(Editor's note: This is the second part of a series on how Kerala's Kasaragod district efficiently controlled COVID-19 pandemic. Read the first part here.)
One of the first COVID-19 cases to surface in India was in Kasaragod district. A medical student from Wuhan, the epicentre of the pandemic in China, tested positive for the disease on February 3.
As the student was being treated at the district hospital in Kanhangad, top health officials huddled at the district headquarters – 25km north of the hospital – to prepare a roadmap to fight the disease. The discussions primarily focussed on the measures needed to trace the primary and secondary contacts of the infected person and put them under quarantine. The meeting also discussed the preparedness of the district health system if COVID-19 posed a serious threat.
The student was cured of the disease and discharged from the hospital two weeks later, but the health department did not lower its guard. Discussions and deliberations continued till they formulated a road map to stop the virus on its tracks if it entered the district, which eventually did on March 16, exactly a month after the first case surfaced.
"We did not panic when the second case emerged because, by then, we had gained enough experience to handle the crisis. Besides, we worked with a clear strategy," said Kasaragod District Medical Officer Dr A V Ramdas.
For the next 25 days (till April 10), the district earned all the bad press across the country because of the exponential rise – from 1 to 155 – of COVID-19 patients. The turnaround began on April 11 with the recovery of six infected persons. The trend continues even now. As on April 23, only 20 COVID-19 patients are being treated in various hospitals.
According to the health department data, the district reported a total of 172 positive cases out of which 152 have been cured so far with a record zero per cent mortality. Suddenly everyone started hailing Kasaragod as a model district. For, it is the only Indian district to treat 100 or more COVID-19 patients.
The 30-day gap between the emergence of first and second cases appears to have helped Kasaragod district manage the crisis better than other severely COVID-19 affected districts in the state.
Surveillance is the key
Based on tests, the health officials have ruled out community spread of the disease in the district recently. (Community spread refers to the third stage of virus spread when infections cannot be tracked back to a certain person. The disease spreads in such a way that people don't know how they are exposed to the virus).
This is unimaginable in a district that recorded 172 positive cases. It is the result of strict community surveillance measures that are employed to track persons coming from abroad and other parts of the country.
District Surveillance Officer Dr A T Manoj said his 30-member team has put in a lot of effort to trace all those who came in contact with the persons tested positive for coronavirus and regularly monitor their health conditions. "Contact tracing was the key in checking the virus spread," Dr Manoj said.
Big challenge
The second wave of COVID-19 began in the district with the arrival of people from the Gulf region. According to the health department data, the district reported 172 COVID cases and 152 have been cured so far. Barring three, all came from Dubai.
But tracing their primary and secondary contacts and keeping those people away from the public were the biggest challenge for the health workers because a minor let-up would endanger hundreds of lives.
Kasaragod did experience such a situation when 23 members of a family contracted infection from a single person who came from Dubai on March 13. The person, Farras, was tested positive for coronavirus on March 16.
The surveillance team tracks all the direct contacts (primary contacts) of the infected persons and people who come in touch with the primary contacts (secondary contacts).
"We will then narrow down the list (of primary contacts) by identifying people who came in close contact with the infected person. They are the high risk group, so we will test their samples first," said Dr Manoj.
"We will also test a few samples of secondary contacts and asymptomatic primary contacts," he said.
After the sample collection, those coming from abroad remain in quarantine under the watchful eyes of the surveillance team. "A person from our call centre will contact them regularly and inquire about their health conditions. Another group from local health centres will visit them daily. It is a two-pronged surveillance strategy," Dr Manoj said, adding that it delivered the best result in Kasaragod.
Thrust on testing
Increase in the number of testing is believed to be the major reason for the exponential rise in COVID-19 cases in Kasaragod.
Health workers sent more than 200 samples to Indian Council of Medical Research (ICMR)-approved laboratories everyday. "We have tested around 3,000 samples so far," said DMO Dr Ramdas. "It's a huge number if you compare it with other states," he said.
The testing apparently gained momentum after a new virology laboratory became operational on the Central University of Kerala campus in Periya. Earlier, samples were sent to the virology laboratory in Alappuzha.
Infrastructure
Ramping up infrastructure and mobilisation of human resources too found pride of place in the health department's February action plan.
As a first step, the department enumerated number of beds and ventilators in government and private hospitals.
"This was followed by earmarking various government and private hospitals to treat infected patients and to keep symptomatic and asymptomatic persons under observation," Dr Raman Swathi Vaman, Kasaragod District Programme Manager of the National Health Mission, explained the operations.
A 70-bed hospital was set up by taking over a private building in Padannakkad near Kanhangad while the hostels of the Central University of Kerala in Periya have been converted into quarantine facilities. Besides, the district general hospital has been converted into a 200-bed COVID Care Centre.
When the number of COVID patients touched 110, the state government asked the health department to convert the medical college under construction in Ukkinadka, which lies 25km north-east of Kasaragod town, into a COVID tertiary care centre in four days.
"Chief Minister Pinarayi Vijayan announced on April 1 that Ukkinadka facility would be converted into a COVID tertiary care centre in four days. We could launch the 200-bed hospital on April 5. It was a milestone in Kasaragod's fight against COVID," Dr Raman said.
The pandemic has put a huge burden on the already strained health sector in Kasaragod, which lags way behind other districts in Kerala. The district has the lowest doctor-patient ratio of ,1:1925 (one doctor serves 1925 patients), while the ratio is much better (1:395) in the rest of Kerala. Kasaragod does not even meet the World Health Organisation's recommended doctor-population ratio of 1:1000.
No wonder, then, that the district badly felt the shortage of healthcare professionals in the time of COVID-19 scare. But the health department tackled the crisis by shifting health workers from general hospitals and clinics to the COVID care centres.
"Our first preference was to contain COVID-19. So we had no other option but to put as many health workers on COVID control duty. They never complained. Those unsung health workers are the real heroes of Kasaragod," said DMO Dr Ramdas.
Read Part - III: The 'three locks' that saved Kerala's Kasaragod from COVID-19's community spread
