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The first few cases of COVID-19 in India were recorded in Pathanamthitta in Kerala and soon it came to be known as a hotspot for the virus. But in a fortnight, the numbers fell drastically to hardly one or even no cases everyday.
The Quint reached out to the Abey Sushan, the District Programme Manager with the National Health Mission, Pathanamthitta, to understand how the district managed to contain the spread of the virus.
Recounting the first few days, he said he remembers receiving a call in the middle of the night from the District Medical Officer, Dr Sheeja, that three persons who had returned from Italy and their two contacts, were positive for COVID-19.
Since the time the first case of COVID-19 was detected in the country, they had a district control room up and running. The very next morning, 8 March, the district collector PB Nooh called a meeting of the rapid response team which comprised eight to 10 teams consisting of community medicine experts and medical doctors from various public health centres.
Soon, Health Minister KK Shailaja arrived at Pathanamthitta and from an initial assessment of 5,000 primary and secondary contacts, they narrowed down and tested a few persons.
Three-Tier System to Ensure People Do Not Violate Quarantine
Sushan pointed out that since the first day, the teams devised an extensive plan to ensure people do not violate quarantine and social distancing norms.
First, with the help of a questionnaire by the community medicine team of the Trivandrum Medical College, they began assessing and identifying people who were likely to break quarantine.
Second, the reason people were breaking quarantine was because they had to buy essentials.
“With the help of community volunteers and panchayat, we were able to meet their non medical needs, which essentially involved provisions for home, baby food, even cattle feed.”Abey Sushan, District Programme Manager with National Health Mission, Pathanamthitta
Third, an Asha worker and a neighbour was put in charge of every home where a person is supposed to be in quarantine. These persons informed the police if the anyone defied the quarantine rule.
The district administration also did a geo-mapping of the households of these people to identify the areas where they needed more volunteers and resources had to be mobilised.
How Equipped Is Pathanamthitta to Handle Any Influx of Patients in the Future?
The testing samples are now being sent to a state public lab in Trivandrum. “Our MP Anto Anthony has given as funds to procure rapid testing kits. Then we will be able to test more patients and treat them early,” he said.
The district administration is also preparing COVID care centres, with nearly 1,000 beds per taluk, which is 6,000 beds in the whole district. And the General Hospital Pathanamthitta and the district hospital in Kozhencherry have been identified as COVID-19 special hospitals, which are equipped with Intensive care units, ventilators and C-pap machines.
“We have started local manufacturing of personal protective equipment, masks and face shields. This local manufacturing is what is going to help us tide over the coming days when large number of cases come,” he said.
They have identified hostels, hotels, schools and other infrastructure, for institutionalised quarantine, that is for travellers who will be coming to Pathinamthitta after lockdown lifted.
He however proposed that they could be even more efficient if there was a single online platform that links all the various departments so that administrators and clinicians can identify where they have free resources and also manage patient traffic.
“One word of advice would be stay at home and listen to your health providers.”Abey Sushan, District Programme Manager with National Health Mission, Pathanamthitta
Surveillance to Identify Even Asymptomatic Patients
Nodal officers are deputed for every block to observe, enquire and identify the people who need to be tested.
“Our testing strategy is slightly different from what is followed in the state as a whole. The state protocol is used to test those who are symptomatic. But we have slightly expanded upon that,” he explained.
Recently, two asymptomatic persons who finished their 14-day quarantine period tested positive for coronavirus in the district.
Sushan told that they could identify these cases because whenever a case is reported in any part of Kerala, the Pathanamthitta district administration also takes the history of that case.
“We check for people who are in quarantine in our district who have a similar history. Since the end of March, when the Nizamuddin Markaz came into news, we started testing people who returned from Delhi as well. Based on that surveillance, we also found out one girl who is positive and her only contact with Nizamuddin was that she took a train out of Hazrat Nizamuddin Railway Station. And she was also essentially asymptomatic,” he said.
Round-The-Clock Counselling Services
The control room in the district has made at least 1,191 outgoing calls for mental health assessment and more than 1,200 calls as follow up.
“Based on the assessment of the one answering the calls, we decide whether this person is in need of some sort of mental health assistance or not. Also, our field teams give us feedback,” he added.
The calls run from anywhere between 15 minutes to nearly an hour.
When The Quint had spoken to the grandson of the oldest COVID-19 patients, 93-year-old Thomas and 88-year-old Mariyamma, about how they made a full recovery, along with seven other family members, he had said, “People need not be scared. If you listen to the advice given by doctors, nurses and medical professionals, then we don’t need to worry. When we were first admitted, we thought we were on a path to death. It was scary. But after complete medical support and several counselling sessions, we gathered the confidence that we shall overcome this too.”
Sushan explained how the medical staff ensured the isolation facilities were tailored to make the patients feel comfortable.
“It was initially a room with a bed and nothing else. Once we started putting patients in, we understood that they needed some more things to improve the quality of life because they were going to be spending 14 to 28 days of their life in that room,” he said.
“Many sponsors came in and started giving us books, newspapers and other things to read. Few of them provided Wi-Fi hotspots free of charge. Also, our medical team was very considerate and spent a lot of time with their patients. The staff in the general hospital, who are non essential staff, started a community kitchen in the hospital itself,” he added.
Lessons to Learn From Pathanamthitta
“I think it would be the teamwork.”Abey Sushan, District Programme Manager with National Health Mission, Pathanamthitta
The district had a whole team up and running in two days.
“Everyone had full clarity on what needs to be done and what we shouldn't be doing,” he said.
There had 10 health blocks, each with one medical officer from Public Health Centres as a designated a COVID control medical officer. Each health block has about six-eight primary health centres and one or two community health centres.
“Usually when such a health emergency happens, it is usually only the function of the health department to keep it in control. But with our district collector’s leadership, we were able to rope in all departments, including revenue, labour, panchayat, everyone came together.”Abey Sushan, District Programme Manager with National Health Mission, Pathanamthitta
Press conferences were held every evening by the district collector, just like the Kerala Chief Minister, Pinarayi Vijayan, ‘to make as much information available to the public.’
“We have got a good working relationship with the local media. We have a team of around 10 people whose exclusive job is media surveillance. The police is also helping us in tracking down people who are spreading misinformation and book cases against them,” he said.
“I should also mention about the spatio-temporal mapping which was done from the beginning. It is essentially where this person has been at what point of time what roots he has taken, where all he could have come in contact with the public.”Abey Sushan, District Programme Manager with National Health Mission, Pathanamthitta
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