Kerala Health Minister: ‘Our strategy is tracing, quarantine, testing, isolating and treating… not testing, testing, testing, nothing else’

The author: Liz Matthew
, Abantika Ghosh

Update : 13. June 2020 4:44:56

K K Shailaja, Minister of Health of Kerala

K Shailaja, Minister of Health of Kerala in an interview on Zoom with Liz Matthew and Abantika Gosh (below)

К. K. Shaylaia, Minister of Health of Kerala, made headlines about how the state treats Covid-19. In this episode of the E-Xplained series, presented to a national audience on Zoom, she explains how Kerala has kept the numbers low and looks at the problems ahead.

The reliable health system of Panchayati Raj and Kerala…

In Kerala we [the Panchayati Raj] established democracy. Our local government is fully responsible for the power, and the distribution of the money is the same. Our primary care centers are now under the panchayate, the local level. They are well planned; with the support of the Ministry of Health, they are implementing many new projects in primary health care centres. It is currently under the responsibility of the Ministry of Health, but the local authorities are responsible for it and the primary health services are under their control.

About the use of contact tracing technology

Yeah, I think the most important thing is the preparation plan. When we heard that a new virus was spreading in China, in Wuhan, we expected it to spread permanently to Kerala, because there are a lot of Malalis in Wuhan, and we started planning in January. I think you know the WHO is scheduled for 18 years. Janvier announced that there is a potential virus in Wuhan. The WHO did not declare it a pandemic at the time, but when we heard about a new virus, a new type of virus from the SARS family, the family of coronary heart disease, we immediately started talking about it. My Health Minister and my team met and discussed this new type of virus and we started planning. The 24th. In January we had a very good meeting with our crisis response team. We have opened our state-level control room and informed all 14 districts, district health workers (RMI). They’ve also set up control rooms. We’ve assembled teams of experts in each control room. Each additional DHS and other senior officials have one or two responsibilities. One is responsible for contact tracing, the other for setting up isolated rooms and hospitals in Covida, and the other for collecting relief supplies and even mental health care.

As we expected, the coronavirus from Wuhan arrived in Kerala. The 30th. In January we received the first positive case, and in February of the first week we received two more. But when we tested the samples, the three students were in our isolation ward at the hospital. This was our success because there was no contact, no transmission of this virus from there. Then, at the end of February, people came again from other countries. At that time the virus spread all over the world – in Italy, Great Britain, the United States, everywhere – and people from those countries started coming back to Kerala. But our surveillance team was at the airport – we didn’t remember the team – and they were watching all the people who were coming back. Our strategy: Monitoring, quarantine, testing, isolation and treatment.

About the recent business recovery from last month’s recession:

Yeah, sure, but we were expecting this sooner. During a lockdown in March and April… The trip was interrupted, no one came from abroad or from other states in India, and we had positive cases among those who came back from other countries at that time, and we treated those positive cases. However, the situation changed when the blockade was lifted, air traffic resumed and ground traffic was restored. People came back from other countries and from other parts of India. Of course we were expecting that, we were expecting that… we thought there’d definitely be a second wave.

The people who came back, there are so many positive cases among them, and we’re dealing with them. We’ll chase them to the airport ourselves. Not only at the airport, they also come by water; in the seaport we have a very good surveillance team – and on the way; our checkpoints are there. There are also 15 to 20 tables in the stations. This time more than 1.5 Lakers returned from the Gulf States; some tested positive. And also from Chennai, Maharashtra – we have received the most positive cases from Maharashtra, Mumbai, the second from Chennai and Gujarat. Not only positive, but some of those who came back from these epicenters… were in a wretched state. The woman, who returned to Kerala by car from Mumbai, was not quarantined but was hospitalized because she was very ill. When she got to the hospital, she died. That’s the state of people coming back. Therefore, the number of positive cases is increasing and the mortality rate is rising.

Because of the pressure on the health systems to which many returnees are exposed.

Yeah, we were planning on dealing with such a difficult situation. It’s certainly difficult, but we have a plan A, a plan B, a plan C, and so on. In Plan A we have three Covida hospitals in each area, and I think there are over 1,500 beds for Covida patients in [each] hospital. And in plan B, we have more hospitals. We’re turning the hospitals into Covid, and we can manage 5,000 – up to 10,000 – under these conditions. As part of our Plan C we organize hotels, hostels and classrooms for coviidosis patients; this is currently under review and we have a very good list of facilities. We also follow the personnel policy, not only in the public sector, but also in the private sector. We have a very good list of medical resources, and we train them to deal with the situation when [many] positive cases emerge.

Liz Matthew & ABantica Links

This has not exceeded our expectations, because we expect that when 1.5 lah comes, there will be about 5000 positive. Six lah people have registered on our portal to return to Kerala and we will therefore receive quite a few positive cases. It’s no problem. The problem is that if positive people do not adhere to our quarantine principles, there is personal contact and transmission of the virus. If you can transmit this virus to four people, they become 40, then 1000, or 600, or any number. It will be like a nuclear chain progression or reaction; it will evolve.

On the possibility of a Community transfer

We cannot say that the community program will not exist, but there is no community program in Kerala at the moment because we are researching everything. When we receive a case from external contacts or import cases, we keep a close eye on the contacts from which it originates and also perform sentinel surveillance tests. We have already carried out more than 15,000 observation tests, of which only a few positive cases have been found and we have also found a link with positive cases or certain contacts, travel history, etc. Therefore, we say that the enlargement of the Community did not take place. We also test for peripheral pneumonia – and this time the cases of peripheral pneumonia have decreased. We collect additional samples from all parts of the company, 3,000 at a time, and so on. This shows that the virus has not yet entered the Community. But tomorrow, if quarantine is a failure – we don’t think so, but if it does happen – the community will certainly expand.

Does Kerala have enough control?

Yeah, the tests are the most important thing. But we don’t follow the slogan test, test, test, nothing more. We’re doing strategic testing. Our main concern is to first monitor and assess the symptomatic cases. And people with a travel history or certain contacts will be quarantined in an appropriate manner. And if symptoms occur during the quarantine period, we take the patient to the hospital and perform further samples and tests. But we have to be very careful that the quarantine is scientific. With the help of the local government, with the help of Anghanwadi employees and assistants, with the help of ASHA employees, we follow people to their homes, keep in touch with them by phone and approach the threshold. We’re investigating whether a person is quarantined or jumping into quarantine. We call them every day to see if they have any symptoms. We send our ambulance home immediately and transport that person to our hospital, where we take and perform samples and tests.

It’s our test method. We will continue in the same vein and slowly expand the number of tests. As more people come out of the epicenters, we need to increase the number of tests at the highest and secondary contacts. Sample and shipping tests are also available. We’re intensifying our tests now, but there’s no need to test them all. That’s where our test kits etc. stop and then we have to cry because we can’t touch the right suitcases at the moment. This has happened in some countries – I think that in Italy and the United States all the test kits have been used in the first part. At the time, they didn’t have the right testing strategy, just a slogan: Testing, testing, testing. It can’t be a good method, and we’re testing our strategy, and we think it’s a scientific strategy.

Questions from the public

In his message to the other Covid fighters.

We have introduced traceability and quarantine, testing, isolation and appropriate treatment of patients or virus carriers. The most important thing was to break the chain. Or people should follow the advice of our health care system – wash their hands, mask themselves, maintain a physical distance, and so on. -which we have to follow for a long period of time. Since this virus has been around for so long, we will have to make some behavioural changes in the meantime. It’s the only way. Each person is responsible; our health is our responsibility. Here’s the slogan: I’m responsible for my health.

To their frustration at the lack of a vaccine or drug:

Yes, everyone knows these disappointments and fears because we’re impatiently waiting for the vaccine. Every day we read everything that appears in newspapers, media and even Lancet magazines etc.. – when there’s good news somewhere in the world about the number of experiments being carried out. As a science teacher, I’m sure one day they’ll find a very good vaccine against this deadly virus.

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