I come from this very interesting piece of land in the southern region of India. Travel aficionados call it the “Gods own country”. Kerala is unique to India if not to the world, due to its high quality of life, which is comparable to most of the developed countries of the world. Kerala recently got plagued with multiple virus attacks and the way it is handling the outbreak is an example of the benefits of intelligently managing knowledge.
Somewhere in May 2018, an individual in northern Kerala was found hospitalised with brain fever, but he was also found showing some unusual symptoms. What was more alarming was that his family members also started showing the same symptoms. On further testing, it was realised that they were infected by the Nipah Virus. Nipah a brain damaging virus is generally found in bats, and the mortality rate is around 70%. The Government machinery already had templates on how to manage a virus outbreak, and even though they were caught off guard, swift action of the health department ensured that the outbreak was contained very fast. By the time things could be brought to control 18 individuals who had come in contact with the first patient lost their lives. However the Nipah virus outbreak gave the officials an on the job training on how to contain a virus outbreak. Kerala state has a very developed health care system and it was not difficult for them to capture the learning that evolved in their attempt to contain the virus.
While they were on it, they also realised that there was a possibility of another outbreak. This was based on an understanding that world across it has come for a second time. Hence the Health department waited for the next occurrence. Any patient who was coming with encephalitis was checked for Nipah virus. The focus was also to find ‘Patient Zero’ at the earliest. This was from a learning of the importance of finding ‘Patient Zero’. In the first coming the identification of “Patient Zero” got delayed leading to transmission of virus to many others. This preparedness helped and by the time the ‘Patient Zero’ was identified, marking the second outbreak of Nipah virus (June 2019) a system was in place to manage this crisis.
A 30 member team was formed to track all the individuals who came in touch with the patient. The team painstakingly identified all the individuals and got them quarantined. Most of them where home quarantined and continuously monitored to check if they were showing any symptoms. In a few weeks the ‘Patient Zero’ recovered and the other individuals were found not to have contracted the virus from him. By the time the second outbreak was contained, the health department had enough knowledge on how to manage virus outbreak as well as about treating Nipah virus.
A few important learning and capabilities that got built as a result where,
- Building route maps (Contact tracing): The approach to track the contacts of infected person, which is then published for public consumption and for them to let officials know whether they were also infected
- The need to be transparent: Kerala learned from China that if information is suppressed it will have a bigger impact.
- Co-opting media: This is a learning Kerala got when it managed the HIV threat. Media became a partner and ensured that news is not sensationalised. They also focused on educating the masses.
- Role of social media: Social media if not properly managed can create major challenges. However social media can be used to improve transparency and cut down fake messages.
- Psychological needs of patients and families: The patients and their families go through lot of trauma and stress and a support system is important for them to stay sane.
- Role of communities: Virus outbreaks cannot be managed by Govt. machineries alone, but they need support of communities, including opinion leaders, religious leaders, media, civil society.
Corona virus came at this juncture. The state was very well prepared and had all the knowledge required for containment. The two Nipah virus outbreak had also created a culture of learning and Government machinery is more conducive and open to knowledge and information from any source related to virus containment. The knowledge on corona virus containment was fast acquired from countries like China, South Korea and Singapore and the same is getting applied.
However an unknown challenge that Kerala faced was because of the source of Corona virus. While the previous two outbreaks happened in Kerala, in the case of Covid-19, it was imported. The Government machinery which was all geared for virus containment, was though not geared to stop virus imports. Since Kerala has a large diaspora, many Keralites or Malayalees who came from outside India, brought the virus along with them. The epicentre of the outbreak also keeps changing, which is adding to the challenge. Even though screening in airports and borders were made stricter, it was something new to the state machinery. There was also a need for multiple government machineries to collaborate. In the case of Nipah, mostly health department was involved, however in the case of Corona virus, the police department also came into the picture. Probably multiple teams working together and the fact that border screening is something new to Kerala, many leakages happened, which resulted in spurt of cases across.
Fortunately, the strength of health department is in containing virus, and they are able to arrest the virus spread, once a patient is identified. As per Kerala Government updates, community transmission is still not detected and unless if some unknown challenges happen for which the state machinery does not have enough knowledge, the possibilities of community transmission is low.
As we look forward to an end to this, let us pray that all of us appreciate the value of knowledge and work towards safeguarding and leveraging the knowledge we are acquiring, for future challenges.
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