HEPL blog series: Country Responses to the Covid19 Pandemic

 

Kerala’s Response to the Coronavirus Pandemic

Hafiz Shahul

 

Kerala’s model of healthcare is well known globally for producing good health at low cost. Health indices such as IMR, MMR etc are at par with that of the developed world, even though per capita health expenditure is very low by international standards. However, Kerala has been facing the double burden of disease – both  communicable diseases and non-communicable diseases – and it also has the ‘low mortality and high morbidity’ pattern.

The Kerala health care system has proven its efficiency in handling emerging infectious diseases and public health emergencies, such as H1N1 and Nipah, and now the whole health system is on a war footing to contain Covid-19 in the State. Kerala is at an advantageous position for handling Covid-19 because of its robust decades-old health system. Having a well-performing system helps the State to meet public health emergencies. The three layers in the public health system —primary, secondary and tertiary care — in Kerala are important for handling any emergency situation. At the time of the Nipah outbreak in 2018, Kerala was facing that kind of deadly virus for the first time. Kerala had introduced processes like contact tracing during the Nipah outbreak and were able to contain it in the second wave of Nipah. Nipah exposed the State to the strategies needed to face a similar outbreak, and that is when a template came into shape. When the coronavirus came, all Kerala had to do was to redesign and build on this system.

 

The Kerala Approach in handling the epidemic

The key to Kerala’s extraordinary efficiency during the pandemic is attention to detail. A great deal of planning has gone into adopting food and health care strategies, to ensure that they cover every section of the population. Systems are in place to regulate public movement, freight transport and the movement of essential supplies. Abandoned private hospitals and other buildings have been taken over as Covid-19 care centres and first-line treatment centres. Community kitchens have been established to feed thousands of the needy.

 

The public health approach: The first case in India was reported from Kerala on 30 January. The Department of Health sprang into action and has taken proactive measures in contact tracing and training of healthcare staff. Surveillance at international airports started as soon as alerts came in from the World Health Organization. The Integrated Disease Surveillance Programme (IDSP) immediately got geared up at the State and district levels.

The ‘second wave’ of the coronavirus happened when a family that flew from Italy tested positive. Kerala then tightened the norms for people returning from abroad. All those who were in primary and secondary contact were tested and kept in isolation or home quarantined, big religious and public gatherings ceremonies were cancelled, and restrictions were placed on marriages, cremations etc. Healthcare workers are stationed at all check posts on roads and railway stations to check travellers before they enter the State.

To ensure that all get the correct information regarding the epidemic, Kerala launched a mobile application – GoK Direct. The DISHA helpline has also been used for awareness generation.  The ‘Break the Chain’ campaign introduced ideas about basic cleanliness, in the hope for behavioural change. Ten more testing centres in Kerala were established. However, the free availability of testing kits is still a major challenge. Kerala came up with a series of guidelines ranging from isolation, treatment and to the handling of dead bodies. A rapid response team with eighteen sub-divisions – surveillance, contact-tracing, transportation, testing, ambulances, infrastructure etc. – were constituted both at the State and district levels when the first case in the second round was confirmed in the first week of March. Kerala declared it as State disaster. A series of training resources were developed for updating the knowledge level of all category staff – doctors to paramedics. An aggressive surveillance system was put in place at airports, railways, and roads. Coronavirus care centres for the surveillance of travellers coming from abroad and other Covid-19 affected states in India were created, major public sector hospitals have been repurposed as Covid-19 hospitals, and each district has exclusive Covid-19 hospitals. Covid-19 first-line Treatment Centres for the isolation and observation of mildly symptomatic persons who have not tested positive have also been set up.

 

Socio-economic approach: A country-wide lockdown was declared on 24 March; however, even before the full lock down, Kerala brought in various measures – e.g. declaring holidays for non-essential departments – to ensure social distancing. India’s population has a high percentage of economically deprived people facing social deprivation. They earn their livelihoods from the informal and unorganised sectors. In order to protect their livelihoods in the lockdown period and to keep the economy moving, the State government announced an economic revival package of ₹20,000 Crore. This included loans for Kudumbashree (women self-help group) members, pensions for those who are not under social security schemes, two-month social security pensions, heavily subsidised meals, and a rural employment guarantee scheme etc. Kerala is making efforts to ensure that the supply of essential commodities, particularly food and medicines, is maintained and that vulnerable sections of society are particularly protected. When the State closed pre-schools and schools on 10 March, the Government made available the midday meals to all pre-school children through Anganwadi (child care) centres, and took steps to distribute a ‘Take Home Ration’ for pregnant/lactating mothers and children aged six months to three years. The State was able to ensure  the nutritional needs of close to 8.3 lakh (0.83 million) children. Also, the State has strengthened its Public Distribution System (PDS) to ensure that all households get 15 kg of free food supplies for a month, which is in addition to the allocation of 35 kg per household for those in the priority category. Further, nutritious meal plates at just ₹20 per plate (one fourth of normal price, roughly) are being served through 1,000 State government canteens.

 

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 Indian Administrative Service Officers overseeing its operations. A senior Additional Chief Secretary was given overall charge of Covid-19 control in the State, with the aim of securing better interdepartmental coordination. He is assisted by a senior public health expert with international experience.

 

The Chief Minister holds press conferences, along with Health Minister, Finance Minister and Chief Secretary on almost all days, for the purpose of sharing facts, figures, plans and concerns.

 

The first cases in the second round of Covid-19 were diagnosed on 9 March in Kerala, and since then the highest number of patients (32 cases) was recorded on 30 March, with the lowest on 19 March (1 case). The total number of cases, as of 14 April is 386, with 211 patients recovered, 2 deaths, and 173 persons are under treatment. 16,235 PCR tests have been done (in a population of 34.5 million), of which 747 were positive (4.6%). On 14 March Kerala was ranked highest in the number of cases, but by 14 April are down to 10th position of all regions in the country. Recent data shows a flattening of the epidemiological curve. These may be indicative of a successful response to the Covid-19 pandemic in Kerala.

 

 

 

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