CHENNAI: When Dubai’s health authorities began door-to-door screening on Saturday for Covid-19 cases in Naif, one of the city’s most populous localities, public health officials in Kerala felt a stab of anxiety. Nearly 70% of those who have returned to the Kerala’s Kasargod district in the past few days lived in this crowded commercial-cum-residential area of the Gulf metropolis.
These returnees — Kasargod accounted for 34 of the 39 new cases reported in Kerala on Friday — have now been categorised as “high-risk” and are being tested for the novel coronavirus infection. “These people have become the biggest concern for the state,” said Dr Amar Fettle, Kerala’s state nodal officer for infectious diseases.
Many of those who returned from Gulf countries to India in February and early March were neither screened at airports nor advised to quarantine themselves. The focus then was on passengers from China, South Korea, Iran, Spain, Italy and Germany. Dubai and Saudi Arabia weren’t even on the radar. Orders for screening passengers from the Gulf did not come until March second week.
As a result, in the past 10 days, several states are seeing a spike in the number of patients with a history of living in or transiting through Gulf countries.
In Maharashtra, for instance, the novel coronavirus arrived with a group of 40 people who had gone on a six-day trip to Dubai and Abu Dhabi. “At least 15 from the group have tested positive so far,” officials said.
After Kasargod became Kerala’s Covid-19 hotspot in a single day, the district administration put 6,511 people who came into the district after February 20 under observation, of which 127 people are in isolation in hospitals. “The number of people in isolation will increase in the coming days. The results of 215 samples are expected in a day or two,” Dr Fettle said.
Public health officials and experts across the country say screening of passengers from the Middle East should have started much earlier in March. “A large number of professionals and skilled workers from across India migrate to the Gulf for employment. It is also one of the most popular transit hubs. That by itself makes it a high-risk zone,” said public health activist Dr Sumanth Raman.
Kerala now is observing nearly 300 contacts of these travellers who landed in Mumbai on March 1 and dispersed to 10 districts, including Belagavi district in the bordering state of Karnataka.
More than three-fifth of the Covid-19 patients in Maharashtra have an international travel history. Most patients travelled from the UAE, according to an analysis by the Maharashtra state department of medical education. Tracking the case sheets of 122 positive cases, officials found 67 people with travel history. Around 28 of them had travelled to the UAE.
In Bihar, a 38-year-old, who died on March 21 before he tested positive for the virus, had landed in Kolkata from the Gulf and returned home to Munger district on March 13 by car. He went to Patna Medical College and Hospital with symptoms, and doctors there referred him AIIMS-Patna. All his relatives who took his body in a private ambulance were exposed. Four people, including two private hospital staff, have since tested positive, forcing the Patna district administration to seal the private hospital, where he first visited.
In Gujarat, more than half the patients with a travel history have come from Dubai or Saudi Arabia. Among 47 people who tested positive, 27 had returned from abroad. Of these, seven were from Dubai and eight were from Saudi.
Last week, after the department of immigration handed over names and travel history of all passport holders, the states are beginning to isolate those who travelled into the country since February.
Some of them who are still asymptomatic may be infecting the elderly or people with low immunity, said officials. In Tamil Nadu, for instance, a 60-year-old man from Rajapalayam, who tested positive on Saturday, did not have any travel history. “But he told us he met one of his relatives who came from Dubai. The relative showed no symptoms,” said Tamil Nadu joint director for public health (epidemic diseases) P Sampath. Officials have asked the relative to remain in quarantine. In the past week, at least three people with a history of travel to Dubai have tested positive for the virus in Tamil Nadu.
Epidemiologists are noticing interesting patterns. For instance, health workers in Kerala found that most people who tested positive had visited a mall at the airport. The mistake cannot be undone now, but experts say testing more people is the only option for the government. “Track, test, isolate and treat,” said public health expert T Sundararaman, former dean of School of Health Systems Studies, TISS.
(Pushpa Narayan and Rajiv G with inputs from centres)