Kerala moves aggressively to limit an emerging COVID-19 public health crisis

Outside a special isolation ward for coronavirus patients at Kochi Medical College, on March 10.

Nearly a fortnight after a family of three with a travel history to Italy arrived at the Kochi airport and later tested positive for the SARS-CoV-2 virus after possibly transmitting the infection to at least 270 people whom they had contact with directly, the Kerala government has launched extraordinary steps to contain a coronavirus outbreak in the State.

The family, which hailed from Pathanamthitta district, arrived in Kochi on a flight from Doha, Qatar, but had disregarded official guidelines to report to the authorities about any visit to coronavirus-affected countries, which included Italy.

On March 10, even as one of the largest religious congregations in the State concluded at the Attukal temple in Thiruvananthapuram, raising concerns about the possibility of the spread of infection among the general population, the Kerala government announced thorough restrictions on all public gatherings in the State until the end of the month.

Despite health advisories, thousands of people had participated in the 10-day annual gathering of largely women devotees at the temple, who waited in long, congested queues for a darshan and, in a climactic ritual, overwhelmed civic facilities in the city for presenting a traditional offering to the goddess with rice and sweet delicacies cooked at the temple grounds, public places, houses and along city roads extending as far away as 10 kilometres or more.

The public health concerns such a mass-scale event highlighted, given the spread of the coronavirus infection in many countries with large NRI populations from Kerala, remained largely unaddressed.

But the very next day, the State government called for festivals in temples and mosques and other places of worship to be limited to essential ceremonies alone, to avoid people gathering in large numbers. Schools, colleges, anganwadis, madrasas, tuition and coaching centres and vacation classes have been asked to remain closed. Cinemas and other such entertainment venues have also been asked to shut down until March 31.

All public functions of the government are to be suspended until the end of the month. Government offices have been asked to take precautions to control the spread of the disease, including requesting people to avoid physical contact for greetings and popularising the use of sanitisers.

Those who return from the 12 countries worst-affected by COVID-19, among them Italy, Iran, South Korea, China and Singapore, have been asked to take voluntary precautions, including remaining at home or hotels without contact with others. Visitors from other countries are required to be in touch with the Health Department immediately on arrival in Kerala and every day of their stay in the State.

Many tourist centres remain closed. Isolation rooms have been set up in all prisons in the State. The State Assembly continues to be in session but visitors are not allowed.

Chief Minister Pinarayi Vijayan said after a specially convened Cabinet meeting on March 10 that six more persons had tested positive for the virus, taking the total number of those infected in the State to 12. Later, the Health Minister said two more had tested positive. All except three of those who have tested positive so far are from among those who have had direct contact with the members of the family in Pathanamthitta since their arrival in the State on February 29. Robust contact tracing established that the family had interactions with at least 719 people. Of them, 270 were in the primary contacts list and 449 in the secondary contact category. The Pathanamthitta district administration has even circulated a map showing the time and place of visit by the three members of the family that came with the infection.

Another family of three, including a three-year-old child, had arrived from Italy on March 8, but had promptly told the authorities at the Kochi airport that the child had fever. The boy tested positive for the infection and was put on isolation immediately. Later, the parents too tested positive and they too were quarantined. No other case of infection has been reported to have spread from this “cluster”.

“We all know the negligence on the part of a few people who returned from Italy to inform the authorities about their arrival from that country (among the worst-affected by the coronavirus) is what has led to the current situation. It has reached a stage when the infection is spreading among the general population. We are trying to control the spread as far as possible. Those who arrive in Kerala from other countries should not hide that information from the government. Even after the authorities got in touch with them, they sought to hide details of where all they visited after returning to Kerala. Such behaviour causes much harm. The government will be forced to take legal action against those who indulge in hiding information,” the Chief Minister said, referring to the family from Pathanamthitta.

Suggesting voluntary curbs on religious festivals, the Chief Minister said festivals in temples and mosques and other places of worship should be limited to required ceremonies alone. He said: “This is the festival season in Kerala, when different denominations of people gather in their thousands. Such gatherings as part of festivals will only prove harmful in the present context. We will not be able to control it if the situation goes out of hand. The Cabinet has decided to issue instructions asking organisers and the people to avoid such festivals, given the seriousness of the situation. The most prominent of such festivals is at Sabarimala. The temple rituals and ceremonies can be conducted. But people should avoid going for darshan there at this time. We must also be able to control large community gatherings as part of weddings. People must take care to limit the scale of such festivities.”

The respective Devaswom Board authorities later asked devotees to refrain from visiting the temples at Sabarimala and Guruvayoor and also announced the cancellation of several ceremonies which usually attract large crowds. The State Transport Corporation has cancelled services to Pampa (near Sabarimala) during the monthly ceremonies. The Kerala Catholic Bishops Council and several other church authorities have also announced restrictions on mass gatherings and cancellations of all programmes except essential church ceremonies.

A total of 1,116 people are under observation in the State, 967 of them in home isolation and 149 in hospitals, the Chief Minister said. In all 807 samples from suspected cases have been sent for tests and 717 tests have returned negative. Other results are awaited.

The State government has also decided to seek the help of private hospitals for providing necessary facilities if and when more patients come in. More surveillance measures are to be introduced in airports and other such places. The government has also sought the support of local body members, people’s representatives, ASHA workers, and residents’ associations in urban areas to strengthen the COVID-19 surveillance system.

The State government also decided to start new testing support facilities for SARS-CoV-2 in Thiruvananthapuram, Kozhikode and Thrissur, in addition to that in Alappuzha, for faster and more widespread detection.

“We have to deal this issue with seriousness. What is needed is not fear but vigilance. We need to be vigilant to prevent a dangerous situation from developing. We must control the spread effectively. Kerala has very good experience in dealing with such threats. But if we falter, it will lead to unexpected problems. This is not a situation where we need to be extremely fearful. The steps that have been announced are part of our vigilance to prevent bigger perils,” the Chief Minister said.

The first three confirmed cases of coronavirus infection were reported in Kerala in early February and the patients, all of them students who returned from China, were identified on arrival at the airport and promptly quarantined, treated and sent home after they had made a full recovery. Swift government action had prevented the spread of the infection among the general population.

But the reluctance on the part of a family, who came on a holiday to Pathnamthitta, to report to the authorities their travel to a COVID-19-affected country has completely altered the situation in the State, creating an escalating public health emergency that has forced the authorities to act more aggressively, implement multiple public health interventions and seek the active support of the people in the surveillance and containment efforts.