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Kasaragod, Apr 19: Kasaragod, Kerala's COVID-19 hotspot, is the only district in the southern state lacking adequate health infrastructure.

In spite of treating the highest number of COVID-19 patients in the state with meagre infrastructural facilities and even without the support of a medical college in the north Kerala district, no deaths have been reported due to coronavirus.

The state health department views the performance of M Kunhiraman and his team, consisting of Janardhana Naik and Krishna Naik, at the General hospital in Kasaragod as a success story.

"Not only did they control the situation quickly with minimum infrastructure, they also started turning out a large number of negative cases within a few weeks and creditably ensured zero mortality.

This can be showcased as a best global model," Chairman of the Information Education and Communication (IEC) Committee and Project Director Kerala State Aids Control Society, R Ramesh said.

Recalling the ordeal, Janardhana Naik said his first major challenge was the physical examination of a patient with suspected COVID-19.

"Even with the PPE kit, nobody knew how effective they were and it took a whole 30 minutes to wear them properly.

But as time passed, we got accustomed to it," he said.

The traditional method of dealing with a patient involved knowing his or her history, observation and physical examination.

For hundreds of years, the hands-on body approach has been the soul of the doctor-patient relationship -- taking the pulse, tapping on and listening to the chest, feeling lumps.

With the onset of COVID-19 all that has changed.

"In fact, the whole exercise was fraught with grave risks because everything connected with COVID-19 was new.

Doctors have to keep a distance even though the physical examination wearing a Personal Protective Equipment (PPE) is difficult.

Sounds from the body are inaudible, vision is blurred through the smog-covered goggles and a stethoscope seldom has any use," Janardhana Naik said.

It was from March 15 that the hospital started receiving COVID-19 patients, primarily from Dubai.

By the time the first person came, the hospital was ready for him.

Soon, patient numbers began to swell and in a couple of weeks they reached about 91.

From then on, it was teamwork.

Committees were formed for each and every task, including the help desk, IT, treatment, medical board, training, food, waste disposal and data maintenance.

Initially, patients had many misgivings about the hospital.

"Some were disillusioned and even aggressive. Some were not happy with the facilities the hospital had to offer.

But gradually through good treatment and counselling by a psychiatrist, who visited the hospital on alternate days, the confidence and mood of the patients changed and they became friendly with the staff," Naik elaborated.

Counselling was also given to the concerned family members of the patients.

Besides treatment, the medical staff had to spend a considerable amount of time clearing the doubts of patients.

When they got discharged some patients insisted on seeing the faces of the medical staff, who till then were anonymous entities covered from head to toe.

Some even wanted to take selfies with them.

However, the medical team politely turned down their requests and preferred to remain hidden in their work attires.

The mood of the patients also rubbed off on the doctors and hospital staff.

All the physicians and hospital staff are now more confident of dealing with contagious diseases after treating COVID-19 patients.

"Our previous experience of treating H1N1, Chikungunya and Dengue cases helped us a lot.

Words of encouragement from the Health Minister K K Shailaja, Health Principal Secretary Dr Rajan N Khobragade and Health Services Director Dr Sarita R L gave us the impetus to build up confidence.

Moreover, the field health workers did a wonderful job in containing the viral spread," Naik added.

As the number of coronavirus cases rose, the state government on April 5 deputed a 26-member medical team from Thiruvananthapuram to set up a COVID-19 hospital in the district.

They turned a block of the under construction Government Medical College as a hospital-like facility, setting up a 200 bed facility to treat coronavirus patients.

The current physical distancing guidelines provided by the World Health Organisation (WHO) and by the US Centers for Disease Control and Prevention (CDC) may not be adequate to curb the coronavirus spread, according to a research which says the gas cloud from a cough or sneeze may help virus particles travel up to 8 metres. The research, published in the Journal of the American Medical Association, noted that the the current guidelines issued by the WHO and CDC are based on outdated models from the 1930s of how gas clouds from a cough, sneeze, or exhalation spread.

Study author, MIT associate professor Lydia Bourouiba, warned that droplets of all sizes can travel 23 to 27 feet, or 7-8 metres, carrying the pathogen.

According to Bourouiba, the current guidelines are based on "arbitrary" assumptions of droplet size, "overly simplified", and "may limit the effectiveness of the proposed interventions" against the deadly pandemic.

 She explained that the old guidelines assume droplets to be one of two categories, small or large, taking short-range semi-ballistic trajectories when a person exhales, coughs, or sneezes.

However based on more recent discoveries, the MIT scientist said, sneezes and coughs are made of a puff cloud that carries ambient air, transporting within it clusters of droplets of a wide range of sizes.

Bourouiba warned that this puff cloud, with ambient air entrapped in it, can offer the droplets moisture and warmth that can prevent it from evaporation in the outer environment.

"The locally moist and warm atmosphere within the turbulent gas cloud allows the contained droplets to evade evaporation for much longer than occurs with isolated droplets," she said.

"Under these conditions, the lifetime of a droplet could be considerably extended by a factor of up to 1000, from a fraction of a second to minutes," the researcher explained in the study.

The MIT scientist, who has researched the dynamics of coughs and sneezes for years, added that these droplets settle along the trajectory of a cough or sneeze contaminating surfaces, with their residues staying suspended in the air for hours.

"Even when maximum containment policies were enforced, the rapid international spread of COVID-19 suggests that using arbitrary droplet size cutoffs may not accurately reflect what actually occurs with respiratory emissions, possibly contributing to the ineffectiveness of some procedures used to limit the spread of respiratory disease," Bourouiba wrote in the study

Tumkur, Apr 11: Despite the nationwide lockdown, BJP MLA from Turuvekere constituency, M Jayaram, was on Friday seen celebrating his birthday with several villagers in Gubbi taluk in Tumkur.

A sizable number of people were seen gathering in Gubbi taluk to celebrate the BJP legislator's birthday.

Meanwhile, scores of people around the country are getting booked for violating the lockdown. In Uttarakhand alone, more than 4500 people have been arrested until Friday for violating the norms of lockdown.

Last month, Prime Minister Narendra Modi had called for a three-week lockdown, urging people to practice social distancing to prevent the spread of coronavirus.

The total number of COVID-19 cases in the country has mounted to 6,761 of which 6039 are active cases, 516 have been cured/discharged/migrated, and 206 deaths have been reported.