COVID-19 pandemic in Kerala

The first positive cases of coronavirus in India were reported from three students of Kerala origin, travelling from the Wuhan province of China, which was the point of origin of the disease. They belonged to Thrissur, Alappuzha and Kasargod districts of Kerala and two of them were medical students at a university in Wuhan. Following the detection of positive cases, the government of Kerala declared a 'state calamity warning'. Over 3000 contacts of the affected individuals were placed under quarantine, out of which 45 were placed in hospital quarantine.

The three positive individuals later recovered from the infection following hospital care. The 'state calamity' warning was withdrawn after 4 days, when no further cases were reported. As China was a popular country for students from Kerala to pursue medicine, several medical students got stranded in China when the lock-down due to coronavirus was put into effect. Some of them, who were stranded in airports in China were evacuated and flown into Cochin International Airport and quarantined at isolation wards in Kochi Medical College. However, none of them were later tested positive for the disease.

The government of Kerala declared high alert from 4 to 8 February and starting 8 March 2020 due to coronavirus cases being reported from the state.[15][16] Isolation wards with 40 beds were set up in 21 major hospitals of the state and a helpline was activated in every district.[17] As of 9 March, more than 4000 persons are under home or hospital quarantine in Kerala.[18] As of 4 March, 215 health care workers were deployed across Kerala and 3,646 Telephone counseling services were conducted to provide psycho-social support to families of those suspected to be infected.[19] Despite the threat of coronavirus infection, the Kerala government decided to go ahead with Attukal pongala, a large, annual, all-women religious congregation in Thiruvananthapuram. The government also urged individuals to refrain themselves from the pongala, take precautions against disease transmission and, if possible, offer pongala at their own homes.[20][21] The government of Kerala has started a YouTube channel for updating the public regarding the status of coronavirus spread in Kerala and precautions to be taken.[22] There are three coronavirus testing centers in Kerala : National Institute of Virology Field Unit, Thiruvananthapuram Medical College, Calicut Medical College.[23]

On 10 March, the Kerala government arranged special isolation wards in prisons across the state.[24] On 10 March, the government of Kerala shut down all colleges and schools up to grade 7.[25] The government also urged people to not undertake pilgrimages, attend large gatherings such as weddings and cinema shows.[26]

Also, the government has launched a mobile application called "GoK Direct" for users to get information and updates regarding the COVID-19 (coronavirus) disease. It is an initiative from the Kerala Startup Mission and the Information & Public Relations Department developed by startup Qkopy. The app can also send text message alerts to basic phones (without internet). The app will focus on general announcements, information and updated guidelines for travellers, details about the quarantine protocol and also health and safety tips for visitors to the state.[27]

On 15 March, the new initiative 'Break the Chain' was introduced by the Government of Kerala. The campaign aims to educate people about the importance of public and personal hygiene. Under this campaign, the Pinarayi Vijayan-led government has installed water taps at public spots such as at the entry and exit gates of the railway stations with hand wash bottles.[28]

On 19 March, Chief minister Pinarayi Vijayan announced a stimulus package of Rs 20,000 crore (€2.5 billion; $2.6 billion) to help the state overcome both the COVID-19 epidemic and economic hardship caused by it. This includes Rs. 500 crore for healthcare, Rs 2,000 crore for loans and free rations, Rs 2,000 crore for creating jobs in rural areas, Rs 1,000 crore for families with financial difficulties, and Rs 1,320 crore for paying two months pensions in advance.[29][30] The government has also ordered salons and workout centers to shut down. This is in order to prevent the virus from spreading via direct contact.[31]

On 22 March, Health minister of Kerala, K. K. Shailaja strongly warned to people to follow the orders from Health department of Kerala.[32] A citizen science initiative, Collective for Open Data Distribution - Keralam (CODD-K), by a group of technologists, academicians, and students advocating open data released first bilingual (Malayalam and English) online dashboard (March 22, 2020) for non-specialists to provide real-time analysis, and daily updates of COVID-19 cases in Kerala by leveraging publicly available data from the daily bulletins published by the department of health services (DHS), Government of Kerala, and various news outlets[33][34]

On 23 March, Chief minister Pinarayi Vijayan announced a statewide lock-down till 31 March to prevent further spread of the coronavirus. This was before the central government declared a nationwide lock-down. Being strictly applied in Kasargod necessary shops like grocery stores were allowed to be opened from 11am till 5pm. And in other districts necessary shops were opened from 7 am till 5 pm with the exception of medical stores. Public transports were shut down. There was no restriction for private vehicles but district to district travels were only allowed with thorough checking.[35]

On 5 September, in its first of a kind in the world, a 19-year-old woman COVID-19 patient was sexually assaulted by the driver of state's health department owned ambulance while shifting her to first line treatment centre near Aranmula of Kerala's Pathanamthitta district.[36]

Passengers inside flights will be seated in a zig-zag fashion, wearing masks. 45 minutes before arrival, announcements will be made inside the flight about quarantine will be checked. Those running a fever will be sent to the isolation bay. If they do not have a fever, they will be directed to the help desks. Each of the help desks will be manned by a doctor, staff nurse, volunteer and a data entry operator. Passengers are checked for fever or other symptoms at the help desk by the doctor. If they do, they are directed to the isolation bay.[46]

The Indian Consulate had appealed to passengers not to overcrowd the airport, maintain social distancing and follow all necessary precautions stipulated by the authorities. Air India crew members on board the repatriation flights will be fully protected with protective gear, including Personal Protective Equipment, to reduce the risk of contracting coronavirus.[47]

Separate mobile health applications have been created to register and track the expatriates who will arrive at three of the airports in the first phase – Kochi, Thiruvananthapuram and Kozhikode. The app to be used at Thiruvananthapuram is named 'Karuthal' (precaution in English), the one designed for Kochi is Ayurraksha and the one for Kozhikode is Agamanam (arrival in Malayalam). All the details of those who have registered on the NORKA website have been plugged into the app. Using QR codes, each of the travelers can be contacted and traced.[48]

Initially, there will be a basic medical screening for those wishing to return home. Only those found asymptomatic will be allowed to board the aircraft. Medical teams will be deployed at the arrival lounge with screening facilities. The passengers will be home quarantined for 14 days and monitored by ward-level Vigil Committees in their residences. Those who wanted to stay in corona care homes will be shifted to such centres near airports. The state government has requested the Centre Government to provide passengers' list before their arrival in Kerala Airports. The expatriates has to strictly undergo the mandatory quarantine time period in government-arranged facilities of seven days. On the seventh day, PCR test for coronavirus will be conducted and those who tested negative will be sent home. The test result will be announced the next day. Those who test positive will be sent to hospitals. Those who proceed to their homes will have to remain in quarantine for one more week. Antibody tests would also be widely done on overseas returnees.[49]

Empty Kunnamkulam town on a full lockdown Sunday

Indian Navy ship Jalashwa entered Male port in the Maldives on Thursday to evacuate Indian citizens stranded in the country as part of India's national effort to repatriate its citizens from abroad. Indian Naval ships Jalashwa and Magar are part of the first phase of evacuation operations from 8 May 2020. The navy has named its evacuation operation as "Samudra Setu" (Sea Bridge).[50]

The repatriation exercise is being conducted in keeping with a standard operating procedure (SOP) prepared by the central government. Under the first phase of Operation "Samudra Setu", Jalashwa is set to bring back 750 Indians from the Maldives, followed by another 250 repatriations by INS Magar.[51]

Sources in the military said there are nearly 3,500 Indians stranded in the Maldives, a tourist paradise that lies to India's southwest in the Indian Ocean. A call is yet to be taken on the repatriation of the remaining 2,500 Indians, the sources added.

Meanwhile, the sources said, two other Naval ships are waiting off West Asia, which hosts the largest share of Indian citizens abroad. Since the area is also being served by the Air India repatriation flights, the sources added, the Ministry of External Affairs (MEA) has not decided which country they will need to enter to undertake the exercise.

The Indian military will begin the repatriation of stranded Indians Friday as a Navy ship sets sail from the Maldives with at least 750 people on board, is expected to reach the Cochin Port port by Sunday. The evacuated personnel will be disembarked at Cochin Port in Kerala and will be under the care of state authorities.[52]

All arrangements have been made at the port to receive the ship, part of the Indian Navy's 'Operation Samudra Setu' to evacuate the stranded Indians overseas amid the COVID-19 pandemic.

The movement of passengers from the ship to the terminal will be held under the supervision of district administration and health department. The e-declaration of the passengers will be completed on board the ship itself. Preliminary tests will also be conducted. Those with symptoms will be allowed to disembark first and moved to a separate zone earmarked on the terminal. And after completing the immigration and customs checks, they would be taken to the hospital in ambulances. The District Medical Office (DMO) will oversee this. Other passengers will be categorized into batches of 50 based on their districts and allowed to disembark next. Their immigration and customs checks will be completed at the Samudrika cruise terminal. The port health organisation will check the e-declaration of the passengers. BSNL will issue new SIM cards to passengers. Passengers will have to install Aarogya Setu app at the terminal itself. After completing the checks, passengers will be sent to various districts in buses with 30 people each. Cars will be provided depending on the need. Visitors, relatives or friends of passengers will not be allowed at the Samudrika terminal.[53]

By 16 April, the Union Health Ministry had identified seven districts in Kerala as COVID-19 hotspots.[55] Initially, CM Pinarayi Vijayan said that the central government's directives on lock-down restrictions would be fully implemented in the state. The state government said it was unscientific to decide on hotspots, but that the centre's decision could not be changed.[56] But the state later took the stand that there was no need to declare some of these districts as hotspots and argued that the decision of the MoHFW was unscientific. Instead, they decided to modify the list of hotspots, considering that the growth rate of infection was rapidly decreasing in the state.[57]

Finally, Kerala designated four districts – Kasargod, Kannur, Kozhikode and Malappuram – as 'Red Zone', Idukki and Kottayam as 'Green Zone' and the remaining eight districts as 'Orange Zone'. Lock-down restrictions in the Green and Orange Zones were relaxed on 20 and 24 April. Inter-state and inter-district travel would continue to be banned. People travelling outside their homes would be required to wear a mask. Every district would be given a special plan for preventive measures.[58] According to the government's order, 13 services, including air, rail and inter-district bus services, will not be available in the zoning system throughout the lockdown.

On 23 April 2020, Pinarayi Vijayan announced that the two 'Green Zone' districts – Idukki and Kottayam – would be added to the COVID-19 Orange Zone. This followed confirmation of new positive cases in these districts.[59] On 27 April 2020, Kottayam and Idukki districts were included in the 'Red Zone' due to rising numbers of new cases. With this, six districts are in the Red zone. State Police Chief, Lokanath Behera announced that two IPS officers have been appointed as Special Officers in the Red Zone, Idukki and Kottayam.[60]

On 2 May 2020, Wayanad district was shifted to Orange Zone following the report of the COVID-19 case. Thrissur, Alappuzha and Ernakulam have been in the green zone with no new cases reported for more than 21 days. Kannur and Kottayam will remain in the red zone. Other districts are in the orange zone. The zonal classification will be changed from time to time to assess the situation in the districts. Lock-down control in hotspots in Red Zone districts has been decided to be implemented more strictly. No public transportation will be allowed, including in the Green Zone.[61]

As of 27 November 2020, there are 527 'Local Self-Government Bodies needing Special Attention' across the state.[62]

COVID-19 pandemic in Kerala by district
S.	District	Active cases	Recoveries	Deaths	Total cases	Change since yesterday
	Ernakulam	9574	49045	196	58826	163
	Thrissur	7950	44612	188	52755	97
	Alappuzha	7826	34752	131	42726	265
	Kozhikode	7242	53592	164	61005	111
	Malappuram	6619	55861	195	62684	157
	Thiruvananthapuram	5795	61186	507	67536	115
	Palakkad	5322	27846	73	33243	247
	Kollam	4692	38131	147	42977	114
	Kottayam	3833	26883	77	30795	407
	Kannur	3657	26014	143	29819	163
1	Idukki	2010	7665	11	9688	64
1	Pathanamthitta	1958	16154	16	18129	8
	Kasaragod	1786	18805	74	20669	76
	Wayanad	1132	7914	21	9067	82
Total (all 14 districts)		69,396	4,68,460	1,943	5,39,919	675
As of 8 February 2021[63]

COVID-19 pandemic in Kerala by district District Total cases Recoveries Deaths Active cases Total 8,84,243 8,08,377 3,588 72,278 Alappuzha 65,466 61,452 287 3,727 Ernakulam 1,01,685 90,463 367 10,855 Idukki 21,577 16,482 30 5,065 Kannur 45,178 41,445 241 3,492 Kasaragod 25,754 23,983 93 1,678 Kollam 69,665 63,921 253 5,491 Kottayam 63,314 56,548 176 6,590 Kozhikode 99,639 92,620 367 6,652 Malappuram 1,02,006 97,234 378 4,394 Palakkad 53,168 47,751 165 5,252 Pathanamthitta 41,135 34,449 78 6,608 Thiruvananthapuram 89,920 85,391 715 3,814 Thrissur 84,072 78,630 373 5,069 Wayanad 21,664 18,008 65 3,591 As of 2021-01-23[1] References

The intensity of the COVID-19 pandemic can be estimated using several statistics. Some such key statistics are cases per million, deaths per million, recovery rate, case fatality rate and case to test ratio. These are calculated as follows:

${\displaystyle {\text{Cases per million}}={\frac {\text{Number of cases}}{\text{Population}}}\times 1,000,000}$

${\displaystyle {\text{Deaths per million}}={\frac {\text{Number of deaths}}{\text{Population}}}\times 1,000,000}$

${\displaystyle {\text{Recovery Rate (percent)}}=1-{\frac {\text{Number of active cases}}{\text{Number of cases}}}\times 100}$

${\displaystyle {\text{Case fatality rate (percent)}}={\frac {\text{Number of deaths}}{\text{Number of cases}}}\times 100}$

${\displaystyle {\text{Case to test ratio (percent)}}={\frac {\text{Number of cases}}{\text{Number of tests}}}\times 100}$

For all these statistics except 'Tests per million' and 'Recovery rate', a lower number indicates a better situation in that regard. The following table compares these statistics for Kerala with India, the World, and two countries - New Zealand and the USA.