Coronavirus (COVID-19): Kerala has bucked the national trend for novel coronavirus disease (COVID-19) with a doubling time of 72.2 days — which means that the number of cases in the state doubled in that many days — against a national average of 7.5 days. Last week, the Centre showcased the contact tracing and containment model of Kerala’s Kasaragod, one of the earliest spots on India’s COVID-19 map, as one of the success stories of the containment exercise.
A look at the Kasaragod model, and how it differs from some of the other models across the country that have generated interest.
Coronavirus: Why showcase Kasaragod?
Kasaragod reported the third case of COVID-19 in the country — a student airlifted from Wuhan on February 3. The district administration mounted a massive exercise to trace the 150-odd contacts of that one student.
According to figures uploaded by the Kerala government, Kasaragod has had 169 cases and zero deaths until April 19, a unique achievement in itself, given the fact that a large proportion of the district’s population have settled abroad. Of those infected, 123 people have recovered so far, leaving only 46 active cases among the original 169.
In the initial days of the epidemic, almost all index cases were people who had caught the virus during their travels abroad (about 15.38%). The second wave in the district happened after people started coming back from the Middle East from March 16.
Kasaragod: Under what circumstances was this containment achieved?
The district is far from major cities, so that the isolation exercise was smoother. Kasaragod is Kerala’s northernmost district, far away from capital Thiruvananthapuram. However, this distance also presented an additional challenge. When expatriates returned in large groups, they landed in various airports and took various public transport options — railways, road etc — to reach home, which had the potential to leave contacts all along the way.
Health Ministry officials said that while Kasaragod has been showcased, the success of Kerala as a whole is a story essentially of the strength of the state’s healthcare system rather than one of the immediate measures taken. “It is not for nothing that it leads in all human development indices. The most amazing thing about Kerala is how receptive they are of suggestions for improvement,” said a senior official in the Health Ministry.
What is the Kasaragod model?
The district administration relied on aggressive testing, technology, foolproof contact tracing, and an effective public awareness campaign on social distancing to achieve the results it can now show. In Kasaragod, as in other districts, the state government appointed a special officer to coordinate functioning of the district administration and for effective coordination between line departments at field and secretariat levels. Section 144 was imposed in the entire district, with seven drones employed for surveillance. Under the Care for Kasaragod initiative, a detailed action plan — common coordinated action plan — was drawn up for combating COVID-19 so that all stakeholders could turn to it when the situation arose.
And what was this action plan?
All quarantined people were tracked using GPS. All essentials were home-delivered in the containment/cluster zones, irrespective of whether they were rich or poor. A campaign on social distancing called “Break the Chain” was carried out to deliver the message of social distancing. Core teams were formed with incident commanders to rush to various areas and take quick action.
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The plan was carried out with a very strong social welfare component, which included free food kits for the poor and migrant workers, a strong check on hoarding and black-marketing, and health checkup on alternate days for migrants or the destitute. Community kitchens supplied free food. Jana Jagratha Samitis at the ward level ensured that the messaging reached every person.
What was the scale of the exercise?
A total of 17,373 people were quarantined. On an average, 100-150 samples were tested every day and new testing labs were started. The medical college in Kasaragod with 200 beds and an ICU facility was operationalised in four days. There is also a 709-bed COVID-19 care centre. ASHAs and health inspectors carried out household surveys.
All primary and secondary contacts of high-risk cases (those aged 60 or above) were quarantined in isolation centres. This was done as many homes did not have separate toilets.
What are the other successful models containment?
In a recent meeting, the Centre asked district magistrates to draw up separate crisis plans for COVID-19 management, and shared several models. These include Agra, Bhilwara, Pathanamthitta etc.
AGRA MODEL: Under the cluster containment and outbreak containment plan in Agra, the district administration identified epicentres, delineated the impact of positive confirmed cases on the map, and deployed a special task force as per a micro plan made by the district administration. The hotspots were managed through an active survey and containment plan. The “hotspot” area was identified within a radius of 3 km from the epicentre, while a 5 km buffer zone was identified as the containment zone.
BHILWARA MODEL: This entailed complete isolation of Bhilwara city with Section 144 CrPC being imposed. In the first phase, essential services were allowed; in the second phase, the shutdown was total with the city and district borders sealed and checkposts at every entry and exit point. Trains, buses and cars were stopped. The district magistrates of neighbouring districts too were asked to seal their borders. The message from Bhilwara was “ruthless containment”.
PATHANAMTHITTA MODEL: Kerala deployed technology to a large extent in the Pathanamthitta model too. Every person who had entered the district was screened and a database created so that they could be reached at short notice. Graphics were created showing the travel route of the positive cases and publicised. This led to self-reporting. As people realised from the route maps and the travel times that they had come in contact with someone positive for COVID-19, many walked up to be screened or treated.
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