‘In Kerala’s fight against the coronavirus, saving lives is our priority’: Shailaja Teacher

Even as the novel coronavirus was just rearing its head in Wuhan, China, almost 5000 kilometer away, in the tiny, coastal state of Kerala, the authorities had already swung into action. In Kerala’s fight against the coronavirus, saving lives is our priority, says KK Shailaja, the state’s health, social justice and woman and child development minister. “No one with the coronavirus should die because of our lack of care. That was our thinking.”

The world-renowned ‘Kerala model’ of tackling the pandemic was devised on the basis of this, the 63-year-old, who is affectionately called Shailaja Teacher due to her early career as an educator, tells BusinessLine in an interview.

She explains chronologically how Kerala tackled the virus in a calm, matter-of-fact manner, almost making it sound painstakingly easy, even in the midst of springing forth flummoxing details. Like, how, at one point, there were around 1,70,000 people under surveillance as a part of the state’s contact tracing effort to curb the virus’ spread. “It was a gargantuan, complex task,” she notes, with an almost imperceptible sigh.

On May 9, Kerala completed 100 days since reporting the country’s first coronavirus case. As on this day, its growth rate of new infections was 0.1 per cent, the lowest among all states that have crossed 500 cases of the virus. At its peak, only 816 people were hospitalised in Kerala, ensuring the health system was never overburdened.

The mortality rate of the virus in Kerala is 0.6 per cent, while in India it is around 3.3 per cent, with certain states showing even a 10 per cent rate, akin to many countries, says Shailaja.

It’s barely two years after spearheading the response to the Nipah virus outbreak in Kerala that Shailaja finds herself at the helm of tackling the coronavirus pandemic.

Is it due to the learnings from the Nipah virus that the preparedness level was strong? It did teach us a few lessons, but it’s not just that, she says. In 2018, Kerala had started a big campaign, to minimise infectious diseases, with ‘Kerala with no deaths from contagious diseases’ (“pakarchavyadhi maranangal illatha Keralam”) as its slogan, she says. The state has been able to greatly reduce such deaths in the past two years, she says, adding that this preparedness also helped it in its fight against the coronavirus.

Kerala identified two challenges, one being infectious diseases, and the other being non-communicable diseases, and the state has projects and its own action plans for both, she adds. While Kerala had undergone a rigorous training during the time of Nipah to handle such outbreaks, the training to contain infectious diseases continued post that as well, she explains.

Kerala set forth on its preparations when the coronavirus outbreak was first reported in Wuhan in January, at a time when the rest of the world was still mostly indifferent to the virus’ monstrous implications.

This kind of conscientious preparedness is what sets the Kerala model apart, she says. “When you sense that a danger is looming close, the most important thing to do is to learn about, and educate ourselves on ways to be prepared for it. When we heard of the Wuhan outbreak, we figured that it can reach Kerala too, due to its rapid human-to-human transfer nature. There are people from Kerala studying there, as well as people involved in business.”

By mid-January, the communist state government had its first meeting by a rapid response team regarding the outbreak, she says. “By January 24, we had opened a state control room and set up 18 expert teams, each assigned specific duties like tracing, quarantine, isolation, treatment, logistics collection and the like,” says Shailaja.

A protocol to combat the virus, with detailed guidelines and standard operating practices, was also devised before the first patient was tested positive for the coronavirus, she says. This was further percolated to every zillah, with words of caution spread about how they should be prepared. Training for the same also followed suit. It is very important that these efforts reach the grassroot levels too, she emphasises. On January 30, India registered its first coronavirus infection in Kerala - it was a student who had returned home from China.

Throughout the interview, Shailaja never fails to use “we” or “our team” while talking about the healthcare system in Kerala and any of their efforts till now. It’s like Kerala has been waging a war against the virus, with the labyrinth of operations it rolled out. She also takes utmost care to shed light on the combined efforts of everyone in the success of the model, ranging from a horde of anganwadi workers to the police.

Kerala’s strong public healthcare system is another important reason, with its decentralised nature ensuring the presence of public health centres in every panchayat, taluk and zillah, she says.

Under the health department’s ‘Aardram mission’, the state has been aiming at transforming its primary health centers into family health centres as a first level health delivery point, to ensure quality care at PHCs, she explains. These FHCs also started the SWAAS clinic over a year ago, as part of the chronic obstructive pulmonary disease (COPD) control programme, particularly in rural pockets. Since those with pre-existing lung or respiratory issues like COPD are more vulnerable, this is another one of those factors that helped, she cites as an example.

“That’s all there is to the Kerala model,” she says simply.

The Kerala model’s success also lies in those carefully thought-out, seemingly nondescript details, ensuring all possible loopholes are plugged, with their care extended to even areas like mental health, which people tend to sweep under the rug.

A mental health team, consisting of 1069 trained counsellors, would call those isolated in hospitals or quarantined at home, to alleviate their mental distress. At the time of speaking to BusinessLine, she says that over four lakh people were given counselling services through telephone.

From the beginning, reverse quarantine was also strictly followed, wherein those who are the most vulnerable - aged 60 plus and those with other underlying diseases - were specially taken care of. 67,000 anganwadi workers were trained to prepare lists of houses where elderly people lived, making sure that they called them or paid visits at a distance, to ensure their needs were met. Around 27,000 ASHA (Accredited Social Health Activist) workers, one for each ward, were also working diligently to check on those quarantined in their respective wards.

“In effect, those quarantined and the elderly people with other illnesses would regularly get calls from 2-3 different places. This accorded them with great mental satisfaction,” says Shailaja.

In terms of treating patients, care was taken to ensure that there were sufficient medicines and facilities in place for every symptom of the virus, like chest congestion, fever, difficulty in breathing and the like, she says. Since no medicine or vaccine is available yet to cure the virus, they ensured a good treatment in this manner, she adds.

She says that some people would point out that Kerala hasn’t tested enough people while other states have tested rampantly. “Well, we have a Kerala model when it comes to this too. We did it systematically,” says Shailaja confidently. For people coming from other countries - since the cases in Kerala were all imported from abroad - the state implemented a strict quarantine at home or hospital policy, based on the symptoms. Their movements were carefully analysed to make sure they wouldn’t step out. There were teams constituted to ensure this, she says. “And if this is the system in place, only those with symptoms need to be tested.”

Citing a scarcity in testing materials, the first priority to test was given to people with symptoms, she says. “When we have everyone within our grasps, it’s unnecessary to use the tests arbitrarily. We judiciously used it in the first phase. Whoever could have been positive, we tested them. That was a great success.” Strict quarantine and judicious testing - that was our strategy, she encapsulates.

Ensuring that people followed the guidelines and instructions was another task.

Though around 85 per cent people did abide by their instructions on how to home quarantine effectively, with guidelines stuck inside their homes (not outside - to prevent stigma, she points out), so that they can read and follow it. But the rest 15 per cent, who ventured out or mingled with their families, posed problems.

To undertake their contact tracing was an enormous, complicated task, she recounts. “Even those far-flung and most obscure encounters were traced with utmost attention to detail and a contact list was created. To ensure everyone gets into the list, it was important to subject them to intense observation. This is very important to control the spread of the virus,” she explains.

Even before the official nationwide lockdown, the Kerala government had started curbing social gatherings in affected areas to curb the spread of the virus, she points out.

How many hours a day does she work, with all the work that goes into this, one would wonder. She laughs quietly, before saying, “It’s not just me, there are my fellow workers, doctors… We start at around 7 AM in the morning and the work, done virtually, starts from 7:30 AM. In the evening, we have video conferences with every zillah, one each a day… Everyone works till late in the night, as they are busy with preparations for the next day - they only ever sleep after finalising it. What time the work gets over is something we never know. It's the kind of job where we can’t strictly specify the number of hours worked.”

She adds, “At the time of a crisis like now, we have to do this.” The team works like a well-oiled machinery, she says.

Would this be a lesson for greater investments in public healthcare and a decentralised system of it, like in Kerala? Yes, she agrees firmly. “Even though we are not such a financially strong state, we strive to invest in health as much as possible, though it’s not sufficient still. In the same way, decentralised planning has also helped us greatly.”

On how the Kerala model can be incorporated across the country, and what the other states can learn from Kerala, Shailaja says, “Each state is planning as per their own ways, it’s not like they are not doing any work. A lot of people in the beginning did engage with our health secretary regarding our preparedness and protocol. We have shared it (our expertise) - those who want to use it can do so, we can’t say or insist that they have to adopt only this, as whatever we prepared was in the context of Kerala. The thing is, one state’s ways cannot be emulated by another state (that easily). Here, we have created such a system, and we are implementing the model on the basis of that.”

“We had proper pre-planning. And what we did on the basis of this pre-planning, if they try to implement it suddenly, out of the blue, on one fine day, I am not sure if that will be possible. Planning is of utmost importance. But if this system is applicable to anyone and can be applied, we are very happy about it. That’s all we can say about this,” she adds humbly.

What about the cost involved in deploying this model? It was a big cost, she replies, without missing a beat. “The state has to spend a minimum of Rs 3000 on a PCR (polymerase chain reaction) test - that’s big,” she points out.

Where did the state get the funds from? Will this put further strain on the state's finances? Currently, India’s investment in the healthcare system is only around one per cent of the gross domestic product and what Kerala receives is a small percentage of that, she points out. Shailaja admits that they somehow managed to adjust with people-centered planning.

Will it be hard for the state to recover from this? “What our chief minister said was to focus on saving lives instead of mulling about the money involved. Despite the financial challenges we have, the chief minister and the finance minister have been helpful and supportive - when it comes to the procurement of medicines, conducting of tests etc. That a major portion of the state funds goes to health is of utmost importance,” she concludes.

There are many things one can learn from Shailaja, also dubbed the “coronavirus slayer”, about how a small, communist state managed to tackle this monstrous pandemic, which is leaving even developed countries rattled.

But, she had somehow managed to squeeze in half an hour’s time for this interview, in a day chockablock with innumerable meetings and obligations. It was time for her to be whisked off to another one of those meetings. But, Shailaja Teacher, in her characteristic patient and considerate manner, adds kindly, “You can still ask one more question though.”

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