K.K. Shailaja has been catapulted to the frontline in India’s fight against the novel coronavirus. As Kerala’s health minister, she heads its enviable health system. So far, three people have tested positive for the virus in the state—also the reported total for India. State authorities have quarantined nearly 2,800 people. But on Friday, Kerala withdrew ‘state calamity’ status on coronavirus, in a sign of winning the fight against the virus.
Having closed the book on the Nipah outbreak in 2018, which killed 17 people, Shailaja said it was not as if Kerala has more infected people—rather, it is detecting more cases early and other states may not be reporting infections. Edited excerpts from an interview:
When were you first alerted about coronavirus?
We were braced for this since the earliest global media reports. On 17 January, our health secretary (Rajan N. Khobragade) and I sat together and discussed what to do because we knew a lot of Malayalee medical students were in Wuhan. We had the experience of Nipah, where we could not identify the first patient before he transmitted it to four family members. Those four people gave it to others (18 people) who tested positive for Nipah. We managed to quarantine all after those four and arrest any secondary infection. But we missed those four, and that memory persists.
What did you do differently this time?
After our meeting, my health secretary immediately held a video conference with officials and asked everyone to be vigilant. After Nipah, we have been conducting mock drills in major hospitals and giving additional training to medicos every few months. It prepared them for what to do if a Nipah case comes to their hospital again. We decided to strengthen such training programmes when news of the coronavirus first appeared. After Nipah, we had also decided to have isolation wards that can be quickly assembled at all major hospitals. That also was reviewed.
And just like we calculated, the first Malayalee from Wuhan came by 30 January. But we had traced her before she came here. Airport authorities were asked to inform us as soon as her plane lands. So, when she landed, we sent her directly to an isolation ward set up in a hospital in her home town, Thrissur. Since she had interacted with her family at the airport, they were also sent to isolation. When interviewed, she told us that two other students had returned from Wuhan with her. We immediately sent a pick-up team to their homes, in Kasargode and Alappuzha districts, and isolated them, along with their family members. For all similar cases that came after these, we quarantined those who don’t have symptoms in their houses, and isolated those who show symptoms in hospitals.
What’s the protocol to contain the spread? How do you make sure you are getting it right?
It’s a protocol we have designed ourselves. There is a rapid response control (RRC) room in the capital, which was readied a day before the first patient landed. We chalked out 18 expert groups in RRC to oversee departments such as home quarantine, contact tracing, isolation, logistics and training. They meet twice every day and I personally attend the second meeting at 6pm—it is when we compile stats from all districts, take note of what is needed, how many isolation beds are remaining, how many beds are available in private hospitals, if there was a need, how many medical kits were distributed, and the stock available with us.
At the ground level, a public health official and a panchayat president are assigned in every village with the task of local monitoring. There’s an army of local health workers in Kerala called Asha (hope) workers, who are also pressed to the field to observe houses, make arrangements for whatever needs these families have, whether it is medical assistance or grocery shopping. They also combat the fear, discrimination and stigma in the neighbourhood.
First Nipah, now coronavirus. Why do you think Kerala attracts all these superbugs?
Everybody is asking me why are all these viruses coming in search of us. I don’t think it is true. In fact, none of this is new, except now we are detecting them early. When H1N1 first came in 2013, more than 160 people died before we realized we have to cover our mouth before we cough, we have to isolate patients, etc. Then it became familiar for us. Now, there are no H1N1 deaths in Kerala. Hundreds died before we could prevent any more deaths out of Chikungunya when it first came to Kerala. And is it only Malayalee students who have returned from China? Elsewhere people may be dying and not getting reported. It is probably seen just as a fever-related death. The Centre seems a little worried about this. They said they are not worried about us, given our precautions. But in other states, they are afraid there would be an outbreak.
When do you expect all of this to be over?
The mortality rate of Nipah was above 65%, up to 99%. Coronavirus is far less deadly, and nearly three-fourths of those who died of Nipah were old people. So we were sure that these young students—all of them have good immunity—will survive. We are treating them for symptoms such as fever and cold, and are making sure they are resting and eating well. So we can say it is under control. Yet we can’t say it has fully gone until the incubation period is over.
The Centre suggested an incubation period of 14 days, but we are taking it to 28 days as a precautionary measure. Only if there is no variation of the situation until the 28th day, we can say it is over. I’m hopeful we can declare Kerala as coronavirus-free by the first week of March.