Kerala

Comment | Reverse flow of large numbers will pose a serious challenge to the containment strategy of Kerala

Passengers arrive from Dubai by an Air India flight at the Kochi international airport, as part of an evacuation operation due to stoppage of commercial air services amid the ongoing coronavirus pandemic, on Wednesday.

Passengers arrive from Dubai by an Air India flight at the Kochi international airport, as part of an evacuation operation due to stoppage of commercial air services amid the ongoing coronavirus pandemic, on Wednesday.  

Community spread is already existing or imminent in the State. It must step up the number of tests to match the testing rates of other States.

Epidemiology of outbreaks, especially of the novel pathogens, could be quite unpredictable. We believed that the COVID-19 would behave like a tornado, wipe out a good share of humanity and disappear. We designed our strategies accordingly. Defending an unfamiliar enemy with no effective weapons in hand is of course not strategic. So, we locked ourselves in expecting a flattened curve while we emerge out of our dens. With no common global or regional strategy, several co-variables on the ground determined the shape of the curve. In our country, Kerala, Goa, ihar, and the northeastern States succeeded in keeping the numbers low, at least until recently. Decades of stepwise advancement in the socio-political and healthcare structure and efficient administration helped Kerala achieve a better level of control than other States, through effective coordination and on the ground execution of the containment, delay and mitigation strategy.

Coronavirus, June 2 updates | State Helpline numbers for COVID-19

In an earlier article in The Hindu, I suggested a change in the Kerala COVID-19 control strategy quoting its non-viability due to its significant socio-economic implications. Does a suggestion of a change in strategy imply a failure of the earlier strategy? Of course not! When we are at war, we change our strategies based on the behaviour of the enemy — the virus. Despite a very strict lockdown, the number of cases is increasing at the national level. The reverse flow of immigrants, due to various social reasons, has resulted in a rapid shift in the status quo; with Kerala, Goa, Bihar and the northeastern States losing their earlier hard-earned advantage. Kerala so far followed an extreme contact tracing and quarantine strategy. How viable is it to continue this strategy, especially when we expect the virus to remain with us for at least a year in significant numbers and for at least six months in a very ferocious form?

Interactive map of confirmed coronavirus cases in India | e-Book on COVID-19 | State-wise tracker for coronavirus cases, deaths and testing rates

Do we have a projection on the expected number of cases over the six months span? It is only a matter of time the quarantine regulations for airline passengers and later the rail and road passengers will be liberalised at the national level. Two lakh Keralites from West Asia and three lakhs living in Indian States have expressed their wish to return to Kerala, due to the difficult living conditions they face, as a result of the pandemic and the ensuing lockdown measures. There is no doubt the reverse flow of such large numbers will pose a serious challenge to the containment strategy of the State, especially when the community spread is already existing or imminent in the State. Only a coordinated and controlled inflow can solve such a challenge. Any delay in returning to the home State will heighten their suffering due to the loss of lives and livelihood. It is true that Kerala has taken care of the welfare of the guest workers to the best possible extent; but it is unreasonable to expect other States and countries to look after our Keralites in the same way. Controlled inflow of immigrants is scientific but less empathetic!

Also read: Should Kerala change its COVID-19 strategy?

Within a short span of opening the borders, the number of cases in Kerala has spiked fast with an average of 50 cases reported everyday. If all the incoming passengers are screened, including those without any symptoms, the number of cases could be several times higher. Kerala must step up the number of tests to match the testing rates of other States. Community spread exists, at least unofficially in most States including Kerala. The situation will get worse over time. If we concentrate all our efforts on COVID-19, the morbidity and mortality due to other communicable diseases and non-communicable diseases could be several times that of the pandemic. On an average, 200-400 Keralites die of communicable diseases every year. The COVID-19 related mortality is extremely unlikely to touch these numbers.

To make the matter worse, we have a heavy monsoon and a flood waiting for the stage entry. Extreme mandatory containment measures are feasible at a very early stage. Kerala has passed that stage already. We should concentrate more on delay and mitigation strategies — maintaining the social distancing measures, stepping up the laboratory facility for testing and healthcare facilities for managing patients, without marginalising non-COVID-19 communicable diseases. At the same time, quarantine measures should be continued in a practical and realistic way. The COVID-19 is a marathon and not a sprint!

The pandemic is a highly political issue at regional, national and international level. Political interferences often surpass science and empathy. The excellent early control efforts by the Kerala community and the government deserve loud applause but the premature projections of achievement without realising the dynamics of the virus cannot be considered an intelligent strategy.

The Kerala community has the capability to effectively tackle the pandemic provided we stand united without political differences, empathetic to the Keralites living outside and always keeping in mind-Kerala is an Indian State and not an independent island nation.

(Dr. Abdul Ghafur is Consultant in infectious diseases, Apollo Hospitals, Chennai. He is also advisory member, National antibiotic policy.)

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Printable version | Jul 12, 2020 9:55:25 AM | https://www.thehindu.com/news/national/kerala/comment-reverse-flow-of-large-numbers-will-pose-a-serious-challenge-to-the-containment-strategy-of-kerala/article31732134.ece

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