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On January 23, three medical students travelled from Wuhan, China to their hometowns in Alappuzha, Thrissur and Kasargod in Kerala, India. They had been studying at the Wuhan Institute of Medical Sciences, but were evacuated from China — along with hundreds of other students — after the government announced it would lock down the city and others in Hubei province, in response to the coronavirus crisis.

On returning, the students were asked to report to their nearby hospitals for screenings and to self-isolate at home, out of concern that someone could bring the virus — which had already infected over 7,000 people and killed 170 others in China — home. A week later, on January 30, one of the three students tested positive for the virus, becoming India’s COVID-19 Patient Zero.

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“It’s not surprising that Kerala was the first to report a case,” Anant Bhan, a researcher in bioethics and global health policy, told the National Post. The state boasts higher-than-average international traffic within the country, due to tourism and travel between the Gulf states.