Covid-19: Kerala shows the way

AM Jigeesh | Updated on April 17, 2020

All out: Kerala ramped up testing to tackle the mid-March spike in Covid-19 cases   -  REUTERS

Boasting a determined political leadership, Kerala has set a record of sorts in flattening the Covid-19 curve

On January 18, KK Shailaja — “Shailaja Teacher”, as she is popularly known for her no-nonsense, science teacher demeanour — summoned a meeting of the Kerala health department, a ministry she had efficiently steered through unprecedented floods in 2018-19 and the outbreak of Nipah virus. There was no cause for alarm for the world had not woken up then to the cataclysmic upheaval that was still brewing in Wuhan, China.

Policymakers in India had not registered the small news item about the World Health Organization’s confirmation that the respiratory illness that was claiming lives in China was caused by the novel coronavirus.

But Teacher was not one to take chances. She was aware that there were several Malayali students in Wuhan. She certainly had not forgotten the hard lessons from the deadly Nipah, a killer virus with a fatality rate of a staggering 75 per cent, which in 2018 claimed 17 lives in Kerala despite the state’s determined containment efforts.

And so she gathered her forces, held discussions with senior officers and, within the week — on January 22, an alert had gone out to all hospitals and district authorities about the need to prepare for a contagious virus. By January 24, a detailed set of guidelines had been framed based on WHO’s protocol for containment of Covid-19 — focussing on social distancing, hand hygiene and possibility of quarantine. Chief minister Pinarayi Vijayan also stepped in and, a week before the first Covid-19 case entered its shores, Kerala had set into motion the formidable mechanism it had created through the lived experience of the floods and the Nipah strike.

“We are a poor country with a lot of constraints. Our strength lies in society, community and our people,” says AC Moideen, minister for rural development and local governments. “During the floods and the Nipah strike, the important lesson we learnt was that we need to work collectively, structures need to work in coordination and there should be no compartmentalisation. A service delivery system was created from the wards, panchayats, municipalities and corporations, as they are the state’s day-to-day interface with the people,” Moideen tells BLink.

By the time the first case — a student from Wuhan — arrived in Thrissur on January 30, the district authorities knew exactly what to do. The chief minister formulated a state-level strategy based on standard WHO protocol of testing, surveillance, self-distancing and isolation, which was to be micromanaged and strictly implemented at the ward level. Simultaneously, airport and port authorities were instructed to conduct hourly check-ups of people arriving from foreign countries. Government departments were familiarised with the protocol, which was widely circulated among the public through Rapid Response Teams (RRT) that comprised Accredited Social Health Activist (Asha), anganwadi and Kudumbashree workers and government officials residing in that ward. Residents in the ward were instructed to get in touch with the nearest public health centre in case any family member had returned from China. Such RRTs were ready in each of the 19,489 wards in the state.

And Teacher was there to check on the first patient along with agriculture minister VS Sunil Kumar and Moideen. Information from each of the wards was communicated to the chief minister and a structured briefing was organised every day with Vijayan and the entire Cabinet sitting down with the health minister to scrutinise the efficacy of the containment strategy. Information was key not just for surveillance and containment but also for the public to act accordingly.

“We invited volunteers to get involved in the efforts of the government. A portal was set up to register volunteers. Some volunteers and RRT members were given basic training by health professionals, fire department and the police ,” Moideen elaborates.

Two more cases followed in the next few days and then there appeared to be a lull. By mid-February, all three patients had been discharged after a full recovery. But then, by mid-March, the state witnessed a spike; the numbers galloped from double to triple digits — from 17 patients on March 10 to 50 on March 21 and 100-plus on March 24. By April 4, the number of Covid-19 infected persons touched 300.

Kerala decided to ramp up testing, tighten surveillance and social distancing. By March 23, a day before Prime Minister Narendra Modi announced a 21-day lockdown, Kerala declared a 28-day lockdown. Simultaneously, the government stepped up coordination and aggressive testing. However, the state also ensured smooth delivery of foodgrains, groceries and cooked food in community kitchens. Cooperative banks distributed welfare pensions to over 51 lakh beneficiaries. The government paid seven months’ pension in advance. About 3,800 street dwellers were brought to camps and provided food and given haircuts.

“We had made it clear that no person should be stranded in search of food or essentials. We created 5,178 camps for migrant workers (Malayalis address migrant workers as atithi thozhilali — guest worker). This helped a lot in stopping community spread of Covid 19,” Moideen says. “We provided free ration for all. RRT members, wearing mask and gloves, delivered ration at the houses of cardholders who could not come to ration shops. We also provided a basic amount to all workers from sectors such as agriculture, cashew processing, fisheries, construction and headload workers,” he adds.

On April 6 Kerala had 327 cases and 266 (81.34 per cent) patients under treatment, 59 (18 per cent) of them had recovered, while two (0.61 per cent) died. A week later, on April 14, 173 patients were undergoing treatment while 211 patients had recovered. The state has recorded the lowest number of deaths in the country (0.53 per cent) with no signs of community transmission even in the worst-hit district of Kasargod. The rate of recovery in Kerala is considered among the best in the world.

Teacher, meanwhile, has remained characteristically stoic, not straining to take credit or flaunting her achievements. She has more important things to do.

Published on April 17, 2020

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