How Kerala fights COVID-19 through efficient governance

Kerala was the first state in India to have reported a COVID-19 case, but has contained the epidemic exemplarily well in its first wave. Although the current number of cases as a result of the second wave stands at one of the largest in the country, the Kerala model of battling COVID-19 has been praised by many international organisations.

[Image: The number of cases in Kerala remained low for a long time before the surge. Source: The Hindu (https://www.thehindu.com/data/data-kerala-leads-all-states-in-testing-for-coronavirus-maharashtra-in-infections/article31146300.ece)]

This post is on how Kerala combats a global pandemic and how a very efficient governance system is at the heart of the battle.

Why is the large number of infections?

So let's start with the most obvious question - why is Kerala having a very high incidence rate relative to other states? Is it because of the curse of God on Kerala as claimed by various hate mongers on social media? I'll try to answer this through certain established facts.

[Image: Reported cases across India. Source: The Hindu (https://www.thehindu.com/sci-tech/health/covid-19-interactive-map-confirmed-cases-in-india/article31041690.ece?utm_source=thehindu&utm_medium=cube&utm_campaign=corona)]

Large population of non resident citizens

It is a common knowledge that Kerala has a significant population of NRIs, particularly in the middle east. Also it is a global destination for tourism, making it a global transit hub. If we take a look at the the reported cases as on today, we can see that out of the 118 reported cases, 91 are imported (citizens who brought the infection from abroad), 8 are foreign nationals and only 19 are local cases, this too is mostly limited to the immediate family members of the imported cases.

Extensive testing

Kerala has tested a significantly high proportion of possible cases, thanks to the extensive contact tracing being carried out by the government authorities. It may come as a surprise that according to the data released by The Hindu 2 days ago, Kerala has tested samples more that all other states combined. This could itself be the most significant factor for the high numbers, which means that incognito spreading could be relatively very low.

[Image: COVID-19 testing rates in India. Source: The Hindu (https://www.thehindu.com/data/data-kerala-leads-all-states-in-testing-for-coronavirus-maharashtra-in-infections/article31146300.ece)]

How is Kerala handling the infections?

There are various factors, both ad-hoc and capability based, that plays vital roles in handling the infection. Kerala is known to be posses excellent infrastructure and human resources in the area of health care. This, along with the high literacy rate has been a major factor in an efficient handling of the situation. However, there a few non-obvious pivotal factors as well.

Extensive contact tracing

Contact tracing is a skill acquired by Kerala health department over the last few years through the tests of time. Prior to the current COVID-19 outbreak, Kerala has already witnessed instances involving Zikka, Nipah, and the first wave of COVID-19. This is in addition to the routine cases of epidemics dealt every year by the system.

As an example of the efficiency of this contact tracing, when the first two cases of COVID-19 was reported in Kerala, over 2000 people were placed under observation within a span of a day or two. For most of the reported cases, Kerala government published detailed route maps of patients such that even the missed out could be identified.

[Image: Patient #1 route map, Kottayam. Source: Manorama Online (https://english.manoramaonline.com/news/kerala/2020/03/12/kerala-government-route-map-covid-19-coronavirus-kottayam.html)]

This system has been so effective that there has been no case so far where the source of infection could not be established. Also the local transmission could be limited to a great extend, that too mostly due to the negligence of a few people.

Local production of essential items

The Kerala government has quickly set up production units for essential items, like face masks and hand sanitisers. The state has sough help from the jails administration for the production of face masks in jails. Also the state has witnessed innovative measures like outsourcing production of hand sanitisers to Kudumbasree units (all women cooperative collectives formed in the state) and to Kerala State Drugs and Pharmaceuticals (KSDP). The KSDP aims to produce over 1,00,00 bottles of sanitisers in 10 days.

Spreading awareness

The government has focused on spreading awareness about the disease and the preventive measures, much before the outbreak has actually reached its peak. Since Kerala is a state with a very high migrant labour population, multi-lingual campaign materials were created and an outreach to the migrant population was made with the help of translators and volunteers.

Also, the government has extensively harnessed technological solutions to address gaps in spreading awareness. An example to this would be GoK-Direct Kerala app by Qkopy, a start-up incubated under the Kerala startup mission. Similar apps/technological solutions were used in spreading awareness, tracing contact and in many other crucial areas.

How the community is taken along?

A crucial factor in the success of combating measures is supporting the community. The community is at stake in events like lockdowns and other restrictive measures, as the measures could lead to situations of decreased income for daily wagers, scarcity in resources, limited support measures to vulnerable categories etc. Kerala has efficiently adopted various measures to support the community through the crisis.

Ensuring supplies

in the event of total lock downs, people and families would experience difficulties in procuring the supplies. In consideration of this, the Kerala government has set-up various initiatives to ensure seamless supply of groceries and other requisites. This includes online grocery procurement systems, dedicated contact numbers to order food, and community kitchens to ensure food is availed to those who have requirement.

Also, the state administration has roped in the district administration and local political bodies, irrespective of the party, to collect details on vulnerable people and people who may require special provisions - like those with prior medical conditions and people unable to cook by self.

Minimal lockdowns

Although a state with a very high reported cases, Kerala has been relatively mild in the lockdown. Private vehicles are mostly allowed in cases of genuine requirements and there is no blanket bans on marriages and such, although restrictions on the number of people involved is in place.

Enhanced broadband bandwidth

The Government of Kerala has impressed quite a few when the government decided to enhance it broadband capacity foreseeing extensive work-from-home, even before such measures were being aggressively mooted.

Involving volunteers

Volunteer support has been a critical factor for Kerala in handling various issues such as the 2018 and 2019 floods. In the event of the COVID-19 outbreak too, the state has sought help from its most reliable army of volunteers- to take stock of vulnerable fractions within the society, to provide with home-cooked food, to assist in health case, to coordinate and support the local administrations and so on.

How are the contingencies managed?

A vision not implemented properly is of little good. When rigorous measure are being adopted, managing the implementation and eliminating the gaps would be crucial. From impacts on the social and economic aspects, to enforcement of guidelines and eliminating hoaxes and concerns, the contingency plans would need to be well planned. This is a pivotal area that Kerala has been exemplary.

Financial remedies

Kerala government has announced a relief package of Rs. 20000 crores, much higher than the union relief package of Rs. 15000 crores. The government has also been proactive enough to prevent hoarding, hold rising prices etc. Such remedies were implemented through measures such as boosting local productions and stocking resources well in advance.

Taking care of weaker sections

The epidemic has put an additional load on daily wagers and labourers. The authorities has announced that free kits of 15 kg rice and groceries would be provided to the needy. Local bodies have been tasked with taking stock of weaker sections within their respective jurisdictions, report to the government and make remedial measures to address those.

DISHA help desk

The government has taken exemplary measures to address the doubts and concerns of the people. This is critical in the era of social media where hoaxes spread faster than facts and people are bewildered on distinguishing information from misinformation.

Kerala government has set up 24 hour help desk- DISHA- to address concerns of the citizens and guide people in various situations relating to COVID-19. I have personally used this service to enquire if it is safe to return to Kerala and what would be restrictions I would be subjected to. The queries of my father were reassuringly addressed and the team guided on the protocols to be followed while picking me from airport, being at home etc. Such a body to reach out has been a great relief in the events of distress, although later I cancelled my plans to return in view of the safety of my family and people.

[Image: DISHA Help-desk, Trivandrum. Source: The Hindu (https://www.thehindu.com/life-and-style/the-team-at-disha-the-24x7-helpline-desk-in-kerala-works-round-the-clock/article31059935.ece)]

Also, the government has arranged for mental health counselling to people considering the enormous psychological pressure as a result of isolation and social exclusion.

What drives the efficiency?

Compared to other states in India, Kerala's bureaucratic system and health sector are much better, which are the primary reasons for the efficient containment of most of the situations within the state. The higher literacy rate and relative scientific awareness among the people compared to the rest of India is yet another crucial factor. To add to this is the contributions from the Kerala chief minister Shri. Pinarayi Vijayan and the state health minister Smt. K K Shailaja, alias Shailaja teacher, who were praised not only by the people of the state, but even from elsewhere in India for the effective measures against the outbreak.

The health minister has been at the forefront of the battle, not just for the current COVID outbreak, but even for the earlier Nipah outbreaks. She has been praised for her efforts by many international media and was portrayed well in a recent Malayalam film on the 2018 Nipah outbreak in Kerala, titled "VIRUS". The minister used to conduct regular press meetings to brief the people on the situation and educate on the remedial measures.

Shri. Pinarayi Vijayan had attracted a lot of criticism earlier for being stubborn in his political outlook and for this outspoken personality. However, in various demanding situations, including the current viral outbreak and the 2018-2019 floods, he was cherished as an outstanding leader. His vision and efficiency in coordinating the various efforts in demanding times has recently attracted a fan following from even the northern India with twitterati appealing to make Shri. Pinarayi Vijayan the PM of India for some time.

[Image: Shri. Pinarayi Vijayan, Smt. K K Shailaja. Source: Government of Kerala Website (https://kerala.gov.in/)]

Conclusion

In short, a significant success in handling the epidemic in Kerala has been to limit the local transmission, and prevent community transmission so far and is owed mainly to a vibrant bureaucracy, an expert health care and a visionary political leadership. But it the community support initiatives are also worth the same credits, that it is the lifeline to a larger non-infected population.

The efforts by the State Government of Kerala shall serve as an example in handling the crisis at a pan-India level. Although India has a strong and willing political leadership, it often falls short in vision and contingency plans. For example, a national lockdown is definitely a very effective measure to combat the pandemic, but it should be supplemented with relief packages for striving businesses and daily wagers, arrangements towards seamless access to food and groceries, including home delivery involving the various non-governmental organisations or volunteer pool etc.

Mere appeals to "adopt 9 families" and provide food is impractical unless supporting measures are to be taken, similarly assuring enough supplies would not be effective enough unless there is a proper delivery or crowd management mechanism. Otherwise the panic and chaos it creates could be detrimental to the efforts undertaken to combat the virus.

I would like to emphasise that I do not have any affiliation to any particular political party and this post is not as a government PR campaign, but mere representation of facts from an ordinary man's point of view. This is a fight that's still going on, and the results are yet to be seen. Let's hope that India would come out of the situation without having to suffer much losses.

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