‘If COVID-19 Virus Evolves As It Did In China Or Italy, We Definitely Have Something To Worry About’

Pathanamthitta: P B Nooh, 41, the district collector of Pathanamthitta district in southeastern Kerala, has been a busy man since March 8, 2020, when the district’s first COVID-19 case was detected. Pathanamthitta now has nine confirmed cases--30% of the state’s total, the most in one district. Kerala itself has 28 cases (as of 5 p.m. on March 20), nearly 13% of India’s 223 cases, the second-most after Maharashtra, according to Coronovirus Monitor, a HealthCheck database.

Kerala has one of India’s strongest health systems and ranks at the top of 21 states on NITI Aayog’s 2017-18 health index, which places it in a strong position to deal with COVID-19. 

Pathanmathitta’s outbreak having started with a family that had returned from Italy, the district surveillance team has been tracking more and more people arriving from overseas each day, as “there is always a probability that at least some of them could be positive”, Nooh told IndiaSpend in an interview. 

The district has created a team in each ward to ensure that everyone asked to remain in home isolation is visited at least once in three days, and has urged the community to inform the control room if they notice people breaking the quarantine. The district does not want to take coercive steps but “we will be forced to do so” if people do not adhere to the quarantine, he said. 

Nooh is from the Indian Administrative Service and is a veteran crisis handler, having dealt with the 2018 floods in Pathanamthitta and the conflict when the Sabarimala temple, also in Pathanamthitta district, was opened up to women. He has been the sub-collector of Ottapalam in Palakkad district and the director of the state’s Department of Social Justice and Empowerment. 

In an interview with IndiaSpend, Nooh spoke about the current situation in the district and his approach. Edited excerpts:

Pathananthitta has almost 30% of the cases in Kerala. What is the strategy for limiting these cases and how has this strategy evolved since the first case was detected? 

The first thing was to track those who had come in contact with the family that had come from Italy [all three members tested positive for COVID-19]. We have been able to track 95% to 98% of the people. Currently, 1,254 people who had primary or secondary contact with the family have been tracked [as on March 19, 2020]. All of them are under home isolation and 16 are under hospital isolation. 

But now, the focus has shifted to tracking those who have come to Pathanamthitta after travelling abroad in the last 14 days. This is an evolving number. There are 1,894 people overall of which 636 were added [to the database on March 18, 2020], and 236 were released from quarantine. 

I am expecting up to 1,500 people to be added to this in the next couple of days, that would roughly be more than 3,000 people overall. There are a lot of non-resident Indians in the district, and since the outbreak, many people are returning and there are people who are frequent travellers.

Are you worried about community transmission? 

If at all it happens, [we need to know] how to prevent it.  

But you have a lot of data from the surveillance and you are probably in the best position to judge if there is a possibility. 

We have three people from Italy who have spread it to 1,254 others. I am not saying the disease has been spread, but there is contact. Now, we have 1,894 people who have travelled to countries, many of whom are infected. There is always a probability that at least some of them could be positive. 

We are strictly implementing home quarantine. We have 920 gram panchayat and municipality wards in the district. Each ward has a sanitation committee chaired by ward members, convened by a junior health inspector and ASHAs [Accredited Social Health Activists], anganwadi and Kudumbashree workers. Every panchayat has five police officers. 

These teams have been constituted and their role is to meet all these home-quarantined people at least once in three days. 

To implement this strictly, we have included the revenue administration and released two exclusive phone numbers to ensure that if community members see any of the home-isolated people out and about, they can call this number and we will pass on this information to the tahsildar or the police station, and ensure they go back home.

Do you think taking coercive steps could be useful?

Actually, we are not taking any coercive steps. We want to convey the message that the government is very serious about you staying back home [if people have been asked to stay under quarantine]. If they do not do it on their own, we will be forced to do it. Using force would be the last step.

We are involving the community to inform us, and I believe in most cases people will accept the officials' advice. At least in Kerala that will happen. 

If there is community transmission or the numbers of COVID-19 cases increase, how will you tackle a possible shortage of hospital beds or resources like medical staff?

We have arranged more than 100 beds in government and private hospitals. We have prepared another 100 beds in hospitals that were shut down (in the last year) and can be converted into isolation wards.

I am working with legislative assembly members and planning to have 100-150 beds in each of the legislative assembly constituencies, which could be a hostel, a school or any other building. I am trying to have 500-750 beds in a week’s time. [The district has a population of about 1.2 million, as per the 2011 census.]

I had a discussion with the Indian Medical Association and have requested a list of doctors who would be ready to work with us [when the need arises]. 

You have handled the 2018 floods and the Sabarimala issue, both of which had an impact on public sentiment. Is COVID-19 more worrying?

We actually do not have any clue how the [SARS-CoV-2] virus is evolving. If it evolves the way it did in China or Italy, then we definitely have something to worry about. At the same time, the way we have managed and intervened is far better than developed countries, and we hope to have better results here. 

You have spent a lot of time in surveillance, including contact tracing. Does Kerala have teams across all districts in the state now that nine of 14 districts have COVID-19 cases (as on March 19, 2020)? Or, is Pathanamthitta an exception due to these existing positive cases?

I am not sure about the others, but here we are going step-by-step [based on the need] for surveillance. We are involving more people like Kudumbashree community counsellors to screen foreign travellers. They will help in mental health counselling. Each step is based on how the problem is evolving.

Correction: The story has been updated to correct P B Nooh’s age.

(Paliath is an analyst with IndiaSpend.)

We welcome feedback. Please write to respond@indiaspend.org. We reserve the right to edit responses for language and grammar.

Pathanamthitta: P B Nooh, 41, the district collector of Pathanamthitta district in southeastern Kerala, has been a busy man since March 8, 2020, when the district’s first COVID-19 case was detected. Pathanamthitta now has nine confirmed cases--30% of the state’s total, the most in one district. Kerala itself has 28 cases (as of 5 p.m. on March 20), nearly 13% of India’s 223 cases, the second-most after Maharashtra, according to Coronovirus Monitor, a HealthCheck database.

Kerala has one of India’s strongest health systems and ranks at the top of 21 states on NITI Aayog’s 2017-18 health index, which places it in a strong position to deal with COVID-19. 

Pathanmathitta’s outbreak having started with a family that had returned from Italy, the district surveillance team has been tracking more and more people arriving from overseas each day, as “there is always a probability that at least some of them could be positive”, Nooh told IndiaSpend in an interview. 

The district has created a team in each ward to ensure that everyone asked to remain in home isolation is visited at least once in three days, and has urged the community to inform the control room if they notice people breaking the quarantine. The district does not want to take coercive steps but “we will be forced to do so” if people do not adhere to the quarantine, he said. 

Nooh is from the Indian Administrative Service and is a veteran crisis handler, having dealt with the 2018 floods in Pathanamthitta and the conflict when the Sabarimala temple, also in Pathanamthitta district, was opened up to women. He has been the sub-collector of Ottapalam in Palakkad district and the director of the state’s Department of Social Justice and Empowerment. 

In an interview with IndiaSpend, Nooh spoke about the current situation in the district and his approach. Edited excerpts:

Pathananthitta has almost 30% of the cases in Kerala. What is the strategy for limiting these cases and how has this strategy evolved since the first case was detected? 

The first thing was to track those who had come in contact with the family that had come from Italy [all three members tested positive for COVID-19]. We have been able to track 95% to 98% of the people. Currently, 1,254 people who had primary or secondary contact with the family have been tracked [as on March 19, 2020]. All of them are under home isolation and 16 are under hospital isolation. 

But now, the focus has shifted to tracking those who have come to Pathanamthitta after travelling abroad in the last 14 days. This is an evolving number. There are 1,894 people overall of which 636 were added [to the database on March 18, 2020], and 236 were released from quarantine. 

I am expecting up to 1,500 people to be added to this in the next couple of days, that would roughly be more than 3,000 people overall. There are a lot of non-resident Indians in the district, and since the outbreak, many people are returning and there are people who are frequent travellers.

Are you worried about community transmission? 

If at all it happens, [we need to know] how to prevent it.  

But you have a lot of data from the surveillance and you are probably in the best position to judge if there is a possibility. 

We have three people from Italy who have spread it to 1,254 others. I am not saying the disease has been spread, but there is contact. Now, we have 1,894 people who have travelled to countries, many of whom are infected. There is always a probability that at least some of them could be positive. 

We are strictly implementing home quarantine. We have 920 gram panchayat and municipality wards in the district. Each ward has a sanitation committee chaired by ward members, convened by a junior health inspector and ASHAs [Accredited Social Health Activists], anganwadi and Kudumbashree workers. Every panchayat has five police officers. 

These teams have been constituted and their role is to meet all these home-quarantined people at least once in three days. 

To implement this strictly, we have included the revenue administration and released two exclusive phone numbers to ensure that if community members see any of the home-isolated people out and about, they can call this number and we will pass on this information to the tahsildar or the police station, and ensure they go back home.

Do you think taking coercive steps could be useful?

Actually, we are not taking any coercive steps. We want to convey the message that the government is very serious about you staying back home [if people have been asked to stay under quarantine]. If they do not do it on their own, we will be forced to do it. Using force would be the last step.

We are involving the community to inform us, and I believe in most cases people will accept the officials' advice. At least in Kerala that will happen. 

If there is community transmission or the numbers of COVID-19 cases increase, how will you tackle a possible shortage of hospital beds or resources like medical staff?

We have arranged more than 100 beds in government and private hospitals. We have prepared another 100 beds in hospitals that were shut down (in the last year) and can be converted into isolation wards.

I am working with legislative assembly members and planning to have 100-150 beds in each of the legislative assembly constituencies, which could be a hostel, a school or any other building. I am trying to have 500-750 beds in a week’s time. [The district has a population of about 1.2 million, as per the 2011 census.]

I had a discussion with the Indian Medical Association and have requested a list of doctors who would be ready to work with us [when the need arises]. 

You have handled the 2018 floods and the Sabarimala issue, both of which had an impact on public sentiment. Is COVID-19 more worrying?

We actually do not have any clue how the [SARS-CoV-2] virus is evolving. If it evolves the way it did in China or Italy, then we definitely have something to worry about. At the same time, the way we have managed and intervened is far better than developed countries, and we hope to have better results here. 

You have spent a lot of time in surveillance, including contact tracing. Does Kerala have teams across all districts in the state now that nine of 14 districts have COVID-19 cases (as on March 19, 2020)? Or, is Pathanamthitta an exception due to these existing positive cases?

I am not sure about the others, but here we are going step-by-step [based on the need] for surveillance. We are involving more people like Kudumbashree community counsellors to screen foreign travellers. They will help in mental health counselling. Each step is based on how the problem is evolving.

Correction: The story has been updated to correct P B Nooh’s age.

(Paliath is an analyst with IndiaSpend.)

We welcome feedback. Please write to respond@indiaspend.org. We reserve the right to edit responses for language and grammar.


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