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Introduction: Disease transmission patterns of COVID-19 have shown that masking, social distancing, contact tracing and quarantine measures are important strategies for reducing transmission. The effective implementation of quarantine is determined by the commitment of the people and monitoring by the State. The aim of the study was to find out the effectiveness of home quarantine practises and its role in determining SARS CoV2 transmission. Methods: Record-based retrospective cohort study was conducted among expatriates of Kerala who were on quarantine at their homes and later tested positive for SARS –CoV-2. Quarantine practises were categorised as strict room quarantine, incomplete room quarantine, home quarantine and no quarantine. Risk of transmission was assessed using risk ratios. Multiple logistic regression analysis was performed to find out the determinants of SARS CoV2 transmission. Results: The median (IQR) age and duration of quarantine of 95 study participants were found to be 35 (29, 44) years and 7 (3,13) days, respectively. Majority of the participants practised strict room quarantine (57%), whereas 11.6%, 16.8% and 14.7% practiced incomplete room, home and no quarantine, respectively. Home quarantine without room quarantine had 24 times odds for transmitting disease [OR (95%CI)): 24.14 (4.87--119.75), P < 0.001] and not being in quarantine for any duration before being diagnosed was found to be 14 times riskier when compared with strict room quarantine [OR (95%CI)): 14.44 (2.42–86.17), P = 0.003]. Discussion: Low-resource settings successful in the initial phases of COVID-19 pandemic should make periodic revisions in the quarantine guidelines while continually promoting physical distancing strategies.

The SARS-CoV-2 pandemic that began in Wuhan in China has spread rapidly with cases currently confirmed in more than 200 countries worldwide. The first case of the outbreak in India was reported on 31st January 2020 in three medical students who returned to Kerala from Wuhan. We report the district level preparedness and response to the first case of COVID-19 infection confirmed in the district of Kasaragod, Kerala. The identification, diagnosis, clinical course and management of the case including surveillance and contact tracing are described. The district level actions before and after the identification of the first case provide a guidance to other resource limited settings regarding the preparedness and mitigation measures to be adopted in times of a pandemic. The evolution of strategies highlights the importance of coordination between district and state health authorities, district administration and line departments; rapid dissemination of health information, disaster preparedness and engagement of the community for surveillance support and home quarantine.