Kerala plans reverse quarantine for elderly

The state, which on January 30 was the first in India to report a coronavirus case, is seeking to preserve the impressive gains it had made in the battle against the pathogen, which has affected 499 people, of whom 95 are active patients.

Kerala, the state with the lowest Covid-19 mortality and highest recovery rate in India, is set to take the fight against the viral pandemic to the next stage by implementing a “reverse quarantine” to protect its elderly and people ailing with medical conditions that make them susceptible to the virus.

A blueprint for the reverse quarantine has already been prepared and health workers have started monitoring the medical conditions of the elderly and people whose immunity may have been compromised and left them susceptible to Covid-19 by existing health conditions.(Photo by Sonu Mehta/Hindustan Times)

The state, which on January 30 was the first in India to report a coronavirus case, is seeking to preserve the impressive gains it had made in the battle against the pathogen, which has affected 499 people, of whom 95 are active patients. Four have died.

A blueprint for the reverse quarantine has already been prepared and health workers have started monitoring the medical conditions of the elderly and people whose immunity may have been compromised and left them susceptible to Covid-19 by existing health conditions.

Experts say reserve quarantine refers to a practice of isolating the most vulnerable people -- those of advanced age and under treatment for existing ailments -- from the rest of the population and monitoring their health closely to protect them from infection.

“In Kerala, we have 70 lakh people who are above 65 years of age and suffer from diabetes, cancer, blood pressure, heart ailments, kidney disease and respiratory tract infections. They are sitting ducks. Our priority is to detach them from others and protect them,” said Dr B Iqbal, who heads an expert panel that advises the state government on prevention of the coronavirus disease.

“In case of a community spread we can isolate vulnerable population and check their mortality rate effectively unlike what happened in some of the western countries. We have formed grassroots committees to monitor their health conditions. Besides local body members, Asha {accredited health activist} workers, resident association office-bearers, youth volunteers and local police officers will be part of these committees,” he said.

The plan is being implemented at a time when Kerala is preparing to receive, once flights resume, citizens from the state who are either stuck overseas, mainly in the Middle East, or have lost their jobs.Family members of Keralites settled abroad, pregnant women and students of Indian origin who want to pursue higher education at home are among the 300,000 people who have registered on a website opened by the Kerala government for such people last week.

Some returnees from overseas locations n March had turned super spreaders after jumping home quarantine, prompting the state to adopt a more cautious approach this time.

Experts like Dr. Iqbal say that a reverse quarantine is a viable option until an effective vaccine is found for Covid-19. Once a person is in put in reverse quarantine, a separate room with a toilet is given to him or her and their interaction with other family members is limited. Social distancing norms and face masks are a must. In north Kerala, many cancer patients have already been put in reverse quarantine.

“Since it is a new virus we need a multipronged strategy to deal with it. Reverse quarantine is one among them. We can’t say how long the virus will be active and {when the local population will} achieve herd immunity. So we can isolate people who are more prone to it. As Kerala is an informed society it is better to practise it here,” said epidemiologist Dr Jayaprakash Muliyil, also former principal of the Christian Medical College, Vellore.

A sense of deprivation and neglect can set in among those prescribed reverse quarantine, and it has to be addressed by family members and medical counsellors. Some areas, especially north Kerala, have strong palliative care services and volunteers from the region can be used elsewhere to tend to patients, said Dr Iqbal.

“We can’t live in a lockdown like this for long. We have to live with it till a vaccine is found. So we have to evolve a mechanism to suit this. Like social distancing, reverse quarantine is a way to check the mortality rate,” said another expert, adding the key is “minimum exposure” of the vulnerable to the outside world. In so-called red zones,a ban has been enforced on people above 65 and children below 10 years stepping out of their houses.