It's only in the latter half of the lockdown imposed due to the COVID-19 pandemic that Kannur district of Kerala has been in the spotlight for increasing cases. As on April 25 (Saturday), Kannur district has the second highest number of positive cases in Kerala, at 109. It is also the district with the highest number of active cases in Kerala, at 57, as well as one of the ‘red zones’ (hotspot). Although its neighbouring district of Kasaragod has recorded 175 confirmed cases, so far, there are only 18 active cases.
However, the district presents unique statistics: the number of individuals under observation (in quarantine at home and hospitals) is dwindling even as the number of COVID-19 cases is increasing by the day. This can be attributed to a new testing strategy that the district administration chalked out earlier this month.
Generally, when a positive case is reported, all the immediate low-risk primary contacts and secondary contacts are traced and placed in quarantine for 14 to 28 days, thus bringing the quarantine cases up. For example, on March 27, when Kasaragod district reported 34 new COVID-19 cases, one of its highest single-day spikes, about 1,159 people were added to its quarantine list that day.
Kannur has not reported any massive single-day jump in cases, barring on April 21, when it saw 10 positive cases. Otherwise, it has reported only single-digit figures.
But, when comparing the number of rising positive cases and the people under observation in the district, it is indirectly proportional.
To understand this, one must go back to April 6 when a man in his 80s, who was already undergoing in-home respiratory therapy, tested positive in the district. His daughter and her two children had returned from a Gulf country on March 18 (all international flight operations were suspended on March 22). It was soon found that nine other members of the same family tested positive, with the 11-year-old boy (one of the two children) being the source of infection.
Read: Foreign returns testing positive after 23 days: Kerala says incubation period unclear
“None of the nine members had any symptoms and the elderly man developed symptoms more than 20 days after his daughter and grandchildren returned from abroad. That was an asymptomatic transmission,” said Dr Shaji, the District Surveillance Officer (DSO).
“That is when we decided to draw a new, parallel action plan, to screen all high-risk primary contacts who are already under observation or quarantine,” he told TNM.
The district administration soon pored over its existing list of individuals under quarantine. “In addition to testing patients as per the state government guidelines, we also took samples of foreign returnees who have arrived in the flight in which a positive case has travelled. Apart from that, we are taking community samples and special surveillance samples, too. All foreign returnees after March 17 have been tested and we have expanded it to all high-risk primary contacts,” Kannur District Collector TV Subhash told TNM.
According to Dr Shaji, the district did not have major cases for testing initially. “When we ramped up the testing with the new action plan, we started collecting more swabs of those who completed a quarantine of 14 to 28 days as well as 28 to 35 days. We conducted 1,700 tests under the new action plan, in addition to other tests as per the state government guidelines,” explained Dr Shaji, adding that the district has conducted 2,668 tests so far.
Current number of COVID-19 cases as per the new strategy
“We are testing at nearly 1,000 tests per million population. This is due to a large number of people who are Gulf returnees, more number of cases reported, and hence their contacts,” the District Collector added.
All positive cases under the parallel action plan — symptomatic or asymptomatic — have been isolated in hospital for strict quarantine.
Hence, a major proportion of the positive cases who have been emerging over the last two weeks, is from the quarantine list. “But the remaining individuals, who are mostly family members of imported cases, are taken off the list once they complete their 14-day (low risk) and 28-day (high-risk) quarantine period. The number of people under observation reduces accordingly,” added Dr Shaji. Some have even completed more than 30 days of quarantine and have been taken off the list.
This also means that many of the latest cases were already in quarantine and have not risked infecting more people, a district health official had told TNM last week.
However, the district officials are not leaving any stone unturned. “We are next expanding our testing to the people who are on the field. Since the rapid antibody testing kits have been stopped, we are in touch with the Community Medicine Department of the Government Medical College. They are working towards developing a strategy for randomised tests of people on the ground so that a community or accidental spread can be detected,” the Collector added.
Kannur, which has been designated ‘red zone’, also has the highest number of areas earmarked as hotspots in the state. According to the Union Health Ministry, a district with the highest caseload, contributing to more than 80% of cases for each state or districts with a doubling rate of less than four days, are designated as ‘red zones’.
The doubling rate of an infection, which is the time taken for the number of cases to double, depends on the prevention measures.
While on one hand the testing has been intensified, Kannur has enhanced its lockdown restrictions, which will continue to be in place until May 3.
“Apart from the general lockdown of the district, the lockdown measures will be enforced for the containment zones. These are focused on the primary and secondary contacts of COVID-19 cases and ensuring their quarantine,” the Collector said.
Read: After 6 more test positive in Kannur, district enforces ‘triple lock’
A total of 28 localities in Kannur have been declared hotspots.
List of hotspots in Kannur, as on April 24
Entry and exit to these hotspots are being regulated by the Kannur police. Police patrolling and strict vehicle checks are being enforced. While many violators are being booked under the Epidemic Diseases Act, some are being sent to a quarantine facility to act a deterrent.
All shops, except select medical shops, will be closed. Shops will remain open only to home deliver essential items, which will be delivered by the municipality or panchayat officials. Banks and post offices will remain closed in the hotspot areas. Those engaged in the LPG (liquified petroleum gas) supply, medical establishments, media, community kitchens and Kerala State Electricity Board (KSEB) offices are allowed to function.
Primary and secondary contacts, who are under surveillance, especially, cannot leave their houses. The district officials have designed an app called the Covid Care Kerala, which includes features for counselling and de-addiction services, food and grocery supply (even for guest workers) and geotagging of persons in quarantine.
“People generally follow instructions. Neighbours also help the administration in ensuring this. Our team does home visits and the health department provides them with Information, Education and Communication (IEC) materials and mental health counselling,” the Collector said.
Read: A large percent of COVID-19 patients are asymptomatic: Why this is concerning