Covid lessons from Kerala

The state shows the merits of timely and organised intervention

In his April 13 address, Prime Minister Narendra Modi had said the three-week lockdown had worked in containing the community spread of the virus to make his case for a further 19-day closure. But the data from the Johns Hopkins Covid Tracker suggests that India’s Covid-19 trajectory has been consistently steeper than its Asian peers, despite limited levels of testing. Although the case count has slowed in the past week — doubling every seven days against four days earlier — the potential for a bigger crisis remains, putting the country’s fragile health care under more stress. Maharashtra, Delhi, Tamil Nadu, Madhya Pradesh, and Rajasthan — which jointly account for 65 per cent of the active cases nationally — are still struggling to contain the pandemic.

Buried in this data is a success story from Kerala. The state, which recorded one of the earliest cases of Covid-19 with the return of a student from Wuhan, topped the charts in terms of the number of active cases when the nationwide lockdown was announced on March 24. With its large overseas and internal migrants and high population density, the state could well have stayed at the top. Yet, today, it stands at number 10, with a 56 per cent recovery rate, just three deaths and tiny growth in net Covid-19 cases. Kerala’s success story has attracted global approbation. Within India, however, it is seen as an outlier because of its superior health infrastructure and high literacy levels relative to the rest of India. These advantages may have played a role in fighting Covid-19 with greater success, especially in the citizenry’s discipline in observing social-distancing norms. They are certainly a pointer to the direction of future social-sector spending in the rest of India. But closer studies, including a detailed one in the MIT Technology Review, reveal a state administration taking a pro-active and common-sense approach, building on its experience in containing the 2018 outbreak of the zoonotic Nipah virus. In contrast to the rest of India, which went into lockdown in late March, the Kerala government had started taking steps as early as end-January. The health minister instituted screening in the state’s international airports much before others. By March, the administration immediately adopted the World Health Organization (WHO) advice of contact tracing, isolation, and surveillance to break the chain.

Bureaucrats at the ground level worked on the assumption that patients would be reticent about divulging information about their movements and sought to create teams and use GPS tracking of patients’ mobile to trace tenuous leads. The state went into lockdown on March 11, the day the WHO declared Covid-19 a pandemic, but Chief Minister Pinarayi Vijayan held daily briefings, and expanded the production of personal protective equipment and food deliveries. Keralites thus were prepared for the national closure as there was already a partial lockdown in place for weeks. The early and proactive response by the state government not only helped contain the spread of the virus but also avoided deaths. The fact that the state is at the top of the table in health care performance has also helped. Even at the international level, Germany, which has the highest number of hospital beds and the best medical infrastructure, is recording fewer deaths than neighbouring countries in Western Europe. One of the biggest pieces of learning from this pandemic would be the importance of building capacity in the health care system.