What Can We Learn from Kerala’s Response to COVID-19?

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Image description: K.K. Shailaja, Kerala’s health minister, smiling

Kerala is a small state on India’s Malabar Coast – home to 35 million people and renowned for its peaceful backwaters and the tea-covered mountains of the Western Ghats. Despite being over 5,000 miles away from the UK, Kerala’s careful yet unrelenting response to the COVID-19 pandemic is of international importance. 

At the centre of the response is K.K. Shailaja (or Shailaja Teacher as she is lovingly known) – a 63 year old former science teacher turned health minister for Pinarayi Vijayan’s communist (CPI (M)) government. Dubbed by the media as the “Coronavirus Slayer”, she is praised throughout Kerala for her swift response and successful strategies.

After reading about a worrying new virus in China, K.K. Shailaja phoned her medical deputy on the 20th January and enquired about the risk to Kerala. Once she realised that an outbreak in India was inevitable, she assembled her rapid response team and began a process of meticulous planning and preparation. 

At the centre of the response is K.K. Shailaja (or Shailaja Teacher as she is lovingly known) – a 63 year old former science teacher turned health minister for Pinarayi Vijayan’s communist (CPI (M)) government.

Sure enough, seven days later, the first case of COVID-19 arrived in Kerala – patient zero. Three medical students returning from Wuhan were temperature-checked upon arrival and placed in quarantine, only being released a month later. K.K. Shailaja’s planning had worked: COVID-19 in Kerala had been contained and it remained that way until late February when a family arrived from Venice.

The family were evasive about their travel history but with the help of social media, hundreds of their contacts were traced and quarantined. In total, 6 people (including a couple, 94 and 88 years old) developed COVID-19, but there were still no deaths.

As cases in the rest of India began to rise, Prime Minister Narendra Modi announced a 21-day lockdown on the 25th March, but Kerala had already imposed a state-wide lockdown a day earlier. These decisions were made quickly leaving thousands of migrant workers stranded and starving across India. Kerala, however, anticipated this and had set up almost 19,000 camps for these workers and an army of 250,000 volunteers helped distribute 280,000 food packets daily.

As cases in the rest of India began to rise, Prime Minister Narendra Modi announced a 21-day lockdown on the 25th March, but Kerala had already imposed a state-wide lockdown a day earlier.

As well as social measures, numerous medical and public health strategies were implemented. Each district was asked to dedicate two hospitals to COVID-19 and each medical school set aside five hundred beds. Testing was also widely carried out at the time. 

The famed “Kerala Model” laid down the foundations for this response. The footings of this model included the decentralisation of and significant investment towards public health. The results? Every village has a primary health centre and Kerala can boast the lowest infant mortality rate of any state in India. This strong emphasis on public health was crucial in keeping transmission low and recovery rates high at the beginning of the outbreak. 

Much of Kerala’s response to COVID-19 was fuelled by lessons learned from previous emergencies. In 2018, Kerala faced an outbreak of the Nipah virus – a zoonotic virus causing acute respiratory infections – which claimed 17 lives in the state. This outbreak was eventually contained and the experience of tackling Nipah served as a lesson to K.K. Shailaja and her team on how to respond to contagious diseases which do not have known treatments or vaccines. 

Just a few months after the Nipah outbreak, heavy monsoon rains brought widespread flooding to the state, resulting in the destruction of homes, damage to agricultural land and the loss of almost 500 lives. The floods highlighted the need for a robust and thorough system designed to deal with state-wide emergencies. 

This outbreak was eventually contained and the experience of tackling Nipah served as a lesson to K.K. Shailaja and her team on how to respond to contagious diseases which do not have known treatments or vaccines. 

Throughout both crises and this pandemic, the government has been transparent and shown faith in the decisions of experts. Their willingness to answer questions and empathy shown throughout the pandemic has helped them gain the trust of the public, thereby increasing public engagement. 

Kerala has received endless acclaim from global media outlets regarding its response to COVID-19 and it was thought that the state had successfully “flattened the curve”. However, recent developments suggest that some of this praise may have been premature. 

Once India lifted its lockdown, Kerala allowed workers to return from the Gulf and other states in India. As anticipated, this caused a sudden spike in COVID-19 cases within the state – jumping to 9609 active cases with around 64 deaths (as of the 30th July). Unsurprisingly, this has caused widespread panic within communities. 

On the 27th July, Kerala announced that it will not be imposing another state-wide lockdown, for the time being, instead choosing to implement “cluster care”. This strategy aims to strengthen testing, treatment, and quarantining in regions where there has been an unexpected rise in COVID-19 cases. 

Regardless of this recent rise in cases, Kerala’s response to the COVID-19 pandemic is unique and its initial successes are not to be taken lightly.

Regardless of this recent rise in cases, Kerala’s response to the COVID-19 pandemic is unique and its initial successes are not to be taken lightly. Kerala’s repeated emphasis on public health provision and education are the key players in this fight against COVID-19 and sets an indisputable example for other nations. 

As the outbreak unfolds, the feelings of uncertainty, powerlessness and trepidation creeping up on Keralites are being brought to light, and they echo those felt during the floods of 2018 – the difference being that the end of the monsoon season will not bring an end to COVID-19. 

Image Credit: Sanu N, Wikipedia

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