More on Covid-19

Kerala has been reporting fresh cases of the novel coronavirus in single digits for the past few days, a flattening of a deadly curve by measures that included early detection, aggressive testing and contact tracing, and a 28-day quarantine period — double that prescribed by the WHO. And underlying it all and making it possible was a robust public health system.From one infection on January 30 to 378 on April 13 and two deaths so far, the state has seen 198 people recover. It recorded its highest cases in a day (39) on March 27, and the lowest on March 19 (1). On April 12, it was just two cases. It realised early on the potential lethality of a curve arcing sharply upward.As early as January 18, the state health department issued a Covid-19 alert and began to screen passengers arriving from abroad, initially from the cradle of the virulent spread: China. International arrivals were given a health card in which they had to list their travel details and health condition.All the state’s five airports were linked to ambulances and emergency response in district hospitals. Any passenger with a fever, cough or sore throat was immediately shifted to a linked hospital and from there a message passed on to the district medical office.Over the next week, it set up district control rooms, started procuring masks, gloves, other personal protection equipment (PPE) and medicines. It ordered district hospitals to designate isolation wards. Within weeks, on February 4, it declared the Covid-19 threat a state disaster. Contact tracing was meticulous. Manual surveillance, from January 30 to March 8, began with interviewing individual patients and working backwards to people with whom they had been in touch.From March 9, it introduced spatio temporal mapping after a family of three came didn’t report their travel to Italy. This involved a detailed flowchart that depicted the date, time and movement of each affected person, based on call details and CCTV footage.Home quarantine was strict — 12,470 were in home quarantine on March 16; this rose to 1,22,676 people on April 11. Each person in home quarantine, for 28 days instead of the recommended 14, received an average of 2 to 3 calls daily from authorities. About 16,000 teams ensured those in home quarantine stayed home.By April 12, 14,989 samples had been sent for testing, of which 13,802 came out negative. From April 1 to 13, the state conducted 227 tests per million people for its population of 3.4 crore.On March 28, CM Pinarayi Vijayan announced the state would conduct rapid testing, involving blood samples, not swabs, and results within 45 minutes to 2 hours. These tests can be repeated on a patient in quarantine and can reveal the extent of recovery.Kerala also kept its doctors safe. A three-tier system was implemented at all government medical college hospitals. Doctors were split into three teams. The first worked on Covid-19 cases and in isolation wards. The second attended outpatient cases and the emergency department. The third stayed home on leave, prepared to deploy if the need arose.The lockdown showed results in Kerala. The state had reported 109 cases on March 24, a day before the lockdown, and was at that point the worst-hit. But, as the lockdown wore on, it almost flattened the curve, bringing the increase in cases per day down to just about 10% by the end of the first week. Since April 3, it’s been between 3% and 4%.