Coronavirus: Kerala's investments in public health pay off

Different states in India have adopted their own methods for tackling the coronavirus pandemic, even as Prime Minister Narendra Modi has set the overall direction for the country by imposing lockdowns and providing financial aid. The quality of state leadership will ultimately determine how successful the nation is in addressing infections and deaths from the outbreak, reports The Straits Times' India bureau

When Mr Robin Thomas, 34, and his wife found out they had tested positive for Covid-19, their first anxiety was about being separated from their four-year-old daughter, Rianna, who had tested negative.

"I thought we were going to die. I kept thinking, who will raise my daughter?" said Mr Thomas.

To his surprise, health officials allowed her to stay with them.

"They explained to our baby that she can't hug and kiss Mama-Papa," he said.

Friends ostracised the family and social media exploded with fake news about the places they had infected. All the reassuring voices belonged to doctors, nurses and health officials.

"Thank God I was in Kerala," Mr Thomas said.

Many residents in the small, urbanised and Communist-run southern Indian state of Kerala echo this feeling of security.

The state had India's first cases: three returning medical students from Wuhan. Pathanamthitta district, where some of Mr Thomas' contacts were found, was India's first hot spot.

And yet, a month into the crisis, as India logs over 13,000 cases and about 450 deaths, Kerala has few new cases, and the country's highest recovery rate of about 55 per cent. Three people have died of the virus in the state since Jan 28.

Kerala has flattened the curve with what the state's Health Minister K. K. Shailaja calls "a fusion of stringent and humane strategies".

The minister first read about the coronavirus in Wuhan in January, and was sure it would come to Kerala. "I knew we had Malayali medical students in Wuhan," she said.

 
 

When these students came home on Jan 27, they were taken straight to isolation. Three tested positive for the virus but did not spread it.

After Kerala battled the much deadlier Nipah virus in 2018, it established its own epidemics surveillance protocol, and has regular mock drills.

Decades of investment in decentralised public health systems, public education and women's empowerment have also nudged Kerala's social and health indicators up to Scandinavian levels.

Kerala has the highest life expectancy and lowest infant mortality of any Indian state. It also has more than twice as many hospital beds for every thousand people as all of India.

But the state is still vulnerable to the coronavirus, owing to a 2.5 million migrant worker inflow, 1.6 million expatriates in the Middle East due to return and a large elderly population.

 
 
 

Kerala widened its surveillance and contact tracing, and started a campaign called Break The Chain about hand-washing and physical distancing.

Mr P. B. Nooh, district collector of Pathanamthitta, developed a contact tracing protocol.

He also set up a call centre, where more than 1,000 volunteers call those in quarantine every day, logging their symptoms and medical and grocery needs. Counsellors address fears and depression. This was replicated state-wide.

By the time India went into a nationwide lockdown on March 24, Kerala had call centres, field surveillance teams and a three-tier Covid-care hospital system.

On Wednesday, Kerala had only one new case. But as Malayalis begin to return from the Middle East, the state is bracing itself for a second wave.

"We are still paying attention," said Ms Shailaja.

 
A version of this article appeared in the print edition of The Straits Times on April 18, 2020, with the headline 'Kerala's investments in public health pay off'. Subscribe