On January 30, the World Health Organisation (WHO) declared the novel coronavirus (nCoV) outbreak a public health emergency with the virus having spread to 18 countries until then. On the same day, the first confirmed case of coronavirus was reported from India. The person, a native of Kerala, is a student who fled Wuhan in China, the epicentre of the outbreak.

Just two days later, on February 2, the second confirmed case of coronavirus was reported in the country, also from Kerala. The next day, a third confirmed case was reported in India, and this once again was from Kerala. The Kerala government, which has been on high-alert, swung into action, declaring coronavirus a state disaster.

But with three cases of the coronavirus being reported from a single state in the country, the question many are asking is why Kerala?

There are a few possible factors at play here. While Kerala has robustly collected medical samples from those who travelled in China, the students who have tested positive are all among those who left Wuhan before the travel ban was imposed and travelled in public transport there.

Meticulous data collection

One of the main reasons why those infected with the virus have been identified faster is because Kerala has meticulously collected samples from those who returned from China and sent it to the NIV.

As per the latest update on Monday night, 2,239 people have returned to Kerala from other countries, including China, where coronavirus is reported. All of them have been tracked down and 2,155 persons who do not have any symptoms are under home quarantine, while 84 people are in isolation at various hospitals in the state.

As explained in this story, the state has seamlessly integrated officials at various levels and has a robust system of volunteers. A mechanism that the state put in place during two nipah virus outbreaks, now replicated during the coronavirus outbreak.

A dangerous journey out of Wuhan

All the three patients, who are now in isolation in three different districts - Thrissur, Alappuzha and Kasaragod - are students in Wuhan.

As hundreds fell ill, officials in China attempted to contain the virus, locking down the city of Wuhan on January 23. All transport services in the city including the airport and railway stations were shut down, with residents not allowed to leave. However, as per reports five million people had left Wuhan before the lockdown.

Students of Wuhan University who were recently airlifted from the region told officials that a group of students had left Wuhan just hours before the lockdown was imposed. According to the rescued students, who are now in Delhi, those who left Wuhan earlier, including the Kerala patients, had taken a dangerous journey to flee the Chinese city, which may have put them at risk of catching the virus.

“I am not sure about their exact numbers but they (students) were around 20 and most of them were from Kerala. On the morning of January 23, by around 2 am, we got information that Wuhan will be locked down. But it was not imposed until 10 am. These students, who were in a frenzy to leave the place, left the university at around 4 am. They went to the railway station and took a bullet train out of Wuhan,” Anaz*, who is now in quarantine in the Army camp in Delhi after being airlifted by the government, tells TNM.

Anaz says the students who left in trains were in panic mode like all of them and perhaps felt leaving was their best option. “The whole city was in a frenzy and thousands had been moving to railway stations to somehow flee the place so that they won’t get stranded. But it was very dangerous. By this time, the outbreak had reached a serious level and to be in the midst of these thousands of people was disastrous I felt,” he says.

According to a Times of India report, the student in Thrissur district of Kerala who first tested positive for coronavirus in India, along with a group of other students, reached Kolkata airport from Kunming on the night of January 23. The students possibly took the bullet train from Wuhan to Kunming and from there took a direct flight to reach Kolkata, that takes around three hours.

From there, the Thrissur native took a domestic flight to Kochi on January 24. The TOI report, also mentions that though the student underwent thermal screening at the Kolkata airport, she did not exhibit any of the symptoms at the time. Another student from the same group, who is from Kolkata, has been isolated after the person showed symptoms of having a cold and fever.

Kerala confident to tackle coronavirus

Kerala has one of the top healthcare systems in the country and earned praise for tackling the deadly Nipah virus during its outbreak in 2018 and in 2019.

In the 2018 Nipah outbreak, the first of its kind in the state, 17 of the 18 infected people died. But when it reappeared in 2019, the health machinery, having learnt from the previous year, knew exactly what to do. The one Kochi native, who was infected was isolated. The state then tracked down people he possibly came into contact with and quarantined them at home. Not only did the sole Nipah patient make a full recovery, but no one else was affected that year.

Though the Centre has announced a home quarantine of 14 days for coronavirus suspects, the state government is taking no chances, mandating a home quarantine of 28 days.