"Understand Kerala through Covid,” public policy professional Balakrishnan M. tweeted on March 20, with an image of two masked policemen on a bike carrying unusual items — a coconut spadix or flower and a big, green, braided coconut leaf.
They were on an errand. Like their counterparts in other parts of Kerala, Niraz K.T. and Umesh U.P., beat cops at Kasaba Janamaithri station in Kozhikode were checking on people placed in home quarantine. One such person was Anand Ramaswamy, a Dubai-based banker. His mother had died, and he urgently needed to buy some things for the post-funeral rituals. He could not step out and no autorickshaw would home-deliver anything to him. So, the two policemen pitched in, buying what he needed. Niraz says he has also been delivering medicine and food to other quarantined people who stay alone.
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For Balakrishnan, the incident is illustrative of Kerala’s communal amity and people-friendly policing.
“Exceptional times call for exceptional thoughts,” said Chief Minister Pinarayi Vijayan in a videoconference he held on March 25, a day after Kerala went into total lockdown. As he instructed officials to make elaborate arrangements to ensure everyone had access to food, medicine and healthcare, his instinctive crisis management skills were evident. Community kitchens, which had fed thousands during the floods, would make a comeback, he announced. And food would be delivered free to the needy.
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The key to Kerala’s extraordinary efficiency during the pandemic is attention to detail. Meticulous planning has gone into food and medical care strategies, ensuring that they cover every section of the populace — from the elderly to low-income groups, from migrant workers to terminally ill people, from fishermen to farmers. Systems are in place to regulate public movement, freight transport and the movement of essential supplies. Home deliveries have been given a leg-up. Milma, the State’s milk cooperative, has launched a delivery app, while the State-run Horticorp is set to follow suit with vegetables. The Catholic Church offered its hospitals up for COVID-19 cases. District administrations have begun to take over abandoned private hospitals and other buildings with bath-attached rooms to function as care centres.
The first State to record a positive patient, Kerala also started tracking early on. Training for healthcare staff was going on and surveillance at international airports on January 23, as soon as alerts came in from the World Health Organization (WHO). The Kerala node of the Integrated Disease Surveillance Programme (IDSP) immediately activated district surveillance units.
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Past experience
The State has drawn heavily on its experience of fighting Nipah . At that time, it had launched a contact-tracing exercise, which stood it in good stead now. Helpdesks were quickly set up at airports and passengers asked to fill declaration forms even before landing. Just as screening at airports was being ramped up, a couple travelling from Italy, which had by then become the epicentre of the pandemic, slipped through the net and reached Ranni in Pathanamthitta, triggering Kerala’s second wave of infection. “They were tracked down after a doctor questioned their neighbours who showed up with COVID-19 symptoms. It required a bit of hard talking to get them to hospital,” says Health Minister K.K. Shailaja.
Police advising people to stay home in Thiruvananthapuram.
The Pathanamthitta administration under collector P.B. Nooh launched a massive exercise to unearth patient clusters. They used Asha, Anganwadi and Kudumbashree workers, healthcare professionals and residents’ associations besides location-tracking technology to create spatio-temporal maps for retracing patients’ movements. “It was scaled up with the National Health Mission at the State-level to unearth contacts of those who defied home quarantine and tested positive,” says Dr. Amar Fettle, State nodal officer for public health emergencies. In north Kerala, police teams used geofencing to enforce quarantine.
As the days went by, Kerala’s surveillance net nearly burst at the seams — covering some 1.02 lakh people. Symptomatic cases were shifted to isolation facilities at hospitals across the State. The government launched a huge ‘break the chain’ campaign promoting social distancing, hand hygiene and work-from-home. Multilingual information material was disseminated everywhere.Companies, voluntary organisations, even prisons got down to making affordable sanitisers and masks and setting washbasins at busy junctions.
Nerve-centre
The State control room where 18 subdivisions — for surveillance, contact-tracing, transportation, testing, ambulances etc. — converge, became the nerve-centre. As Fettle explains, at each district control rooms, a ward member, an Asha worker and a police officer teamed up to attend to quarantined patients. Simultaneously, the State’s testing capacity was augmented, with four centres added (over 5,000 tests done so far), and the procurement of medical supplies was accelerated. In a single day, 276 doctors were recruited from the PSC rank list, with similar plans in the pipeline for paramedical staff. Importantly, to ease the load on healthcare personnel, they were divided into three alternating teams, so that each team could get enough rest. In addition, the government recently announced the creation of a war room at the State secretariat with a Principal Secretary at its helm and five senior IAS officers overseeing its operations in turn.
In a highly progressive move, 626 councillors were deployed to safeguard the mental health of the quarantined. A 24x7 Disha call centre was activated for COVID-19 with six lines, soon growing to 30 lines that had responded to and mapped 35,826 calls until 5 p.m. on Thursday.
The Chief Minister unfailingly held elaborate daily briefings each evening, sharing facts, figures, plans and concerns, using audio and video conferences with administrators and people’s representatives. The committee members and multi-agency officials communicate among themselves with Zoom video chat. “We’ve done rather well for a small State. There’s an open and dynamic relationship between a government that’s responsive to criticism, a society that’s aware, and the media,” says Dr. K.P. Aravindan, retired professor of pathology and former president of Kerala Sasthra Sahithya Parishad.
Health department workers in protective gear in Kochi
Game changer
Public health expert Dr. B. Ekbal attributes it to the decentralisation of governance in 1996: “It was a game-changer for primary health centres up to district hospitals, whose governance was handed over to local bodies.” Under the 2006 government, this infrastructure leapfrogged, and under the present government’s Aardram mission, all healthcare facilities were given better hygiene and amenities. “If about 28% of people were using government hospitals between 1996 and 2000, it is 40% now,” says Ekbal. In all this, there’s enormous community participation. “We thus have the social capital to tide over the COVID-19 crisis,” he says. “We also have academic capital in the form of high-profile health experts.” The challenges for Kerala lie elsewhere: the high comorbidity of the population, the high percentage of the elderly, and the difficulty in asking a socially active population to confine themselves at home.
Just before the lockdown, Vijayan announced a relief package of ₹20,000 crore. This included arrears due to contractors, loans for Kudumbashree women, pensions for those not under social security schemes, a cumulative payment of two-month social security pensions, heavily subsidised meals and a rural employment guarantee scheme. “The fiscal package has sought to put money in people’s hands, addressing the critical question of demand. But the mark of this pandemic is that it has disrupted supply as well. If the crisis is prolonged, the State may have to chip in to take care of large chunks of manufacturing and production,” forecasts R. Ramkumar, professor of economics at TISS in Mumbai.
Is Kerala ready for what promises to be a long-haul battle? Vijayan is unfazed and says with characteristic calmness: “The government will be at the vanguard.”
anandan.s@thehindu.co.in
