Officials say each person in quarantine is closely tracked, to check on their health and requirements and to ensure they do not risk spreading the disease by stepping out.

How Kerala is monitoring over 52000 people under home quarantine in the stateRepresentational image
Delve Health Sunday, March 22, 2020 - 19:41

There are a total of 52,785 persons under home quarantine in Kerala due to the COVID-19 pandemic as on Saturday, March 21.

On one hand, the number of positive cases of COVID-19 in Kerala has been slowly increasing, with 64 under treatment (as on Sunday). On the other hand, the number of people being kept under quarantine at homes has been exponentially increasing, every day. The number of people under quarantine at homes was 30,936 on March 19 (Thursday). By the next day, this number rose by 13,220 cases, bringing the tally up to 44,165 on March 20 (Friday).

These may be mere statistics to a reader. However, for the Health Department and District Administrations of the Kerala government, this daily spiral means tracing passengers arriving from other countries and states, as well as convincing and ensuring they stay at home until the quarantine period is completed.

“Unlike Nipah, this is one of the greatest health crises we have ever faced,” said Dr Sheeja, the District Medical Officer (DMO) of Pathanamthitta District, which has 5,242 home-quarantine cases and nine coronavirus positive cases under treatment.

“It is a Herculean task to force a person, who has come from abroad for a short period, to stay at home. Some have come for elective surgeries, and we cannot allow that at this time. Others have come for official purposes, while others have come for funerals and weddings. They have various demands but we have to stop them,” she said. 

A majority of the people under home quarantine are travellers. For instance, Kozhikode district has the highest number of people under quarantine (7,626) and no positive cases until Sunday (the district reported two positive cases on Sunday evening). “These are passengers who have arrived from various countries. We have been identifying and quarantining them for over the last 20 days as a precautionary measure,” Kozhikode District Collector Seeram Sambasiva Rao told TNM.

The district administrators have been culling data of passengers arriving in Kerala from airports and teams on the ground. “We also have data entry teams led by health workers at transit points like railways stations and bus stations to identify inter-state passengers, too,” said the Pathanamthitta DMO.   

Apart from international and inter-state passengers, many districts have individuals who came into primary contact of COVID-19 positive persons. For instance, about 1,300 people under quarantine in Pathanamthitta are contacts of positive cases. “We select the high-risk contacts among these and send their samples for testing,” said Dr Sheeja.

As on March 22, a total of 3,716 samples of suspected cases have been sent for testing of which a total of 2,566 has been tested as negative.

Multi-layered surveillance system

According to officials, each person in quarantine is closely monitored — to check on their health, if they have any medical and non-medical requirements and to ensure they do not risk spreading the disease by stepping out.

To execute this, district administrations have set up district-level call centres and ward-level teams. “Earlier, we were able to call about 300 to 500 people under quarantine every day. We used to call them twice a day, especially the primary contacts. Now, as the numbers increase, we are able to call them only once, but with the help of an app developed by a few engineering students. With this, we are able to contact at least 1,600 people per day,” says the DMO.

The daily calls are to address the medical and non-medical needs of these people. Depending on the data collected, information about their medical needs is sent to the respective primary health centres (PHCs), while the non-medical needs, including groceries and other essentials, are shared with the local panchayats.

“We encourage online payment but those who do not have that option, we make certain arrangements, like buying provisions for them,” said the DMO.

To ensure field monitoring, ward-level teams have been deployed in Kerala, which has 21,871 wards across 14 districts. Pathanamthitta district has formed teams of health workers and Primary Health Centre (PHC) medical officers with the help of the Ward Health and Sanitation Committee, to ensure the people remain in quarantine.

Kozhikode district too has formed Rapid Response Teams (RRT) with the help of the local government. Every ward has a team that comprises ward members, ASHA (accredited social health activist) and Janani Suraksha Yojana (JSY) workers, among others. A police officer, too, has been included in some of the teams.

“A few days ago, we started a task force of volunteers, which include residents in these wards. Two volunteers are assigned for every one person under quarantine to ensure stronger surveillance on ground,” said the Kozhikode Collector.

The Public Distribution System (PDS) employees, who facilitate the distribution of grains and essential commodities, have been directed to supply groceries to the members under quarantine. These volunteers will deliver the essentials to these households.

In Kottayam district, the police resorted to technology to ensure those under quarantine stayed at home. Using the technology called geofencing, the Kottayam police could track a person’s location using Global Positioning System (GPS) and the cell tower of the respective mobile network. They started using this technology on March 17, especially to track the high-risk contacts who are in quarantine. They were able to track at least 10 people who stepped out of their houses during this period.

Emulating this method, the police in other districts followed suit.

“We try to convince people to remain under quarantine multiple times and if they do not comply, we seek police help. In some instances, we have filed a case against them,” said the Collector Seeram.

“We have meetings every day, morning and evening. We collect international, national and state data and do media surveillance to find the positive and negative responses to the regulations. We formulate plans for the next day accordingly. This is also to chart our future course of action, including deploying manpower and setting up other facilities,” elucidated Dr Sheeja. 

“The lesson we, as officials, have learnt from instances across the globe is the need to follow and enforce strict quarantine,” said Collector Seeram, adding, “Despite all efforts, there are gaps; we admit it. But we are trying our best to ensure there is no community spread.” 

 
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