Training doctors and investing in health care was key to suppressing previous lethal outbreaks in the Kerala state of India, Sierra Leone and Nigeria.
In early March, doctors in the Indian state of Kerala identified a patient with Covid-19 related symptoms. Kerala, known for its beaches and palm trees, is located on the Malabar Coast, more than 2,000 kilometres south of the capital New Delhi.
Instead of waiting for central government’s advice, the state health machinery kicked into action. Doctors knew it was important to get to the source of the infection even before laboratory test confirmation. And they quickly figured that the patient's relatives had travelled from abroad.
A couple and their son arrived in Kerala via Qatar Airways on February 29. They hadn’t disclosed that they were in Italy, which has become the hotbed of novel coronavirus casualties.
Dozens of medical workers quickly tracked more than 3,000 people who might have come in contact with the family. They were asked to stay indoors. Twice a day, someone from the state’s health department called to check on their symptoms.
If anyone needed hospitalisation, a dedicated ambulance was sent to bring them to a building specially earmarked within the Kozhikode Medical College premises to treat them. Anyone who wanted to get checked for the viral infection was asked to show up at this better-equipped building instead of outpatient departments.
Kerala’s preparedness and prompt action stands in stark contrast to Prime Minister Narendra Modi’s dillydallying response to the contagion as more and more cases were reported in other states in the following weeks.
Kerala's effective handling of the recent outbreak was motivated by its experience with tackling the deadly Nipah virus in 2018.
“Unlike Nipah, the epicentre of the epidemic was known. The advantage is that you know where carriers of the virus are coming from. People under low risk of contracting it can be put under home quarantine, while a health worker follows up with them morning and evening. This was a technique developed during the Nipah outbreak,” Dr Rajeev Sadanandan told media platform The Better India.
Sadanandan, a former health official, is widely credited for leading the efforts to contain the spread of Nipah, the deadly viral disease with a fatality rate 40 to 75 percent that first appeared in Malaysia two decades ago.
Kerala’s Kozhikode and neighbouring Malappuram districts saw dozens of Nipah infections and 17 deaths. Things could have been much more severe if not for the prompt steps taken by local doctors to quickly identify the disease, isolate the family members and track the people they might have come in contact with.
Covid-19 is far more viral and contagious than Nipah or other haemorrhagic fevers, which are deadly but quickly peak and have mostly remained confined to few towns, villages and cities. Yet, Kerala and African countries such as Uganda, Nigeria and Sierra Leone can teach the world a lot about how to deal with infectious diseases - especially if they have jumped from the animal kingdom.
With Nipah’s outbreak, epidemiologists and veterinarians didn’t wait for special gear to go in search of the source animal. The family that first became infected was thought to have come in contact with bats, which lived in a well. So experts with construction gloves, and plastic coverings taped to their elbows went there to collect samples.
A year before Nipah cases surfaced in Kerala, a few doctors there were trained by America’s Center for Disease Control and Prevention in identifying exactly such viral outbursts. It paid off as the doctors didn’t wait for test results to come through. They sifted through the medical literature to identify the illness. This was crucial since Nipah’s symptoms are similar to encephalitis, which kills many people in India every year.
“If the identification and isolation of high-risk cases and tracing contacts of positive cases is done well, India may be able to keep the number of infections and deaths low. Barring a spike in community-based infections, the country may not face a major threat. But in public health it is always a good policy to prepare for the worst while hoping for the best,” Sadinandan wrote in a recent article.
Kerala’s success can also be traced to its high literacy rate and religious diversity.
Similarly, in Uganda, the recurring outbreaks of viral infections such as Murburg and Rift Valley fever have necessitated the urgency for early detection of potential carriers.
As part of a programme launched in 2010, hospitals and district health staff were trained on how to clinically identify patients, safely collect samples and isolate the infected people.
A biosafety level three laboratory was created to test haemorrhagic fevers and over the years it has carried out thousands of tests, helping identify Ebola, Marburg and Crimean Congo haemorrhagic fever outbreaks multiple times.
The deployment of the system and lab has shortened the time between diagnosis done by doctors and lab confirmations from two weeks before 2010 to an average of just 2.5 days now, notes a 2018 study published in medical journal The Lancet.
Aggressive contact tracing helped Nigeria stop the potential spread of Ebola in 2014. After a man who had flown to Lagos from Liberia was suspected of carrying Ebola, he was swiftly quarantined and rigorous effort was started to find the people he might have come into contact with.
A team of 150 contact tracers was assembled. They carried out 18,500 interviews - a difficult feat in a city where “houses cannot always be traced by street numbers”.
But it’s probably from West Africa that developing countries can learn more. An Ebola outbreak in Guinea, Liberia and Sierra Leone killed more than 11,000 people.
People in Sierra Leone were greeting each other with elbow knocks before it became a common sight in recent months. It was there that people altered their daily lives and social relations to curb Ebola’s spread.
For instance, if a household was infected, a single carer was deputed to look after the sick before professional help arrived. Instead of taking patients to far-off treatment facilities, community care centres staffed by local trained nurses were organised. This helped build trust among people who were adamant that they care for their family members - no matter how sick the person gets.
Covid-19 is stretching the health infrastructure everywhere with hospitals looking for ventilators and overworked doctors getting sick. This is where West Africa can offer another lesson, as anthropologist Paul Richards writes, Ebola taught that epidemics cause deaths from other diseases through their impact on health systems.
“In all there were about 12,000 Ebola deaths in Upper West Africa (Guinea, Liberia, Sierra Leone) in 2014-15 but many additional fatalities resulted from, for example, closure of facilities such as maternity clinics.”