With planning, preparation and prevention, the southern state of India have managed to contain the latest coronavirus outbreak. Dr Shimna Azeez lists the simple, yet effective measures that make the ‘Kerala Health Model’ work.
By Dr Shimna Azeez
In India, Kerala was the first state to report positive cases of Novel coronavirus or COVID 19. Thanks to an efficient health ministry and past experience of tackling the deadly Nipah and other epidemics, the southern state of India has managed to contain the outbreak.
With planning, preparation and prevention, the ‘Kerala Health Model’ has prevailed once again. Here’s looking at the simple, yet effective ways in which the state adopted methods of disease control – right from airports and kitchens to hospitals and isolation wards.
Decoding the virus
COVID 19 belongs to the family of Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) viruses. They are called corona because of their crown-like peculiar shape. These viruses spread through droplet transmission. In other words, any secretion from the respiratory system of COVID 19 affected patient that reaches the eye, nose or mouth of a healthy person can lead to the disease.
While there are no hi-tech methods to prevent COVID 19, we need to embrace the wisdom of good old habits that help prevent any contagious disease. Ultimately, it was the isolation strategies and education among common people regarding disease prevention has helped Kerala fight the virus.
Wash your hands
Most of us know about the importance of handwashing, yet we either do it the wrong way, or we don’t do it at all. Handwashing, done with soap and water, should take at least 20 seconds to complete. If you are using a hand sanitiser, it should contain a minimum of 70 per cent alcohol. The dispenser pump should be pressed at least twice to deliver three ml solution and the procedure should be done so as to involve all the seven steps of handwashing. Those allergic to alcohol can use a hand sanitizer containing chlorhexidine.
According to WHO, we should wash our hands on the following occasions:
*Before and after taking care of a disease suspect/patient.
*Before preparing food.
*Before and after eating food.
*After using the lavatory.
*After taking care of domestic animals and their waste.
In addition to these, healthcare professionals need to follow hand hygiene procedure during the following times:
*Before touching a patient.
*Before aseptic procedures.
*After body fluid exposure/risk.
*After touching the patient.
*After touching patient environment.
Wear a mask
One of the measures that helped prevent the outbreak of COVID 19 in Kerala was the insistence on patients, suspected patients as well as people in their close proximity wearing a three-layer surgical mask, ‘the right way’. Various countries provide different guidelines on whether or not to wear a mask.
The N95 mask is required only for those health professionals who directly deal with respiratory secretions, as those collecting throat swabs and those who intubate them. The regular caretakers can wear a three-layer surgical mask that provides adequate protection from the virus.
In Kerala, we wear the mask such that it covers the nose and mouth. Once it’s on your face, you should not touch its front side or even your face. While removing the mask, you have to hold on to the string alone and never touch on the fabric. Also, the mask should not be worn for more than six hours.
If you are a healthcare professional or a hospital visitor, you should not carry the used mask outside the hospital. They should be put in the yellow-coloured bag used to discard infectious waste items. For those who are in isolation at home, the used masks and tissues used should be burned properly. The person doing the disposal procedure must wear a mask and gloves for his/her own safety.
In case you have visited a country that has reported COVID 19 outbreak and you have symptoms like coughing, sneezing and running nose, please wear a mask to prevent the infection from spreading to others. When you cough or sneeze, do that into your flexed elbow or into the shirt. Avoid using handkerchiefs and carry tissue papers instead. Discard tissue paper to waste bin after coughing and immediately follow the hand hygiene procedure. Remember not to spit in public. Do that into a washbasin and open the faucet to pour plenty of water into your body secretion.
Maintain cleanliness
As COVID 19 is proven to be spread by fomite transmission, any surface exposed to the droplets of cough or sneezing from a person with respiratory infection can be a source of the disease. So, cleanliness (in its microscopic and macroscopic dimensions) is much necessary.
The common disinfectant Dettol is not found to be effective for cleaning infected surfaces. Lizol is found to be a more effective option. A cheaper alternative would be 0.5 per cent hypochlorite solution, prepared by adding 15 grams bleaching powder to one-litre water. This solution is to be kept aside for 10 minutes before the supernatant can be used to clean surfaces. It takes about 30 minutes for the chlorine in the solution to act on the surfaces, which can later be cleaned using regular soap and water.
In case the surface is visibly contaminated with blood, vomitus, urine or any other body secretion of the disease suspect or patient, the secretion has to be cleared first with some absorbent material. Later, the area can be flooded with the hypochlorite solution prepared as described above. For gadgets and other regular surfaces, hand sanitiser poured on tissue paper can be used for cleaning.
Though these measures may sound simple and small, they demand a lot of patience and perseverance for proper implementation. It takes teamwork to fight a deadly public health disaster. We hope that the world will benefit from the lessons we have gained from our experience of dealing with the worst of epidemics.
(The author is Dr Shimna Azeez)
