Every morning for the past week N.K., a 35-year-old community health activist, has received a WhatsApp message from her supervisor with the names of the latest group of travelers returning to India from countries affected by the coronavirus. Once she has the list of names, N.K. tracks down their addresses. By noon, she’s at someone’s doorstep, armed with a list of do’s and don’ts for people suspected of carrying the virus.
Over the phone, she reeled off the list of instructions she gave people: “Wash your hands, clean your living spaces. Avoid: crowds, religious gatherings, weddings, elderly people and eating food from outside. If you have a cough, cough into a mask. If you have fever or any other symptoms, call me. Even if you don’t, I’ll be here.”
Women like N.K. are known as ASHAs — an acronym for Accredited Social Health Activists, which also spells the Hindi word for “hope” — and have been deployed as India’s first line of defense to track down “imported cases” of the coronavirus. These are Indian travelers who might be bringing the virus home from China, Europe or the Gulf countries, where a large section of Indians work as migrant labour. According to the latest Indian health ministry advisory, India currently only has “imported cases” of the novel coronavirus and no recorded cases of community transmission — which makes the ASHAs’ work of monitoring travelers and their families even more crucial.
India has so far appears to have escaped the worst of the coronavirus pandemic, with 194 cases and four deaths, and has been praised by the World Health Organization for its response so far. But while the government has launched an aggressive airport screening program, it is not carrying out widespread testing, and Indians returning from Europe have raised concerns about the quarantine centers they were held in.
Several Indian state governments, such as in Punjab, Karnataka, Andhra Pradesh, Kerala, and Maharashtra, have deployed community health workers to do the work N.K. is doing — track down returnees, monitor them and their families for 14 days to check whether they develop any symptoms of the coronavirus, and go door to door teaching people how to practice social isolation, and to protect themselves.
It’s crucial but dangerous work. In Italy, where coronavirus has killed more people than in any other country in the world, one in 12 people infected by the virus so far have been health workers. In the US, the CDC recommends that public health professionals who do the work that the ASHAs are doing in India, conduct interviews over the phone or on video chat. In the event that they are checking for symptoms in person, health workers should wear full personal protective equipment (PPE) before entering homes of possible patients. Recommended PPE includes a gown, gloves, face shield, goggles and a respirator mask like the N-95.