As the COVID-19 epidemic spreads across countries the State, too, is bracing to launch its next phase of surveillance to pick up any virus transmission in the community. Kerala’s initial response to COVID-19 outbreak in Wuhan and the possibility of the infection being imported to the State was pre-emptive and focussed.
Given the manner in which the situation surrounding COVID-19 has rapidly changed across the globe, the State’s initial strategy of aggressively isolating and imposing quarantine on all travellers from Wuhan seems to have been spot-on.
However, now that the risk stratification has changed and there is on-going local transmission of COVID-19 in not just China, but Singapore, South Korea and Italy, there is a lot of confusion regarding the steps that the State should adopt.
Best response
With even the WHO now accepting that the “window of opportunity” for the containment of the virus is as good as lost, the crucial question would be whether Kerala can sustain the aggressive response it launched in the first phase and manage to check a possible community-level transmission.
“Kerala’s response in the initial phase has been the best because we did not wait for a case to surface in community before initiating containment measures. Against all advisories by WHO and ICMR, we isolated and quarantined Wuhan-returnees ahead and then tested them to identify cases. Kerala’s all three COVID-19 cases were already in isolation in hospitals when they developed the mildest of symptoms (day 1 or 2), which is why we could prevent a secondary spread. Not even a single family member of the positive cases contracted the infection from them,” said a public health expert.
“In the next phase, our focus should be on detecting possible community-level transmission at the earliest. We have proposed that our response be scaled up by initiating hospital-based surveillance and investigation of all cases of viral pneumonia with bilateral lung infiltration, even if the patient has had no history of travel,” R. Aravind, Head of Infectious Diseases, Government Medical College Hospital (MCH), Thiruvananthapuram, said.
“The Outbreak Monitoring Units in MCHs are already flagging and investigating all cases of acute respiratory distress syndrome and pneumonia, encephalitis, diarrhoea or hepatic failure without diagnosis. We need to scale up this system across the State, in major government hospitals and rope in private hospitals too,” he said.
Infections in hospitals
SARS-CoV-2 has been estimated to have caused about 41% infections inside hospitals. So all hospital employees with mild fever, dry cough and fatigue, should be closely monitored and followed up. The State could also go through the records of at least sentinel hospitals in the past three years to examine the general trend of the incidence of viral pneumonia, to pick up any change in the pattern.
