Eight weeks ago, Health Inspector R Sheeba from Kerala’s Thrissur district received a phone call. It was from her daughter who was a medical student in China’s Zhejiang province. She told her mother that a strange disease was spreading fast in China and that she and all her classmates had locked themselves up inside their hostels, hardly stepping out.
That was the first time that Sheeba heard of coronavirus, an epidemic which has now spread across continents, killing 3,000 people and infecting 1,00,000 globally.
But what the 50-year-old didn’t know then was that the tiny village where she worked as Health Inspector would report the first case of coronavirus in India in the weeks to follow, and that she would be at the forefront to fight the epidemic.
On January 23, two students from China’s Wuhan – the epicentre of the virus – landed at the Nedumbassery International Airport in Kochi. Among them was 20-year-old Shahnaz* who was the first positive case of the virus in India. Shahnaz, who exhibited no symptoms then, was picked up by her mother, father and brother from the airport. The family chatted away during the 2-hour drive home to their village in Thrissur – the same village where Sheeba worked.
“As soon as she reached, Shahnaz reported at the local Primary Health Centre. She was checked and asked to wear a mask and remain in self-quarantine at her house. Four days later, she rang me up with throat pain and cough,” Sheeba recounts.
It was when Shahnaz was moved to the isolation ward at the Thrissur district hospital that panic began gripping the village and its residents. Luckily for them, the local Primary and Family Health staff with the support of the panchayat had already begun battling the virus.
Across the country, Kerala's public heath system has been lauded for its effective epidemic control measures. But the state's real secret lies in its local self governing bodies, which are immediately activated to nip a potential outbreak in the bud.
Over the next 28 days, 21 ASHA workers along with Sheeba and the rest of the health department staff surveyed each house in the village, speaking to residents and identifying persons with recent travel history. Their extensive combing led to the identification of 5 persons from the village who had recently returned from China.
“These were 4 students from China, including Shahnaz, and a 35-year-old businessman who initially claimed that he had flown from UAE. We immediately quarantined them and their families. A total of 15 houses were locked down and inside were 22 people who were family members or those who visited potential carriers,” Sheeba said. Quarantined residents included 8 teenage boys who had unknowingly visited Shahnaz’s house on January 25 to celebrate her brother’s birthday.
The ASHA workers were also tasked with visiting every house barring the quarantined house and preparing daily reports of the health status of each of its residents.
"We would then discuss these health reports in daily meetings to ensure that no other resident outside of the quarantined houses exhibited symptoms of COVID -19," Sheeba added.
Meanwhile, contact tracing efforts by the health department staff led to the identification of one more student - a 23-year-old boy who had travelled from Wuhan with Shahnaz. This was the second case of coronavirus (now fully recovered) reported in the state from Alapuzha.
Survival under quarantine
For the 15 families who survived nearly a month in quarantine, life in isolation was not easy. However, their daily routine practically ran without glitches, thanks to the joint intervention of various departments of the state government as well as the local self government.
“Even before the families went into quarantine, we contacted SupplyCo - Kerala State Civil Supplies Corporation - and sourced pulses, rice, gram, wheat, milk, etc as well as items such as washing power, detergent, soap, toothpaste and other necessities for a whole month. This was entirely funded by the panchayat. The local self-government also provided financial aid to a family who found it difficult to make ends meet without work,” Sheeba adds.
Right down to activities such as paying electricity bills, picking up couriers and mailing letters, officials in the panchayat office and health department chipped in.
Speaking to TNM, Additional Director of Health Services Dr Raju added that teams were formed in the Animal Husbandry Department who would visit quarantined houses to milk cows and feed poultry. This was to avoid man-animal contact in quarantined houses at any cost.
“Among the quarantined residents there was one boy who had epileptic seizures. His family had run out of medicines. So they sent us a list on WhatsApp, and a nursing assistant from the Thrissur Medical College came all the way to our village and dropped off the medicines. They were paid again by the panchayat,” Sheeba says.
Material facilities and food aside, the quarantined residents were also offered support in the form of mental health counselling. Not only did Sheeba ring up Shahnaz’s parents once every day, she would also regularly check up on the other residents who were in lockdown.
Recalling her days in the isolation ward, Shahnaz told TNM that she and the 50-year-old health inspector formed a bond during this phase as the latter would call and speak to her twice a day.
“She wouldn’t just enquire about my health. She would ask me how I was doing. Sometimes in the evenings I would start getting depressed in the room and before I picked up the phone, I would get her call,” she says.
On March 1, a fully recovered Shahnaz who had returned home stepped out of her house for the first time in over two months. Her days of home quarantine too had been completed. However, for Sheeba and the rest of the village, the fight is far from over.
With the virus spreading fast globally and infecting people in the Middle East, South Korea, USA, Italy and other places, Kerala's local health units and panchayats are fully expecting to battle more cases of the epidemic in the state.
*Name changed