On January 30 afternoon when Health Minister K.K. Shylaja made a television appearance to announce that the first novel coronavirus infection in Indian had been confirmed in a medical student from Wuhan, none could have imagined it was just the beginning of a long innings with a virus hitherto unknown. Though a sense of panic had gripped the State then, it could contain the first three cases from spreading to even the immediate family members.
The sense of elation was short-lived when on March 8 a three-member family from Italy tested positive for COVID-19 in Pathanamthitta. Cases began climbing in the State as people began returning home from abroad. On March 24, when the 21-day nationwide lockdown was announced, Kerala had 109 cases. On May 8, when expatriates were beginning to return to Kerala in large numbers, the number of active cases was just 16. The cumulative number was over 500.
Rapid change
The scenario changed rapidly with imported cases of infection. The picture changed by May end when the proportion of locally acquired infections began to rise, many of which had no epidemiological link. While the government continued in denial about silent disease transmission happening in the community, the outbreak in the State’s coastal belt three weeks ago took the entire health administration by surprise. With the coastal belt becoming transmission zones, the government admitted community transmission at least in some places.
Kerala’s initial response to the COVID-19 outbreak was pre-emptive and focussed. The initial strategy of aggressively isolating, quarantining, and contact tracing worked very well. However, in the next phase, the focus should have been on sharpening surveillance strategies to detect community transmission rather than just containment. Early hospital-based surveillance, surveillance of viral pneumonia, and SARI (severe acute respiratory infection) cases in a decentralised manner should have been initiated.
Focus
Public health experts believe that an early acknowledgement of community transmission followed by focussed surveillance studies and testing in areas such as markets would have made the public more aware of the importance of safety precautions and helped the State limit the spread of the infection in a much better manner. The State should have focussed better on having solid mitigation plans on ground but when the surge in cases came, the health system found itself buckling under the pressure. The global experience has shown the importance of amping up critical care capacity. Yet, the private sector was not taken into confidence till recently.
Six months hence, the State is facing a scenario when there could be at least 75,000 patients filling the hospitals at a time in August-September. The government is now trying to enhance the health system capacity and keep the transmission down. It is trying to draw on its strengths at the grassroots so that the capacity management is a decentralised affair.
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