Kerala Model Delivers in Covid -19 Control
-- Dr E P Mohan

KERALA is in limelight in the international media for its performance in dealing with the Covid-19 crisis. Critics of the acclaimed “Kerala Model of Development“ have argued that the development paradigm in Kerala Model is not sustainable in the long run nor acceptable as a taken for granted remedy, and have pointed out many contradictions inherent in this model.  

But even those who were arguing that the Kerala welfare model had long been outdated and stagnant, have now seen that the very same infrastructure generated through decades of hard labour in the state, came to our rescue in these crucial days of Covid-19 pandemic.  

No sooner outbreak of novel corona virus in Wuhan did get officially reported by China on January 20, 2020 and subsequently WHO cautioned the world, Kerala had started preparations to deal with the pandemic. The first case of Covid-19 in the country relates to a batch of students returning from Wuhan to Kerala in the end of January. These students after having been kept in isolation and few of them tested positive, they were given treatment and all hospitalized care. Their contact trails could be successfully mapped and thus probable secondary transmissions were blocked with cent percent efficiency. When this episode was successfully overcome, it marked the closure of first chapter of Covid-19 in India.

Then the second episode of Covid-19 was experienced by Kerala. In the evening of February 29, three members of a Kerala family landed at Cochin International airport. They had started their journey a day before from Venice in Italy, which at that time was the country with the second largest number of Covid-19 patients and deaths, immediately after China. Actually they had somehow managed to make their exit escaping the screening formalities at the airport for tracing passengers coming from abroad who might be infected or could be potential carriers of Covid-19. Until March March 3rd these arrangements in airports were quite loose. By the time the authorities could trace these three, and collect all details about the people and places they visited after returning from Italy, two elderly people in their own family and many others were already affected. However, all these affected people were hospitalized and given proper medical care so that all of them recovered and left hospitals in few weeks. In this episode, all who suspected to have had primary contacts also were put on observation under home quarantine; tests were done and in cases found positive, hospital care was given. A similar procedure has been successfully adopted in more cases involving people traveling from abroad as well as coming from other states.

Certain telling statistics about Kerala in the case of primary spread of Covid-19 from affected patients to others has come up. It is seen that while the picture in the whole country or even world wide is like 2.5 to 3 people getting Covid-19 infection from primary contacts with a single patient (in other words, 250 to 300 persons get infected from 100 primary patients), in the Kerala scenario, the ratio of infection by primary contact is just one for three (33 people got infected from 100 patients). This has been achieved by scientific, professional practices of institutional quarantine, including isolation and hospitalised care for symptomatic patients and home quarantines for other suspected patients. Kerala’s health infrastructure and Government tapped into its own experience in combating previous epidemics. There was clear, effective communication from the Government, explaining the practices needed but steering clear of narratives that would stigmatise or communalise Covid-19 patients. In the absence of such practices and infrastructure, there would have been a much higher number of people infected through primary transmission in Kerala as well. In the case of all people put under observation in home quarantine, health workers would regularly visit them twice each day to ensure successful quarantine. For this, health committees are formed at ward levels with which ASHA workers, Health Inspectors, Field Medical Officers work in a co-ordinated manner. All the information received by them through such work were passed on to the PHCs and DMO offices on a daily basis. After reviewing all developments on a day to day basis, corrective measures are taken with the help of district administrations.

In the case of Keralite employees, workers, students, and others living in other states who wanted to return to Kerala, their entry was strictly regulated through mandatory entry passes from designated authorities at check-points set up at the inter state borders. This gave rise to several criticisms but such a drastic measure had to be taken only to make quarantine and observation most effective in the case of each person coming in from other states. In view of the essential preparation and arrangements needed to carry out the process, their entry could only be allowed in a phased manner based on our given capacity and infrastructure.

According to the available information so far, just around 0.5 % of Covid-19 affected patients have died in Kerala. With two deaths reported latest on a single day, there can possibly be a small change in the above figure. But still, one can see the contrast with many other states where the death rates are staggeringly higher like between 4% and 5%.

The experience so far undergone by Kerala in fighting the Covid-19 menace is unprecedented. From Anganwadi–ASHA workers to doctors, officials in police, revenue, labour departments, IT professionals, people’s representatives, young volunteers recruited in local self administrative bodies exclusively for assisting in Covid-19 combat, all were mobilized, attaining a new level of efficiency of our public institutions.

This was also an occasion when people of Kerala witnessed members of its bureaucracy and police less in their conventional roles as agents of an oppressive state and more in their ascribed roles as true public servants. This change would not have been possible without the kind of matching administrative and political leadership at the helm of affairs.

Many have noted that the pandemic might prove itself capable of forcefully reasserting the truth about the real strength of public healthcare system and upturning the myth of privatization as panacea for all ills. The Kerala experience certainly bears out this hypothesis.

[ The author currently works as Nodal Officer, Palliative Training in National Health Mission. He is also an ENT Consultant in Kerala Health Services.]

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