A large number of Kerala residents travelling outside and testing positive were seen as yet another sign of community transmission. The fear was heightened because authorities in Kerala could do nothing about these cases, especially the tracing of their contacts here, as Kerala Chief Minister Pinarayi Vijayan himself said the other states were not informing Kerala of these cases.
Since there was no sharing of information, the department of health looked for such cases in the National Centre for Disease Control (NCDC) portal. From the NCDC portal, it was found that a total of 110 persons from the state were tested outside Kerala and found positive till June 30. Out of these, three were duplicate entries and were excluded from the report.
In short, there were 107 Kerala residents who had tested positive n labs outside Kerala.
Eleven of them could not be studied as they were either non-cooperative or they could no be contacted. So the immediate back history of 96 of the 107 were studied and it was found that only six were likely infected in Kerala, and one of them it was felt could even be a 'false positive' case.
As for the remaining 90, the health department concluded that it was either "not possible" or "unlikely" for them to get infected in Kerala.
Even among the six, three were obvious cases: they had not gone out of Kerala, only their samples were taken outside. Therefore, it was clear they were infected in Kerala itself. These included a 55-year-old female, a 74-year-old male and a 49-year-old male, all from Thrissur.
Their samples were taken as part of pre-operative procedures; hysterectomy with ovariectomy for the female, herniorrhaphy for the 74-year-old male and oedema for the third.
The other three who were "likely" infected in Kerala were males below the age of 30. The first patient, a 27-year-old Kozhikode native, came from Coimbatore on March 20 and was in quarantine for 28 days. He had no history of travel or contact with persons who travelled outside India or Kerala. There were no positive cases in his panchayat (Koothali) area those days either.
The youth, who worked as an accountant in a jewellery shop in Coimbatore, travelled to Coimbatore on June 15 along with his three friends in an A/C car. All wore masks while travelling. They halted at a tea shop along the highway. But neither did he get down nor had tea.
On arriving at Coimbatore, his throat swab was taken at a government hospital at Coimbatore on June 19 and this turned positive. He was shifted to isolation at ESI Hospital, Coimbatore, on June 20.
His throat swab was repeated on June 24, which showed negative. He was discharged on June 26. He stayed there for two days in a hotel and returned to Kerala on June 28.
Now he is in institutional quarantine at Perambra. He was asymptomatic. Three of his friends who travelled along with him did not turn positive. His family members also did not test positive. None of his 52 contacts turned positive. Repeat samples taken at Coimbatore was negative.
"Considering the above factors there is a high chance that his first test may be false positive," a department of health report said.
Guest worker from Assam
The second person who could have possibly been infected in Kerala is a 20-year-old guest worker from Assam. He was staying at Valanchery, Malappuram, in a dormitory along with other co-workers.
He travelled to Guwahati by train and arrived there on June 19. He developed fever on the same day and the next day he was tested positive. Even though he did not have any direct contact with any positive cases there were positive cases in Valanchery.
While in Kerala, he used to go out to the market nearby. Most of his contacts went back to their native places on different dates in different trains and could not be traced. Those who were staying back were tested and were negative.
"Considering the incubation period there is a possibility that he contracted the infection while travelling since none of his cohabitants/contacts in Kerala turned positive," the report said, suggesting there were equal chances of him getting the virus outside Kerala.
Sure case of Kerala-borne infection
The only person the health department says has caught the virus in Kerala with a measure of certainty is a 24-year-old youth who left for Katpadi in Tamil Nadu on June 9.
He was asymptomatic. On June 11 his swab was taken and result came as positive on June 16. He travelled along with seven other passengers from Palakkad to Coimbatore by bus and from Coimbatore to Katpadi by train. All of them tested negative.
"There is a possibility that he contracted the illness from Kerala considering the incubation period. There were cases in Palakkad during these days and they have halted at Walayar check post for permission to cross the border," the report said.
A top sources said the department of health and family welfare was further examining the six cases. "The teams have been asked to do further back series studies to see whether there were more cases during the same period. It is also instructed to do more testing in these panchayats to see whether there is an active infection source in the localized areas," the source said.