Kerala has done a wonderful job in COVID-19 control so far, keeping the numbers at a very low level. However, I have serious reservations about the sustainability of the strategy.
A rich island nation such as New Zealand can take all measures to control the pandemic and still absorb the economic impact of remaining isolated from the rest of the world. But, Kerala is a consumer State and depends on products manufactured in other States and a lion’s share of its income is from Non-Resident Indians. Even before the pandemic, this remittance had been drying up due to the economic challenge in the Gulf.
Keralites will starve if the supply of essentials from neighbouring States stops. The State treasury is already in the red and is on the verge of a grave financial crisis.
I believe that the State may be able to effectively quarantine Keralites returning home, though this will require the efforts of the entire government machinery. The pandemic is expected to last for a long time. Can the State continue monitoring those who are coming home in such a structured mode and still sustain the economy? Industrialised States such as Tamil Nadu, Gujarat, and Maharashtra can survive the crisis, as these States have a strong economy.
I work in Chennai, a hotspot with hundreds of cases being reported every day. Of these, nearly 98% cases are asymptomatic contacts. But there is no serious COVID-19-related health-care crisis in Tamil Nadu. The economy is strong and the State can very well balance the health impact and economic slowdown.
Pressure on State
The COVID-19 control efforts by Kerala have been widely appreciated. Unfortunately, such media attention has pushed the State into an achievement mode and it is now under pressure to maintain it.
So what is the solution? First, Kerala should denounce her achievement mode and accept reality. It is an Indian State and not a rich island nation. It cannot continue the very high standards of pandemic control without strong and sustained financial backup.
Extreme containment measures are financially unviable in a consumerist State with near-empty coffers. It may not be a futuristic strategy to divert the attention of the entire government machinery and resources to contain the outbreak to an extremely low level. The excellent containment of the outbreak so far has raised the expectation of the public. The public should be counselled on the need to prepare for a long-haul and the need to live with the virus.
Quarantining interstate passengers is not a long-term viable strategy from an economic perspective. Though this practice is based on the recommendations from the Union Ministry, it will have a larger impact on Kerala.
A more practical, futuristic, and viable approach should be devised. With the influx of Non-Resident Indians (NRIs) and interstate passengers, the number of cases is bound to increase. We should consider a hospital-based syndromic approach for virus screening, rather than running after the virus and testing all contacts.
It is true that Kerala is following a more conservative approach unlike Tamil Nadu. Kerala has so far tested only 37,000 samples, while Tamil Nadu has tested more than 2 lakhs already.
Kerala should concentrate more on rebuilding the economy, by rehabilitating NRIs and initiating urgent measures to be self-reliant on agricultural products. A balanced, sustainable approach of curbing the pandemic at a practical and realistic level, without seriously impacting the economy should be the medium to long-term aim of the State.
(The writer is an infectious disease specialist and leader of the Chennai declaration on antibiotic resistance.)