On Friday evening, Kerala Chief Minister Pinarayi Vijayan said that two areas in the capital district of Thiruvananthapuram have community spread of COVID-19. These are Pulluvila in Karumkulam panchayat and the coastal area of Poonthura – the latter having witnessed a super-spread only a few days ago.
Questions of a community spread have been raised for many days, ever since the state began to witness a steady increase in coronavirus cases since mid-May. From two-digit figures, more than 700 cases have been reported on a single day. Worryingly, the number of cases spread through local transmission became more than the number of infections found in people coming to the state from outside.
Dr Amar Fettle, state nodal officer for COVID-19, says that community spread was inevitable because people did not heed advisories of physical distancing, wearing masks and other precautions. "Community transmission basically means a large number of people without any link to each other, and without knowing the source, get infected. It means that people who have not travelled abroad and are moving about within the community only are infected. If the public does not maintain safety and take precautions, community transmission is an almost inevitable event.”
Kerala now has 6,416 active cases, out of which 1,685 are in Thiruvananthapuram. Data in the last month shows that Thiruvananthapuram had only 35 active cases on June 20. On July 2, there were 72 active cases. This rose to 107 on July 6 and 427 on July 10. Almost exponentially, the number rose to 772 on July 14 and more than doubled in the next four days.
It is now important that the transmission is slowed. “If the community transmission progresses slowly, our augmented facilities can deal with it. We are augmenting beds, First Line Treatment Centres and other facilities on a need-based manner; deploying more in the more problematic areas,” Dr Amar says.
However, this could be challenging because community transmission happens much more quickly than with imported cases. “With higher number of patients, there will be a shortage of these facilities and the health staff will also be exhausted. But if we can slow down the transmission, then there will be an [almost] equal number of people getting discharged on one side, while new admissions happen on the other. Beds and other facilities will be available,” Dr Amar explains.
Slowing down the transmission will require minimal contact between two people. One challenge to this, Dr Amar points out, is that people assume that those who are infected show symptoms. But a good percentage of the patients do not show any symptoms at all and are asymptomatic.
“We have come to a stage where we have to consider every other person whom we meet as a possible carrier – including our friends, relatives, and people at home. That drives us to the four main points of the break-the-chain campaign that the health department has been insisting on,” Dr Amar says.
The first of the four points in the break-the-chain campaign is wearing masks, and even though enough and more has been said about it, there is a percentage of people who don’t pay heed. These people, though fewer in number, can create havoc for the majority, Dr Amar cautions.
“It is also important to wear the masks properly – tightly covering the nose and the mouth, not loose around the ears, and it should also be wide enough. People should also not lower it when they talk. Even at home, if a person in the vulnerable group is present, it is better they wear the mask. There is no need to go for disposable masks,” Dr Amar says.
Physical distance, the second point of break-the-chain, has also not been followed efficiently. It needs a person to put at least 1.5 to 2 metres of distance between themselves and another person. This is equivalent to keeping a person at a distance of one foot further from the point till where you can stretch your arms, says Dr Amar. In other words, stretch your arms around, draw a circle around you, and then keep another foot from the fingertip.
Hand washing or sanitising too is important, especially after coming from visiting a place. As far as possible, avoid going anywhere at all, he says. If you have to buy things, call and give a list of the items you need, go there with a bag and pick it up instead of hanging around the place.
Fourth – and he says he can’t stress this enough - don’t spit openly.
“The public have not paid enough attention or given credibility to our warnings. That’s the reason why contact transmission has increased so much and that’s what has now led to community spread. The Health Department cannot possibly put a health worker in every house. It is the responsibility of the public to behave responsibly. Leaders of the public should also be responsible and send a strong message about taking the precautions,” Dr Amar says.