COVID-19 Fight – The Kerala Model, A Masterclass in Disaster Management

This is a sequel to the blog: COVID-19 Fight – the Kerala Model. What makes Kerala resilient in the face of a calamity like COVID-19? This question will be answered as we course down through this blog. Before we proceed further, let me ask a fundamental question, “What is the most important resource in the world?” The answer without a blink is ‘Human Resource.’ Kerala is blessed to have the best resources in its people who are conditioned to be so by the leaders of yesteryears, who guided the society in progressive and renaissance ways across the generations and developed timely infrastructures as the state progressed through the years.  Let’s look into the nitty-gritty of the COVID fight by Kerala. In order to understand it easily, let me breakdown the fight into the following components: Treatment, Epidemiological Preparation, Epidemiological Administration and Overall Response by Governance.

Treatment: How does Kerala treat COVIDian patients? As of now, it is evident that human immunity, along with antiviral drugs, is the best possible medical way to defeat the virus. Though there is no specific anti-COVID-19 drug available at present, there is working unanimity among the medical fraternity on the different combinations of drugs to be given to the patients, a conviction practiced astutely by the earnest doctors of Kerala. That brings us to the other variable: immunity. In order to keep the immunity at the highest possible level, Kerala prepared a balanced and highly nutritious diet for the patients, and here goes the menu: For Indians, breakfast includes dosa, sambar, two eggs, two oranges, tea and one liter mineral water served at 7.:30 a.m., followed by fruit juice at 10:30 a.m.;lunch: two chappatis, rice, fish fry, thoran — dish of sauteed vegetables —  fish curry and curd, followed by tea, biscuits, banana fry and vada served at 3:30 p.m.;and dinner comprises of appam, vegetable stew, two bananas and one liter mineral water. What a menu!

One sterling nugget of the Indian ethos is “Atithi Devo Bhava,” meaning “The guest is god.” Despite being engulfed by these extremely distressing times, Kerala continues to retain that ethos! Have a look at the menu being served for foreigners who were unfortunate to get caught up in the virus-web while touring the state and are at different hospitals. Breakfast: toast, omelette without onions, soup, fruit juice and one liter mineral water at 7:30 a.m., followed by pineapple juice at 11 a.m.;lunch: toast cheese, and fruits at 12 p.m., followed by fruit juice at 4 p.m.;and dinner: toasted bread, scrambled eggs, fruits and one liter mineral water. The menu is strictly maintained for both Indians and foreigners till they have recovered fully and are discharged from the hospital. Well food is enough for a man to live! Those who want to read are provided with books. They are even given WiFi! In short, every justifiable demand is met with to make their stay comfortable.

Epidemiological Preparations: The Health Service Department prepared and put into action a 3-tier medical preparation: Isolation Beds: more than 10,000 isolation beds were made ready at various hospitals; Corona Care Homes: 636 of such centers were set up near the airports to accommodate, especially foreigners, who have to be kept under observation but do not have home to have them quarantined. These centers can accommodate 4000-5,000 people, along with enough health staff, doctors and laboratory facilities;and Preparation of 125,000 hospital-beds to accommodate any future requirement. As a part of this preparation, 38 hospitals were converted into exclusive Coronacare hospitals, besides, temporarily calibrating Kasaragod Medial College into COVID Hospital – incidentally, Kasargod district recorded the maximum number of the virus outbreak.

Epidemiological Administration: As soon as the first case was reported, the government rolled out an institutional mechanism to manage the epidemiological administration of the COVID-19 affairs. At state level, a State Response Team, or S.R.T., was set up under the leadership of Health Minster Shailaja, with senior officials from various departments like epidemiology, community medicine, infectious diseases, pediatrics, drug control and food safety. In order to support the S.R.T. as well as to coordinate various functions such as surveillance, call centers, human-resource management, training and infrastructure augmentation, 18 state-level teams were constituted, which report to a round the clock operating control room that consolidates the information and feeds S.R.T.  The Chief Minister and his staff are also involved in providing the required thrust for inter-departmental coordination. Chief Minister Pinarayi Vijayan, S.R.T. Chairperson&Helath Minister Shailaja teacher and other administrative staff form the top of the COVID-administration pyramid and take all policy and strategic decisions. 

The Malayalees across the globe are glued to their TV sets at 6 p.m. Indian Standard Time on all weekdays to watch the Chief Minister’s press conference. The Chief Minister flanked by his Pyramid team briefs the Press. He begins with the statistics of the day’s fight against COVID-19: a district-wise break up of the number of cases that have tested positive, the number of people under quarantine and observation, number of cases that have recovered etc. He also elaborates various other measures that are being implemented as well as contemplated on for immediate implementation. Complete transparency is maintained by the government, including information regarding the contributions made by the public and various organizations to assist the government in its fight against the virus The fourth estate is free to ask questions and make suggestions, and fruitful suggestions will be taken up and acted upon, with the details of the action taken being given in the subsequent days. The Press has been an active watchdog, bringing up during the press conference, various issues being faced by the public in every nook and corner of the state. The efficacy of these press conferences are two-pronged: they are a vital source of credible information, virtually annihilating the possibility of hearsay and conjecture; it boosts the morale of the general public when they see their Chief Minister leading from the front

Most of the media have been contributing immensely in educating and updating the public about the virus, displaying pragmatism and sensibility in its coverage of the pandemic, slaying the slew of fake news being circulated while eschewing dramatization and panic mongering.  It has played a major role in highlighting the route maps of COVID-19 positive patients, busting myths, bringing in experts from the medical field to ensure that the public knows the enormity of the situation that is upon us and ways to tackle it.

S.R.T.s had been constituted at the district level, too, and each district is assigned to a minister, with district collectors and district medical officers coordinating the various actions. The government had laid down clear guidelines to handle all the steps in the action plan related with the COVID menace. The clinical guidelines, a part of the action plan, to deal with suspected cases as well as to treat confirmed cases have been kept as a work in progress document which gets updated with information about the virus as and when such news is available. The document comprises all the steps needed to be taken right from precautionary cases to cremation of the COVID-19 deceased. It is unfortunate for the relatives of the two COVID-19 victims that they could bid adieu to their loved ones only through video before the burial was done by the government  — Kerala strictly follows the W.H.O. protocol for burial/cremation of the virus victims.

Well-Firing Welfare Governance: These are extra-ordinary times that need extra-ordinary governance. The Left Democratic Government in Kerala has risen up to the occasion and is governing the state like a welfare state. This is unavoidable, if not inevitable, for the state is under lockdown and that the people must stay indoors and could not go to work,  especially the vulnerable sections need government help to tide over the situation. So the government quickly adjusted itself to the welfare state mode. See the running-milestones below:

Entire COVID-19 treatment is free of cost. Kerala has 941 Grama Panchayats, 152 Block Panchayats, 14 District Panchayats, 97 Municipalities and 6 Corporations. The government set up more than 1300+ Community Kitchens across these Panchayats to provide door-delivery of meals to households. It is free for financially weak people identified by the Panchayats. Those who can afford to buy, meals will be delivered to their homes @ Rs.20 (USD 0.38) per meal, along with a delivery charge of Rs.5. The lunch packets from the kitchens consists of rice, rasam, cabbage and mango pickle. This has become a huge relief for the vulnerable sessions of the society, and on an average 500 lunch and 600 dinner meals are being served by each kitchen, with the demand rising everyday. The most beautiful thing about this program is that all these kitchens are being run by volunteers under the guidance of Grama panchayat. The volunteers are mainly contributed by the Kudumbasree workers —  Kudumbasree is a women-empowerment initiative — and  ASHA —  a community-health organisation; and the Integrated Child Development Services, a government scheme for children. 

The famed benevolence of the Kerala spirit is in the forefront again as it took the guest-workers under its protection. Special community kitchens have been set up for 2.5 million guest workers, catering specifically to different food palates like Bengali, Oriya as well as North Indian cuisines. You would be hard pressed to find another state anywhere on the world, carrying out such a magnificent gesture, especially when it is grappling with a catastrophe of such magnitude.

Another welfare initiative by the government is providing free 15 Kg rice and other provisions through Public Distribution Shops, or P.D.S. This covers Priority card holders — yellow and pink cards — as well as non-priority card holders — blue and white cards. Non-priority card holders will get 15 kg of rice over and above their regular ration, Those without ration cards can also purchase grains by giving an affidavit at the distribution shops.. There are 8,714,000 ration-card owners in the state, and a record 81.45% collected these provisions from the P.D.S. in the first week of April. To this staggering statistic, add the astonishing fact that the 1 meter social distancing norm was strictly followed while executing the distribution. This was made possible, while executing the distribution, by allocating different collection times for different type of card-holders. It highlights the level of planning that goes into every scheme.

An enviable initiative that is underway is to provide FREE food-kits to all the 8,814,000 families in Kerala, irrespective of their income status. Items included in the kit are as follow:

Sunflower oil – 1kg • Coconut oil – 1/2kg • Salt – 1kg…Wheat flour – 2kg • Rava – 1kg • Green gram – 1kg • Black chana – 1kg…Tuvar  dal – 1/4kg • Mustard – 100gm • Fenugreek – 100gm • Coriander – 100gm • Urad dal – 1kg 

Chilli powder – 100gm • Sugar – 1kg • Tea – 250gm • Soap – 2.

Each kit costs around Rs.1000 — USD 13.15— and it will cost Rs.800 crores — USD 105 million to the exchequer. The  government has left it entirely to the people to voluntarily give up the free food kits if they can afford to do so.

The slew of measures being taken by the  Kerala Government is umpteen, and this blog will go endless if I list out all of them. Here are a few noteworthy ones: procuring vegetables from farmers; home delivery of medicines to people who are suffering from health problems but can not move out due to the lockdown; home delivery of books to children by the libraries; early release of monthly pensions;etc. When a state is battling a pandemic, it is bound to overlook small things. Not the Kerala Government! It found time to arrange for home delivery of books from libraries for children who are bored for want of avenues in the lockdown. The plight of monkeys and stray dogs also did not escape the sensitive eyes of the state.

The government earmarked Rs 20,000-crore — USD 2.64 billion —- for implementing these welfare measures.

Now, let’s revisit the questions that I raised in the beginning: What makes Kerala resilient in the face of a calamity like COVID-19? “What is the most important resource in the world?” Human Resource. 

Examples to answer the second question is the Volunteer Power being demonstrated in Kerala during this COVID time. All the community kitchens and food delivery are being run by volunteers. Delivery of food provisions to those homes, which could not visit public distribution shops, were made by volunteers. Tens of thousands of ASHA workers volunteered themselves to train people on precautions to be taken against virus and in keeping a vigil on people who are home-quarantined. Besides this, 235,0000 people registered on a government portal, expressing their willingness to work as volunteers. A few hospitals which remained closed were taken over by the government, and the youth organisations came forward and cleaned them — all on volunteer basis. This marvelous repository of kindness is made even more poignant by the fact that these volunteers are aware that they risk exposure to the deadly virus and are putting the lives of themselves and their loved ones at risk.

Kerala has public libraries in all the villages for a long time. I remember visiting the library at my village, Chavara Thekkumbhagom in Kollam district. These libraries offer an array of books from a range of spheres, besides, news papers. Most households in Kerala have newspaper subscription. Let’s look at this number: the leading newspaper daily, The Malayalam Manorama, has 17.5 million readership, followed by The Mathrubhumi with 13 million readers. Both together forms around 93% of the population. Hence, the people are well read, aware of and updated with the news happening around the world. 

Besides the people, what makes Kerala resilient in the face of the COVID calamity? The answer is an already established and well-running infrastructure. For example, Kerala has 1600 Supplyco  outlets — government-run consumer stores. They are present in all the villages — all the villages in Kerala have paved tarred-roads with public transport system connecting them to towns and cities — so it was easy for the government to utilize this network to distribute food-kits. Similarly, the state has 14.250 P.D.S. shops which were used to distribute free rice and other provisions. 

There are many of infrastructural indices of Kerala that are comparable to the level of a developed country. Indices like number of hospital beds per 100,000 people (Kerala: 330 beds, the highest in India;Singapore: around 240, Germany: 870);Literacy Rate( K:100%, S: 97%, G:99%;Mobile Phone Subscription Rate (K: 30 million out of 33 million people: 91%, the highest in India, S: 148%, G:87%); Electrification of Households(K: 100%, the ONLY state in India with 100%, S:100%, G:100%);  Internet  Penetration (K:54%, the highest in India, Singapore: 84%, G;86%). This list is so long that it qualifies for a separate blog! However, these high indices are indicators of significantly higher progress made by Kerala in other sectors of social and economic development.

With 345 confirmed cases over a period of more than 4 months, mortality rate of 0.58% from 2 deaths, 60 recovered cases and with no community spread as on April 8, 2020, Kerala had flattened the curve, but the descent of the curve was a bit slow because of a few cases reported from the people who returned from abroad. However, the curve will hit the base sooner than later as it is only a matter of time. For a society to be resilient, it needs to have its best resources in its people, along with functionality active infrastructural networks supporting various facets of life. Kerala proved the effectiveness of these two elements by bouncing back from the massive floods in 2018. Kerala is firing on all cylinders in its fight against the deadly COVID-19. It will definitely ace this test, too.

Note: The blog is edited by and also has contribution from my wife, Linet, who is a journalist.

Chief Minister Pinarayi Vijayan and Health Minister Shailaja

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