COVID-19 Fight – The Kerala Model

The ongoing fight against COVID-19 by Kerala is, in all probability, the best in the world. Most of you could possibly know that as a country, it is Singapore that is waging the best war against the virus, with 1114 infected cases and a mortality rate of 0.45% as on April 3, 2020. But one place, which has a population that is 6 times more than that of Singapore, that is bettering the best-Singapore in the fight against the virus is Kerala. Before going into the metrics, let me list out a few ubiquitousness which accentuate the COVID-18 menace of Kerala.

Kerala has a population of 38 million people, of which 10% is working abroad. That means a whopping 3.8 million Keralites are scattered all over the globe. You will find the Malayalees anywhere and everywhere, be it the landlocked countries like Burundi and Rwanda in Africa; Caribbean countries like Haiti; Europe; the USA; Middle East; and anywhere and everywhere in the world. Besides, hundreds of thousands of students from Kerala are pursuing their studies abroad, including at the COVID-19’s birth place: Wuhan. Kerala lives across the globe, so any global shock, whether epidemiological or economical — around 35% of the Kerala’s GDP is contributed by the foreign remittance — the reverberations will be felt in Kerala, so did COVID-19 immediately after the outbreak in Wuhan at almost the same time as it was felt in Singapore.

Kerala had the first COVID-19 case reported on January 30, India’s first, from the students returned from Wuhan. From that day, Kerala reported 295 cases with 2 deaths and 25 recoveries as on April 3, 2020. Out of this, 206 cases are returnees from abroad, 7 foreigners and the remaining cases are their relatives and those who came in direct contact with the infected. With no case of community spread and a mortality rate of 0.68% — both the patients who died were aged above 65 years and had underlying severe health problems — Kerala’s fight against the virus exemplifies what humanly possible to keep the virus at bay. And it can be an enviable model even for the best-fighting Singapore! What is that model? Any model to fight the virus should have the following elements: Quarantine, Source-tracing, Testing for the virus, Strength of healthcare system, Proactive establishment and solidarity among people. Let’s look how Kerala is doing on these elements.

Quarantine: How long does Kerala quarantine suspected COVID-19 persons? For 28 days. Yes, you read it right. Not 14 days as other countries do. This is very important, but why? Do have a look at the following chart published by a Medical Association:

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The chart shows that if a person gets infected with COVID-19, he/she will remain asymptomatic till 4th day, start to show symptoms from 5th day to 14th day and that with medicines and/or immunity, he/she will start recovering from 15th day and by the 28th day, the person will be fully recovered with long-term immunity. Now, the crucial question: Does the recovering person have the potential to spread the disease? I checked this with a doctor-friend who gave the answer: yes.

The World Health Organisation says lots of people show little symptoms to mild symptoms and get recovered with the help of their own good immunity, and in this process, sometimes the infected recovers without him or anyone knowing that he/she was infected. Now, imagine that someone is suspected to have virus, hence, quarantined but showed no symptoms till 14th day — no test was done as it was only a suspicion. Also, imagine that the person was infected; his/her strong immunity defeated the virus; and that he is recovering from the virus from the 15th day — mind that nobody knows whether person was infected by or recovering from the virus. If we leave that person from the quarantine, there is a possibility, as my doctor-friend answered, that he would spread the virus. Hence, Kerala’s decision taken in the very beginning to quarantine all the suspected persons for 28 days is foolproof and limited the virus-spread to a large extent.

Source-tracing: Kerala is the first place in the world where, when a person is diagnosed with the virus, a route map of the person — detailing the travel history from his/her entry point to Kerala till he/she was diagnosed or from whom the person got the virus till the diagnosed time — is prepared and published to source-trace all the possible social contacts as well as to alert people who, in case came in contact with the infected person, can come forward to inform the healthcare authorities.

A Specimen copy of the route map of a patient:

Look at these numbers: As on April 3, 2020, Kerala has 169,000 people who were source-traced for possible social contacts with the confirmed 295 cases! Wow, it is an astronomical 57,288% of source-tracing against the known infected cases! And out of this 169,000 people, only 706 are at various hospitals, with the remaining home-quarantined.

Testing: Higher number of testings is how Singapore and South Korea contained the menace. For example, testing for COViID is around 6148 people per million in South Korea and 6800 people per million in Singapore. As these are developed countries — per capita income per annum is above USD 20000 — they were able to ramp up the testing rate quickly. It was 210 people per million for Kerala as on March 9. It is, however, noteworthy that Kerala, though having just 2.8% of India’s population, had done almost 18% of the total COVID-19 tests in India as on March 9. Kerala had, subsequently, ramped up testing by opening up more testing centers. Such a higher level of tests helped to identify the infected from amongst the suspected cases as early as possible. Another remarkable thing is that all those tested positive for the virus were from the already-quarantined ones — so none infected was roaming around undetected, hence, no community spread.

Strength of healthcare: Kerala is a 100% literate state with development and social indices like education, healthcare, life expectancy, low infant mortality, low birth rate, etc. comparable to those of the developed world — this is acknowledged by the international organizations like the UN. Also, Kerala is the only state in India that has palliative care included in its health policy, with more than 200 clinics established across the state for this purpose. Kerala’s palliative care is rated as one of the best in the world. All these healthy milestones are founded on the bricks of primary health centers present in each and every village in Kerala.

Proactive establishment: Kerala’s fight against the virus is led from the front by none other than the head of the government, Chief Minister Pinarayi Vijayan, and the Health Minister, Shailaja ma’am, whose enviable leadership during the Nipah virus outbreak in Kerala was exemplary. She, a retired High School teacher of Chemistry, was honored by the European country, Moldova, by appointing her as a lifetime visiting-faculty at its famed institute, National Medical University. The MOST IMPORTANT aspect of the government’s fight against the virus is that FULL COST OF TREATMENT for all the patients are BORNE BY THE KERALA GOVERNMENT.

The government prepared plan A, Plan B and Plan C to confront the virus. The plan A, which is in operation, involves quarantining all the suspected cases, providing the best possible healthcare to the infected persons — the recovered include foreigners and an elderly couple: Thomas aged 93 and 88-year old Mariamma. This is stupendous and does show the efficiency and effectiveness of the Kerala healthcare workers as well as the the healthcare system; strictly enforcing social distancing as well as the ongoing lockdown; opening community-kitchens in every village to provide food for those who went jobless, hence, can not feed themselves during the current lockdown — this includes around 2.50 million guest workers who are from other states in India and now provided with free food and accommodation; distribution of food-kits to almost 800,000 families; etc. As of now, there is no community spread in Kerala. But the government had prepared plan B and Plan C anticipating it. These plans are into action already and do involve preparing tens of thousands of hospital beds; taking over hotels and home-stays to covert them into hospitals as well as to accommodate the healthcare workers; further expanding testing among people with inclusion of rapid tests; etc.

Solidarity among people: You go anywhere in the world, and it is unlikely that you would not see a nurse from Kerala. All our healthcare workers are putting in their best — they are our front-line infantry fighting the battle everyday. Our police force is working round the clock to ensure the lockdown is enforced without causing any problems to movement of people for essential services. Kerala is the most politically charged state in India, with the neutrals forming only around 2.5% of the population. But all the political parties had come together to support the government in this unprecedented fight. Kerala is a multi-religious society with different faiths coexisting peacefully. During this difficult time, all the religious heads showed solidarity with the government and offered the hospitals under their guardianship for the virus treatments. Kerala is fighting the virus in unison.

It was reported that various states in India, the central government and different countries from across the world approached Kerala to share with them its model of the COVID-19 fight. This is an acknowledgement for one of the best healthcare fights ongoing against the virus. Like Singapore and South Korea , Kerala is fighting the virus in the best possible way!