The Telangana government has decided to initiate hospital-based surveillance for severe acute respiratory infections (SARI)/pneumonia as a surrogate marker for community-based spread of Covid19. In picture, Gandhi Hospital in Hyderabad. (Express photo by Rahul V Pisharody)
The five southern states, which together account for one-fourth of the total Covid-19 cases in the country, are stepping up surveillance and disease mitigation measures in a bid to arrest the spread of the infection into the community. A host of measures taken by the states include a public campaign promoting social distancing and personal hygiene, installing testing centres at state borders, extensive screening of passengers on trains, using popular social media platforms like Telegram to address queries of the public around the viral infection and cracking down on dealers hoarding essential supplies such as masks and hand sanitisers.
As of March 16, Kerala (21) accounted for the second-largest number of active cases in the country excluding the three who recovered. Karnataka has seven active cases and one casualty, Telangana two cases along with a patient who has recovered and one each in Tamil Nadu and Andhra Pradesh. Across India, Maharashtra stood first with 32 active cases, according to recent statistics of the Union Ministry of Health and Family Welfare.
Kerala changes track from containment to mitigation plan
Over the last couple of days, Kerala has changed its strategy with respect to hospitalisation of suspected patients in order to ease pressure on the public health machinery and focus on those with critical issues. As of Sunday evening, Kerala had a mammoth 10,944 people under observation, out of which 10,655 people were under home quarantine and the rest undergoing treatment in isolation at hospitals.
Gandhi Hospital in Hyderabad. (Express photo by Rahul V Pisharody)
"(In coming days), the number of hospital admissions will be lower because we are only shifting patients with serious symptoms. Those with mild symptoms are to be managed at home. It is a transition from a containment plan to a mitigation plan because the disease may have spread into the community more than what we anticipated. That's the experience we're getting from US and Italy," said Dr Abey Sushan, district programme manager of the National Health Mission (NHM) in Pathanamthitta district. Nine out of the 21 positive cases in the state are in Pathanamthitta.
"A 100 per cent containment is not possible. To ensure the health system is not overburdened and to provide care to the most deserving patients, we have to prioritise. People with mild symptoms don't have to come to the hospital. That itself relieves the health system of a lot of pressure and enables it to cater to the people who actually deserve one-to-one care."
That doesn't mean the health apparatus is ignoring those under home quarantine. Officials said those at the district and primary health centre levels are monitoring updates of those under quarantine on a daily basis, checking up on their symptoms and enquiring if they have non-medical needs such as buying cattle-feed or groceries for the family. For the most impoverished sections, the local panchayat helps out with delivering cooked food.
Screening at the Ernakulam South railway station in Kochi. (Express photo)
Dr Sushan admitted that such welfare measures can apply stress on the health machinery, but that this is the only way to slow down the epidemic.
"Civil lockouts have helped to contain the virus in Italy and Spain according to reports. They have to be enforced. We have to do everything to make people under quarantine sit at home. Now, 99 per cent of people in home quarantine have absolutely no symptoms and if you ask such people to stay at home, it's difficult. So far, the quarantine compliance has been stable at 84 per cent. When we began the exercise, it was 65 per cent," he said.
In fact, the 'Break the chain' public campaign launched by Kerala's Left government hopes to reinstill in people the need to maintain social distancing and personal hygiene. Private firms, residential complexes and offices of local bodies have been requested to add 'break the chain' kiosks in their facilities with items like hand-wash, hand sanitiser and soap. The state is already in a high-alert mode with people putting off their social and religious functions till the quarantine period passes.
A medic wearing protective suit interacts with patients outside an isolation ward, set up in view of coronavirus pandemic, at Aluva Government General Hospital. (PTI Photo)
To ensure adequate supply of face masks and hand sanitisers, the state government has roped in the prisons department and the Kerala State Drugs and Pharmaceuticals (KSDP). Prisoners employed with tailoring units in three central prisons in the state have been producing masks on a war footing with the KSDP given a target of producing one lakh bottles in 10 days.
The state has also begun testing samples of suspected patients at the medical colleges in Kozhikode, Thrissur and Trivandrum, apart from the apex virology lab at Alappuzha. Once the testing centres become further decentralised, more tests can be conducted. The state is pinning hope that any new positive cases that may emerge would be out of the pool of those already under isolation or home quarantine.
Stringent screening at bus stands, railway stations in Chennai
In addition to the airports and seaports, the Greater Chennai Corporation in neighbouring Tamil Nadu has initiated stringent checks at bus stands and railway terminals in the city for those who could have symptoms of Covid-19 and requires immediate isolation.
A view of an empty classroom is seen after Tamil Nadu state government ordered the closure of primary schools across the state amid coronavirus fears, in Chennai. (Photo: Reuters)
“As per the directions of the Health Department, we are disinfecting the busses daily. Close to 3,400 busses operating under MTC in the city are taken to their depots for sterilisation,” an official of the Metropolitan Transport Corporation (MTC) said.
At the MGR Chennai Central station, a check-up centre has been set up at the main entrance where passengers from local trains and the ones who travel to other states assemble. The passengers are screened using an infra-red thermometer to check for fever.
Since close to 19 trains from neighboring states like Karnataka and Kerala halt at the Central station daily, the authorities are keeping a close tab on passengers who travel in those trains. Fumigation of trains before departure are also being carried out. People with above-normal body temperature are sent to Rajiv Gandhi Hospital and the Madras Medical College for precautionary tests.
Meanwhile, a medical student from Wenzhou in China who spent 28 days in quarantine at her home in Chennai due to her travel history, told indianexpress.com that the local health officials were quite helpful in ensuring her safety during the quarantine period. “Officials from the district health department visited almost every day along with doctors from local government hospitals to check on me. The Health Ministry also has a hotline and they called me every morning to enquire about my health. They were very helpful," she said.
Chief Minister Edappadi on Monday announced closure of cinema theatres, malls, amusement parks, swimming pools, gymnasiums, zoos, and museums till March 31. The government also announced to shut down all schools, colleges, universities and other educational Institutions till March 31. Public examination for Class 10 and 12 students will continued as per schedule. All tourist resorts in the state to be closed till March 31. They have been instructed not to accept any advance bookings until March 31
At hospitals in Telangana, SARI/pneumonia surveillance too
The Telangana government has decided to initiate hospital-based surveillance for severe acute respiratory infections (SARI)/pneumonia as a surrogate marker for community-based spread of Covid19. In a government order Monday, the director of Public Health department said a rising trend of SARI/pneumonia cases will trigger the need for further investigation for Covid19.
Medics outside an isolation ward of the novel coronavirus (COVID-19) at a hospital in Hyderabad, Friday, March 13, 2020. India has more than 70 positive coronavirus cases so far and recorded its first COVID-19 death in Karnataka. (PTI Photo)
Meanwhile, at the Gandhi Hospital in Hyderabad, the nodal centre in the state for treating Covid-19 patients, scores of people are arriving with suspected patients. At present, a 24-year-old woman from Italy and a 42-year-old man from The Netherlands are the two active cases, with another patient having recovered after testing positive.
But what's perhaps worrying is that top health officials in Telangana have maintained studied silence about the Covid-19 situation in the state. The only public statements have come from the chief minister and the health minister. Even after two patients tested positive for the virus, details about the primary and secondary contacts have not been disclosed to the public. Health Minister Eatala Rajender, who used to hold a press conference daily, has stopped the practice and the daily medical bulletin is not forthcoming on statistics.
On Monday, Rajender said he would be reviewing the need for erecting check-posts and installing testing centers at the state borders, especially with Maharashtra. The state government is mulling check-posts at Dharmabad, Boraj, Zaheerabad, and Sirpur Kagaznagar among others. Just like at the Hyderabad airport, screening using thermo-imaging scanners will be done.
A Telangana State Road Transport Corporation (TSRTC) worker disinfects a bus as a precaution against COVID-19 in Hyderabad. (AP Photo)
The state is also mulling quarantining all passengers who arrive in the state from the seven high-risk countries of China, Iran, Italy, France, South Korea, Germany and Spain. Quarantine centers are being set up at Haritha Plaza in Vikarabad and Forest Academy in Dhulapally and GMC Balayogi stadium sports tower in Gachibowli, away from Hyderabad. This is because the two recent Covid-19 cases are those who were asymptomatic initially and sent to homes.
In Karnataka, anganwadis home-deliver groceries for 35 lakh children
Taking a cue from neighbouring Kerala, Karnataka is now ensuring the home-delivery og groceries for over 35 lakh children who were dependent on anganwadi centres. Officials across the state have been asked to "home-deliver raw materials including groceries to prepare daily food to the beneficiaries," an official circular issued by the Department of Women and Child Welfare said.
Karnataka Minister for Women and Child Welfare Shashikala Jolle clarified that the department initially thought of delivering cooked food to respective houses of the beneficiaries asking parents to collect the same. "However, it was later decided to deliver rice and other groceries to the doorstep," she said.
KSRTC bus conductor and passengers wear protective masks in view of coronavirus pandemic in Chikmagalur. (PTI Photo)
As part of controlling the spread of Covid-19, the South-Western Railway has begun operating separate clinics for patients with symptoms at railway hospitals next to stations at Hubbali, Mysuru and Bengaluru.
"Quarantine wards have been created as a preparatory measure that can be used for the treatment of patients infected with the virus. On SWR, 229 rooms (706 beds) at 7 locations have been identified, sanitized and prepared with quarantine facilities. Out of them, 216 beds have been isolated exclusively for treatment of suspected coronavirus victims," said SWR Chief Public Relations Officer E Vijaya.
At the same time, front-line employees including those in booking offices, inquiry counters and traveling ticket examiners (TTEs) have been advised to report any suspected or detected case to the District Medical authorities for follow-up.
The Karnataka State Road Transport Corporation continues to fumigate all premium services (air-conditioned buses) and wash other buses using disinfectants after each trip in depots across the state. While Bangalore Metropolitan Transport Corporation (BMTC) has reduced up to 20 per cent of its daily services citing the absence of public transport takers, each bus is being cleaned using disinfectants at entry point in depots around the city. Drivers and conductors have been advised to wear masks and to maintain self-hygiene.
A conductor of a state transport bus distributes free masks to passengers to prevent spreading of novel coronavirus (COVID-19) in Hubballi district. (PTI Photo)
As part of utilising popular social media platforms for Covid-19 awareness, the Karnataka government has opened a channel on Telegram for the same. It will be used to field queries from the public and check proliferation of fake news about the pandemic. Started on March 13, the group has 7,400 members as of Monday afternoon.
P Manivannan, secretary of the state’s Information and Public Relation Department, said it is handled by teams of five members including doctors and officials in eight-hour shifts. The members in the group are mainly asking queries on home quarantine procedures, coronavirus testing centres and labs. “We have to curb the fake news and misinformation about CoVid-19. Hence we created the group in Telegram which has no limits of the members in a group. The best way to reduce fake news and panic is by providing real-time answers to the questions and doubts by the public," he said.
In another important development, as part of contact-tracing of the six active cases in the state, the Karnataka government released information outlining the places visited by all of them. The exercise involves tracing the movement of a COVID-19 patient from the time he/she landed in India or came in contact with an infected person up to the individual's admission to a hospital. The public can call on 104 Arogya Sahayavani if they were in the same place as the infected person.
“The tracing of high risk and low-risk contacts for Covid-19 positive cases is extremely crucial. It has been decided to put in the public domain the movement history of positive cases in Karnataka. The time and place of movement are shown in the flowchart. The public is requested to call 104 helpline and inform the department of their presence at the place and time mentioned. This will help us in better contact tracing and further transmission of novel coronavirus in the community," a senior health department official said.
Taking cues from other states like Kerala, the government last week announced the closure of schools, colleges, coaching institutes, theatres, pubs and night clubs, exhibitions, swimming pools, summer camps, music fests and sports events for one week beginning March 14. It has also advised the people to postpone or cancel marriages and parties that involve big gatherings.
“What happened in Italy and Spain and the way the disease spread in these countries within a matter of weeks because control measures were not put in place was presented to the government to facilitate the decision to curb public gatherings,” said Dr R Ravindra, a member of the Indian Medical Association who was at the government meeting.
“All IT/BT companies have been advised to allow their employees to work from home and to avoid any kind of international travel,” Karnataka Chief Minister BS Yediyurappa said, adding that it was decided to make it compulsory for all international passengers to be in home quarantine for 14 days beginning from their day of arrival in Karnataka, even if they are asymptomatic.
To prevent hoarding of important supplies like masks and hand sanitisers, the Central Crime Branch (CCB) police in Bengaluru raided over 200 medical shops. The police are conducting special drives across the city as per the information received by the health department and general public. Sandeep Patil, Joint Commissioner of Police (Crime), said, “In five shops, they were selling masks and sanitizers at a much higher price than the MRP in Jayanagar, Kalasipalya, Chamarajpet, Mahalakshmi layout and Sanjay Nagar. We received information from the concerned department and further action will be initiated.”