(Editor's note: This is the fourth and final part of a series on how Kerala's Kasaragod district efficiently controlled COVID-19 pandemic. Read previous parts here, here & here.)
Last Saturday, a team of health workers from Chemnad Primary Health Centre (PHC) in Kerala's Kasaragod district rushed to a coastal neighbourhood in Chembirikka after a woman was diagnosed with COVID-19.
The six-member team – medical officer, public health nurse, health inspector, junior public health nurse and an accredited social health activist (ASHA) – first shifted the woman to the district general hospital in Kasaragod in an ambulance and three members of her family to another testing centre.
Even as they were completing the procedures, they heard wailing from the neighbouring house. The neighbour's nine-member family feared that they too would infect COVID and the life of their five-month-old baby was in danger. Their cause of worry was a reported death of a COVID-infected baby of the same age in a Kerala hospital.
The health team spent a few hours consoling the family. They could convince them that the disease would not give much trouble to healthy babies and the deceased child had a heart ailment.
After sending nine persons to the testing centre at Kasaragod general hospital, the team launched contact tracing. They visited all nearby homes and checked if any of them had contacted the infected woman.
Aggressive contact tracing and testing have become routine for the health workers at the PHC ever since Chemnad panchayat reported its first COVID-19 case on March 16. Till April 28, Chemnad reported 38 COVID cases, the highest in a panchayat in the state. Of them, 36 have been cured and the remaining two are being treated in hospitals.
The impressive disease containment and recovery data is in line with the waning pattern of infections in Kasaragod district, which had reported the highest number of COVID-19 cases – 173 – in Kerala. Proactive interventions of the health department, district administration and police department could rein in the virus and effectively bring down the number of active patients to just 13 on April 28. In the process, it set a record of sorts by becoming the first Indian district to cure the highest number of COVID-19 patients – 160 – without mortality.
Chemnad is the biggest panchayat in Kasaragod district in terms of size and population. It lies just four kilometres south of the district headquarters of Kasaragod and borders the Arabian Sea on the west.
Of the 65,000 residents here, around 5,000 work in various foreign countries, mainly in the Gulf Cooperation Council (GCC) countries.
Twenty-three of the infected persons in the panchayat came from abroad – 22 from Dubai in the United Arab Emirates and one from the United Kingdom – while the remaining 15 got the disease through contacts with foreign returnees.
Tackling the crisis
Health workers in Chemnad were in a shock when the first COVID case emerged on April 16.
Not that they were unfamiliar with the disease. They knew that the dreaded disease originated in Wuhan in China has been creating trouble across the world. They had conducted numerous public awareness campaigns on the importance of social distancing and hand-washing to keep the disease at bay.
"I think coronavirus (which causes the disease) came a bit early to Chemnad. We were expecting it because of the panchayat's link with the Gulf countries," said Dr C M Kayinhi, Medical Officer at the PHC, who leads the health workers in the COVID fight.
The fast-spreading disease did not give his team time to relax. The second positive case emerged in the next three days. In a week's time, the number of cases rose to eight and it kept on increasing.
"We did aggressive contact tracing and sample testing even as things looked going out of control," said O T Salmath, Public Health Nurse, who took great pains to ferry people to the testing centres.
The core team from the PHC, along with ASHA workers, visited every neighbourhood where the cases emerged, identified primary and secondary contacts and requested them to undergo tests and quarantine.
But it was easier said than done.
"We faced a lot of difficulties. People scolded us and alleged that we were creating unnecessary panic when we went to identify the contacts. Such harsh behaviour made us cry," recounted Health Inspector K B Sujatha.
Sending people for testing was another tough task.
After contact tracing, the team would prepare a list of persons to be sent for testing the next day.
"We would tell persons to get ready by the time the ambulance arrived at their homes. But many of them tried to skip the test. Then we had to go to their homes and convince them about the importance of tests. It was a herculean task," Salmath said.
The efforts, however, paid rich dividends.
Between April 1 and 20, when the infections were at its peak, 25 persons from Chemnad got tested everyday.
Till April 28, the panchayat tested around 750 samples, one-fourth of the 3,000 samples tested in Kasaragod district.
Kerala tested 23,277 samples till April 28. Kasaragod district surveillance officer Dr A T Manoj said Chemnad experienced a surge in cases because of the diligent testing. "The number of positive cases increased in the panchayat because of its thrust on testing," he said.
Effective contact tracing
Statistics speaks volumes about Chemnad's effective contact tracing and containment measures.
Of the 23 wards in the panchayat, positive cases have been reported only from 12. The virus has not only affected half of the panchayat, but it also did not create any trouble in areas sandwiched between the COVID-hit wards.
Medical officer Dr Kayinhi saw this as the result of extensive contact tracing and containment measures. "The disease could have spread across the panchayat in the absence of such measures," he said.
Panchayat president Kallatra Abdul Khader said words are not adequate to describe the health workers’ hard work. “They saved our panchayat,” he said.
Health standing committee chairperson C M Shaziya agreed. "The health workers did a fabulous job," she said.
The health workers were ably supported by people’s representatives and volunteers.
At Kalanad, the worst affected ward with 12 COVID cases, member Abdul Rahman was busy monitoring the Gulf returnees. "In my ward, 118 people came from Dubai. Seven of them tested positive for coronavirus. The rest were in quarantine. I used to call them regularly and urged them not to step out of their homes. It helped reduce the virus spread," he said.
Unfinished task
Though the viral spread of disease appears to have stopped for the time being, the health workers at Chemnad say their work has not finished yet.
Recently, they collected 80 samples from the vicinity of COVID-19 hotspots to check whether there was a community spread of the disease. (Community spread refers to the third stage of virus spread when infections cannot be tracked back to a certain person. The disease spreads in such a way that people don't know how they are exposed to the virus.)
All samples returned negative.
But Chemnad is expecting another wave of virus attack with the arrival of persons from other parts of India after the lockdown period ends.
Dr Kayinhi said his team is ready to face any eventuality. "A month ago, we were in a really bad situation, but rigorous testing and contact tracing saved us. We are ready for the challenge,” he said.
(Corrections and clarifications: The headline of this article has been corrected to make it clear that Chemnad registered 38 COVID cases. The earlier headline mentioned 37 cases. The error is regretted.)
