Advance planning, effective execution: How Kerala is fighting its battle against COVID-19

Prema Prakash was making bed coffee on Sunday morning when she got an alert that a person reached his house at Balussery, about 25 kilometres from Kozhikode city in North Kerala, from the neighbouring Kannur district, which is a COVID-19 red zone. Prema rushed to the spot and advised him to remain in home quarantine.

Prema, aged 44, is among the 26,740-odd Accredited Social Health Activists (ASHA) in Kerala who have been playing a key role in fighting COVID-19 at the grass root levels.

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When the first COVID-19 case was reported on January 30, two more in the subsequent days and a spike from March 8, Kerala health sector remained unshaken as the plan to face even a community outbreak was already in place.

This vision of the top echelons of Kerala Health Department and the well-coordinated activities up to the grass-root levels helped Kerala put up an impressive fight against COVID-19 with close to 100 percent recovery rate and 0.6 percent novel coronavirus mortality rate till date.

How effective quarantine was ensured

Vigil by health officials, local bodies and police, played a key role in effective home quarantine and deal with community spread if it was reported.

Sreevidya, an ASHA of Madhur in Kasaragod district that shares borders with Karnataka, tells how the grass-root level systems worked to contain the COVID-19 spread in the district, which witnessed up to 178 COVID-19 positive cases coming down to nil with zero mortality.

"As soon as an alert against COVID-19 came, ASHA workers, with support on local authorities, would trace NRIs in their regions. Once an NRI reached his house, the NRI and his family would be advised to remain in home quarantine. Contacts of each person will be collected in advance and in case a person is later tests positive, all his contacts would be swiftly quarantined," said Sreevidya.

Even as technology-based surveillance systems were there, ASHA has traditional surveillance mechanisms like alerting neighbours of those on home quarantine about the chances of contracting the infection if the persons advised to remain on home quarantine moves out of their house. Hence, the neighbours would give alert in case of any home quarantine violations in their neighbourhoods, said Prema, who is also the state president of ASHA union in Kerala.

Apart from strictly enforcing the lockdown norms using police, the Kerala government also initiated various measures like doorstep delivery of essential commodities to ensure that the people have no reasons to move out of their houses. The comparatively higher level of compliance to lockdown norms by Keralites also helped in containing the COVID-19 spread.

Early detection led to high recovery

While COVID-19 patients aged above 65 were considered as a high-risk group, Kerala witnessed even a couple aged around 90 recovering from novel coronavirus.

Dr Santhosh Kumar, chairman of the state-level medical board for COVID-19 control, said that owing to the effectiveness of Kerala's health network, most of the COVID-19 patients could be traced at initial stages of infection. This, as well as the health infrastructure put in place well in advanced to fight the virus, helped in attaining high recovery rate and low mortality.

He said that even as the state was generally following ICMR guidelines for COVID-19 treatment, necessary modifications were being made based on conditions of each patient.

Preparations for possible spike in coming days

With NRIs and Keralites from other states started to come in, Kerala is still facing a risk of a further spike in COVID-19 cases. Already, five NRIs who were evacuated tested positive for the virus.

Anticipating this risk, Kerala made advance measures like online registration for those who wish to return to Kerala. Around 4.3 lakh NRIs and 1.7 lakh from other states have already registered. This data is being distributed at the local levels.

Any Keralite coming into the state from aboard or other states would be allowed to remain in home quarantine only once the authorities at local levels are convinced of adequate home quarantine facility. Otherwise, they would be shifted to the institutional quarantine as the state has kept such facilities ready for 1.65 lakh persons already.

Dr Santhosh said that the state could very well contain a further spike in COVID-19 due to local contact if all those who return to the state strictly adhere to the government channels.