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Sunday, February 23, 2020

The Flu: How Kerala, China are tackling coronavirus

With India reporting three positive cases of the novel coronavirus, all in Kerala, The Sunday Express on how the state is leaning back on its Nipah experience to tackle the latest outbreak. Over 4,000 km away, in China’s Hubei and nearby provinces, life in lockdown is a series of do’s and don’ts.

Written by Shaju Philip , Sowmiya Ashok | Updated: February 9, 2020 7:20:38 am
coronavirus, coronavirus india, kerala coronavirus cases, ncov 2019, nipah virus, nipah virus kerala, indian express news For Kerala, the virus is a fresh challenge after the deadly Nipah outbreak of 2018 and 2019 that had claimed 17 lives, all in 2018.

Kerala: Three positive cases in country, all from state; 3,144 people under observation

The 22-year-old, a medical student at a university in Wuhan, China, is home in Malappuram and, as usual, the focus of everyone’s attention. Only, this time, it’s edgy. Twice a day he gets a call from the local government hospital, inquiring if he has fever or sore throat. A few times in the day, his mother serves him food wearing a mask. The rest of the time he is on his smartphone.

The 22-year-old has been under a 28-day quarantine at his home in Kerala’s Malappuram district ever since he came back on January 22 from Wuhan, the capital of China’s Hubei province and the epicentre of a virulent outbreak of the novel coronavirus (nCoV) that has, as of February 8, claimed at least 723 lives and infected 34,600 people in China.

The 22-year-old is one of the 3,144 people under observation in Kerala, which has reported three positive cases of coronavirus, so far the only confirmed cases of the virus in India. “I am feeling perfectly fine. But the person who calls from the hospital says that if I develop any symptoms, the local primary health centre will send an ambulance over. The health inspector has told me that I should not voluntarily move out,” he says over the phone.

“I watch the news on my mobile phone. I am also in touch with friends from Wuhan who are under observation,” he says, adding, “I recently got a message from the state health department calling me a hero for surrendering my freedom for the safety of society.”

For Kerala, the virus is a fresh challenge after the deadly Nipah outbreak of 2018 and 2019 that had claimed 17 lives, all in 2018. The state has been on vigil since January 17, when the Centre sounded an alert for coronavirus. By January 30, the figure of those under observation had touched 1,053. Within the next five days, with the three positive cases being reported, Kerala declared a state ‘calamity’. At 418, Malappuram district has the highest number of persons under observation for suspected exposure to the virus.

To tackle the challenge, the state health department has fallen back on its past experience in managing the Nipah outbreak and put in place a multi-level mechanism for surveillance and control of the infection.

coronavirus, coronavirus india, kerala coronavirus cases, ncov 2019, nipah virus, nipah virus kerala, indian express news Outside an isolation unit at the Government Medical College, Thrissur, where one of the three positive coronavirus cases has been reported. Express Photo by Anoop K Venu

“We have an excellent system at various levels to monitor those exposed to the infection. We have activated the emergency system which was in operation during the Nipah days,” says Dr Mohanan Kunnummal, vice chancellor of Kerala University of Health Sciences.

By the third week of January, when the Union government sounded a nCoV alert, the health department set up a state-level control room and a rapid response team which were directly linked to the 14 district medical offices.

Isolation units were prepared in all the six medical colleges and 14 district government hospitals. “The most critical aspect of reining in the virus was zeroing in on persons with suspected exposure to the virus in China and isolating them,” says Dr Amar Fettle, the state health department’s nodal officer for Public Health Emergency of International Concern.

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The control room started by first obtaining a list of passengers from China who had deboarded at the state’s international airports, and tracked them down. Initially, only passengers at Kochi International Airport were screened, but the exercise was soon extended to the other three international airports — Kozhikode, Thiruvananthapuram and Kannur — in the state. Even domestic passengers — who had landed at international terminals in other states and moved to Kerala — were screened.

Simultaneously, a screening exercise was initiated at the grassroots level. Junior public health inspectors, public health nurses and ASHA workers kept a tab on those who had returned from abroad. A list of those suspected to have caught the flu was sent to the control room, which, in turn, sent a list of people to be monitored to all district medical officers. Thereafter, each person on the list was assigned to a primary or family health centre.

“At the primary health centre, the medical superintendent and the staff ensure that the patients are strictly following the quarantine guidelines. These centres also have to mail two reports, one in the morning and another in the evening, to the state control room everyday via the district medical officer,” explains Dr V Jayasree, the medical officer in Kozhikode district, where 378 persons are under observation (as on February 8).

Since those who left China before the Indian government’s evacuation exercise came to Kerala via Kolkata, it was fairly straightforward for the state health department officials to prepare a list of those with Chinese travel history. “As the list was compiled quickly, all of them were put under instant observation. While many of these people voluntarily reported to the department and went into isolation at homes, we had to track down another section of people who had returned from China but were unsure about what to do next,” says Dr Fettle.

After the health department received information about the positive tests, the next step was to prepare a list of those who had come in contact with infected patients. These people were categorised into two sections — high- and low-risk. Those in the high risk were persons who had spent long hours with the confirmed cases, or those who had had any fluid contact with them.

“The Nipah virus was confined to Kozhikode and Malappuram districts. This time, while the three confirmed cases are from Thrissur, Alappuzha and Kasaragod, those under observation hail from districts across the state,’’ said an official.

So far, Kerala has deployed over 100 experts and officials, including doctors, at the state-level control room. The team has been further split into 18 committees, each with a specific task — managing the treatment of the positive cases, collecting samples and their dispatch, community-level volunteers for supporting those in isolation, and a psychological support team for those under home quarantine, among other duties. Apart from a state-level medical board, three separate medical boards have been instituted in the three districts that has reported the positive cases of coronavirus.

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“We have also set up a call centre to address the public’s doubts about the infection. We have received 9,000 calls so far,” said an official. Also, 7,515 elected representatives in local self-governing bodies and 14,177 Kudumbashree (the poverty eradication and women empowerment programme of the state government) volunteers have been trained on public health issues as part of a capacity-building exercise by the state health department.

Since February 3, the control room has also been helping those in quarantine with tele-counselling. “So far, we have not received any complaints of mental trauma. Most people in quarantine only had doubts about the infection,” says Dr Maya Peethambaran, nodal officer for tele-counselling in Alappuzha district.

China: 723 deaths, over 34,000 infections

coronavirus, coronavirus india, kerala coronavirus cases, ncov 2019, nipah virus, nipah virus kerala, indian express news Patients at an exhibition centre that has been converted into a temporary hospital in Wuhan. (AP Photo)

Ningning thinks of them as ‘DIY’ slogans. From 8 am to 5 pm, a loudspeaker outside her parents’ home in a closely packed apartment compound in Shiyan in northwestern Hubei hollers at the community: “If you have one peck of rice, don’t go anywhere crowded; if you have one sprig of onion, don’t hang at the market; if you have one piece of meat, don’t show your face at the supermarket; if you have a breath of air, stay home and guard the ranch.”

Like the rest of Hubei province, Shiyan, a prefecture-level city about a seven-hour drive from Wuhan, is under lockdown. For the 300 families confined to their apartments, “these slogans sound like cheesy poems on a loop”, says Ningning, a 26-year-old who studies in Beijing. Like millions of people in China, she too was part of what is seen as the world’s largest annual migration — a trip home for the Chinese New Year. But from 1 am on January 25, Shiyan went quiet.

The lockdown has brought life to a halt for the over 50 million residents of Hubei, who are now following a series of instructions — stay indoors, wash hands with soap regularly, wear a mask while stepping out, and nominate family members for grocery runs, among others. With authorities racing against time to build two hospitals, gyms and exhibition centres in the region are being converted into make-shift isolation wards.

Read | Why Kerala could have a lesson on how to contain coronavirus

According to Chinese health authorities, as of February 8, the virus has claimed at least 723 lives and infected 34,600 people in China. Twenty-four other countries have confirmed at least 266 infections in all. On January 30, the World Health Organisation declared the outbreak a global emergency.

Among those forced to stay indoors in Wuhan is Monika Sethuraman, a PhD scholar in international relations at the Central China Normal University in Wuhan. From late December, the 31-year-old had been poring over virus-related articles, after first reading about it in a Chinese blog. “By the last week of January, I still saw very little news about it in the Indian media. I was worried, lots of Indians had left the town before the lockdown,” she says.

As the virus outbreak grew, the first batch of 324 Indian students were evacuated from Wuhan on February 1. One of the evacuees captured the journey in a five-minute video titled ‘Indians evacuation on silent roads of China’, set to the soundtrack of Miss Everything by Mindme and uploaded it on YouTube. The next day, a video of students wearing masks and dancing to Punjabi music from their quarantine camp in Manesar, Haryana, went viral.

For weeks, says Sethuraman, she remained confused over whether to stay or leave. “I was sniffling a bit and felt confused over what to do, whether it was safe to travel… There were reports that the virus could be transmitted through faecal material, what if the public toilets are unclean? I just decided to stay,” she says over WeChat, a popular Chinese messaging app, from Wuhan.

Among those who, as Sethuraman says, left just before the lockdown was a 25-year-old medical student from Delhi. He travelled with two of the three students from Kerala who tested positive for the coronavirus. “We were doing our internship at a hospital in Wuhan in January when a patient with coronavirus was admitted. All foreign students were told to stay away though it wasn’t certain at the time if human-to-human transmission was confirmed,” he says over the phone from South Delhi.

When word got out that a lockdown was imminent on January 24, he and a group of 12 students left town immediately. “We took a train from Wuhan to Kunming, and then from there we flew to Kolkata. I then took a train to Delhi,” he says. A journey of roughly 48 hours in all.

Back in China, as the virus rapidly spread out of Wuhan, many kept a watch on those coming from Hubei — a Chinese identity card starting with the digits ‘42’ indicates Hubei residency. In the weeks following the outbreak, many residents of the province have been subjected to unsolicited phone calls from strangers inquiring if they are running a fever.

coronavirus, coronavirus india, kerala coronavirus cases, ncov 2019, nipah virus, nipah virus kerala, indian express news At Roshchino Airport outside Tyumen, Russia, medical teams prepare to receive passengers arriving from Wuhan. Reuters Photo

Earlier this week, four Chinese cities, including Hangzhou and Taizhou in the eastern province of Zhejiang (about 800 km from Wuhan), restricted movement of its residents. The AFP reported that landlords in some parts of the province were also forbidden from renting property to people from “severely affected areas such as Hubei” if they had travelled to their hometowns recently.

In Zhengzhou in Henan province, over 500 km from Wuhan, an Indian doctor explains the restrictions on residents. “People in my apartment block are allowed to step out for only five hours each morning: 6 am to 11 am. We border Hubei province and we are under ‘red alert’,” he says. “Everywhere they check our temperature, when we leave the apartment, at the supermarket, on our way back. When I come back home, I have to show the apartment security team my passport and briefly pass through a room that sprays disinfectant on me to kill any germs on my clothes,” he adds.

Also Read | At key testing centre in Pune, 604 samples checked so far

Since January 31, the 25-year-old doctor, who has been in China for seven years, has not been allowed to visit the hospital he works at. “I step out of my room to use the toilet or cook some food. There is no fresh air here,” he says.

Across China, danwei or work units have been asked to monitor every employee. “Every danwei across the country has been instructed to keep health details of its employees updated, including information such as temperature, health problems in the family, and if they have travelled to Wuhan,” says Shanghai University Assistant Professor Rajiv Ranjan, adding, “In Shanghai, there is a rationing system for masks, to avoid hoarding. The first batch of masks will be handed out from February 2 to 11. A household can register in their society using their hukou (household registration) or passport, and five masks per family for 2.5 kuai will be handed out.”

A British national who was visiting a friend in Hubei for the Chinese New Year says smaller towns have been dealing with the health crisis in a much calmer manner, unlike big cities which have been alarmed with real-time news reports. “In villages, local authorities have been using gongs and loudspeakers to disseminate information because people may not read the news.”

While most Chinese cities wear dystopian looks, online, people seem to have found ways to amuse themselves. Videos of bored people reading books on statistics to their cats, making masks out of orange peels, dressing up as dragons, and playing indoor badminton have flooded the Internet.

“A Chinese man went to a public square in France wearing a mask and held a placard that read ‘I am a human, I am not a virus.’ And then French people are seen hugging him,” says Ranjan, recalling a video shared on a WeChat group to address the prejudice against Chinese people abroad after the outbreak.

While most took to the Internet to kill time, Cui Xiaohui, a professor at Wuhan University’s Big Data and Cloud Computing Lab, decided to use it to build an online platform to connect hospitals in need of medical supplies and those wanting to donate them. Using WeChat to organise 40 students, who sat alone in their apartments plugged into their laptops, Cui built ‘Luoying Shanlian’ that connected donors to 800 hospitals across China. “It is designed for smart phones. We send you a link and both donors and hospitals can submit contact information and details of what they have or need,” he says. In the first two hours of its launch on February 1, the platform saw 1,00,000 clicks.

For the Chinese, the year of the rat was meant to be auspicious, and as the country struggles to deal with the public health emergency, Lin Yin, a 35-year-old university professor from Foshan city in Guangdong province, is hopeful. “This Spring festival, my father suffered a stroke and now there is misfortune for my country… But we shall overcome this and help each other out,” she says.

Back in Wuhan, Sethuraman now spends her days volunteering at her university’s disease control centre, serving food and sharing information and reminders in various dormitory groups. “During nights I do my term papers,” she says. “Apart from that I am trying to stay updated about the virus. I have no idea how this is going to end.”

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