outside. They also send symptomatic persons for testing samples.
Health inspectors and public health nurses will contact those under quarantine regularly over phone and check their well-being.
"We strictly follow the movements of quarantined people. If we find that they are not following the norms, we will inform the district health officials. They will put them in places under strict restrictions," Raveendran said.
People's vigilance
Lending solid support to the health department's initiatives are the ward-level people's vigilance committees, a panel comprising people's representatives, political party leaders and volunteers.
Each ward has a 10-member committee with the ward member as the chairman and the health department official – either ASHA worker or the health inspector – as the convenor.
These vigilance committees, in fact, act as a bridge between the people and health officials.
"The people's vigilance committees in all gram panchayats became functional in the second week of February and this helped the district administration and health department to disseminate information easily," said District Collector D Sajith Babu.
The committees identified the people who came from abroad in each ward and convinced them and their families about the importance to be on home quarantine. They also provided food for the quarantined people and took care of their families.
"All committees worked in coordination with the government agencies," the collector said.
The people's vigilance committees worked really well in Chemnad, too. "Around 1,300 persons came from Dubai to our panchayat after the COVID-19 outbreak. We could easily trace their primary and secondary contacts with the joint efforts of the public vigilance committees, ASHA workers and health inspectors. This contact tracing helped us keep the number of COVID-19 patients to 37," said gram panchayat president Kallatra Abdul Khader.
District Surveillance Officer Dr A T Manoj said Kasaragod could check the community spread of coronavirus because of the strict contract tracing.
"ASHA workers, health inspectors, public nurses and people's vigilance committees played crucial roles in this effort. Kasaragod is deeply indebted to them," he said.
Part-II: How the Health department tackled COVID-19 crisis in Kasaragod
