“You do not build your health systems when you need them and you do not bridge the equity gap when you need to. You do it before you need it.”~ Dr. John Nkengasong, Director of Africa Centres for Disease Control and Prevention
Ever since the COVID-19 outbreak began, Kerala, a state in Southwestern India, has come under the spotlight countless times. Currently, while most of India is reeling under the onslaught of a third wave of COVID-19, Kerala once more represents the lone warrior fighting to bravely overcome the odds.
Allow me to be your Kerala tour guide.
Kerala, with a population of around 35 million people and a per capita income of under $3,000, has, to date, seen around 12,000 COVID-19 deaths. Switzerland, with a population of 8.5 million people and a per capita income of $82,950, has to date seen about the same amount of COVID-19 deaths. Switzerland is one of the wealthiest countries in the world. Kerala’s numbers become even more remarkable given the state’s relatively high population density (2,200 people per square mile), and its four moderately busy international airports.
As I take you to the most remote area in Kerala, imagine you’re up in the cool air of the hills amid fields of tea. In a ‘tea stall’, you’ll find groups of people wearing masks, maintaining social distance, scheduling their vaccination appointments all the while listening to the daily COVID-19 media broadcasts, critically turning over the information.
But the tea stalls are not the reason why Kerala - a low resource state - is showing a shining example to the world on how to efficiently combat a ruthless viral outbreak.
So, what’s Kerala’s secret?
In 2019, a year after Kerala had curbed the deadly Nipah virus outbreak, a movie called “Virus”, made in Malayalam, was released. The movie’s timely production and meticulous portrayal of the disease highlights some of Kerala’s unique traits. The movie had to stay true to the facts and science in every detail; otherwise Keralites, known for their broad scientific cognizance, cynicism and appraisal, would pounce on any inaccuracy and rate the movie poorly. For another, it is a shout-out to the tremendous social responsibility and civic awareness of this state’s citizens and government. Keralites keep their government on its toes, especially when it comes to important public issues.
Long before the first cases arrived from Wuhan, Kerala was ready to contain COVID-19 with the World Health Organization (WHO) recommended “test, trace, isolate and support” protocol. The state, on the double, adopted fiercely meticulous containment measures. This allowed it to effectively stop the disease from ravaging the state for several weeks and, in the process, saved countless lives. In fact, Kerala tenaciously held the fort for much longer than any Indian state, or for that matter, than many developed nations.
Kerala’s government prudently anticipated the need for more hospital beds, additional ventilators and importantly, abundant oxygen supply, in the event of a COVID-19 surge. As a result, the state had stocked up on all such essential supplies well ahead of time. Subsequently, when the third virus surge did hit, Kerala was well positioned to fight it.
If preparedness alone served to quell the first wave of COVID-19, then clear communication worked to slow down subsequent waves. Concise information on COVID-19 etiology, its symptoms, contagiousness, potentially deadly nature and the importance of self-isolation was quickly and widely communicated.
Shailaja Teacher - the “coronavirus slayer”
The COVID-19 response in Kerala was until May 2021, led by a phenomenal woman leader, K. K Shailaja, the Minister of Health and Social Welfare. Referred to as “Shailaja Teacher” out of fondness by Keralites, she worked as a secondary school teacher before turning her talents to health and social welfare. Her approach, marked by proactiveness, clear communication and learning from past disease outbreaks, has been highly effective in combating COVID-19.
After reading reports of a new viral outbreak in Wuhan in January, Shailaja immediately realized the possibility of it spreading to Kerala. Working with her rapid response team which in turn coordinated with medical officers in all of Kerala 14 districts, she worked to ensure that the disease wouldn’t take them by surprise.
Shailaja’s decision to rapidly and proactively put in place these measures were also informed by her previous experiences dealing with the Nipah virus outbreak. However, that outbreak was much smaller, and localized to one district. Dealing effectively with COVID-19 was then a question of rapidly scaling up and rolling out the Nipah virus response to all 14 districts. It’s no wonder that Shailaja is being hailed as Kerala’s “coronavirus slayer.”
The Kerala Model
As Dr. John Nkengasong, Director of Africa Centres for Disease Control and Prevention bluntly put it, “You do not build your health systems when you need them and you do not bridge the equity gap when you need to. You do it before you need it.” Without the robust health care infrastructure that Kerala enjoys, any strategy or protocol, however well planned, might have missed its mark.
The strength of Kerala’s primary healthcare system arises out of decades long investments from the state government. This strong foundation made it possible for the state to efficiently operationalize strategic plans. In fact, Kerala has one of the most efficient “war rooms” in the country, set up to fight the virus. One such “war room” set up in Kochi, a major business center in the State, continuously gathers data on patient status, capacity around hospital beds, ventilators, medications and oxygen supply. Medical doctors and staff literally working round the clock at these rooms, are able to quickly triage and allocate patients to the nearest hospital. Additionally, doctors are now set up to provide telehealth services to those battling COVID-19 at home.
This “Kerala model” has ensured that every village has a primary health care center, and that there are enough medical colleges in the state to provide well trained medical doctors to treat patients. The government’s push for free or heavily subsidized education at all levels has also been an integral part of this model. The result? Kerala has the highest literacy rate (93%) and the highest life expectancy (77years) in all of India. Literacy alongside strong leadership has gone a long way in promoting widespread awareness about COVID-19.
Lastly, and perhaps most importantly, the severity of the COVID-19 outbreak was acknowledged and given due importance by leaders and citizens alike right from the onset.
The majority communist government of Kerala aided Shailaja’s efforts by taking a people-first approach and making sure all other government departments (transportation, police, small industries and others) had coordinated seamlessly with the health department. The Kerala Chief Minister, Pinarayi Vijayan, well known for his pragmatism, wasted little time in issuing a state-wide lockdown order, weeks before the nation as a whole put a lockdown in place.
As with other paramount issues, the Kerala Government did not stop at issuing daily updates; the public was told what to expect in the coming days and how exactly the government was planning to address challenges. The unique governance in this state is set up to allow free-flowing, bidirectional communication between ministers and citizens.
The war against COVID-19 is far from over, but the state of Kerala has already won several ominous battles so far. Extrapolating into the future, a hard-fought, gold star worthy victory against the virus may not be all that far off for Kerala.