A mock drill underway in Ernakulam in the southern Indian state of Kerala, as part of efforts to prevent the spread of COVID-19. Image Credit: ANI

Padma Kumar, a Dubai resident, walked straight into quarantine in Kerala when he arrived in the southern Indian state on March 20. At the airport in the state capital of Thiruvananthapuram, the 50-year-old was asked to sign papers that consigned him to 28 days of home isolation.

For four weeks, Kumar was unable to see his mother and children. A volunteer kept tabs on him every day, and a doctor would call occasionally peppering him with questions on his health and state of mind. Groceries and medicines were provided periodically at government expense.

“I was happy. There were no issues. Everything was taken care of. Every time the volunteer phoned me, she used to asked whether I needed anything...vegetables, groceries and other eatables,” Kumar said.

On Vishu (New Year Day in Kerala), konnapoo (Casia fistula, the flowers specifically used for the occasion) and vegetables were delivered to his door. Kumar paid, the only payment he made in four weeks. The Panchayat (village council) provided a bag of rice, free of cost.

After 28 days, Kumar underwent a medical checkup and was given a Quarantine Release Certificate. This is how Kerala fights coronavirus. With quarantine, regular testing, tracing possible contacts and community support.

Kerala has been held around the world as a model for preventing the spread of COVID-19. Global media have been showering praise on the state’s success.

Corona Certificate
Dubai resident Padma Kumar's Quarantine Release Certificate, which he received after 28-days of home isolation in Thiruvananthapuram, Kerala, India. Image Credit: Supplied

What’s the secret behind Kerala’s success?

The state sprang into action as early as January and rolled out measures that helped reduce the spread of the disease. The steps were simple but proactive. They also imposed stringent controls that required all passengers arriving from foreign countries to quarantine.

These efforts were backed by an excellent healthcare system and a highly literate population. The state leadership too was agile enough to respond swiftly to the demands wrought by the crisis. 

What prompted Kerala to plan so early?

K.K. Shailaja, the state’s health minister, told Gulf News in an interview in March that Kerala had started planning much before the first case surfaced in her state. When the epidemic in Wuhan was reported, the government began to draw up plans, she said, adding that they were aware of hundreds of Keralites studying in the Chinese city.

A control room was set up on January 23 in Thiruvananthapuram, and a week later the first case was detected in the state. It was India’s ‘Patient Zero”, one of the three medical students who returned to Kerala from Wuhan.

Why is Kerala’s risk high?

Population density, affluent non-resident Keralites and thriving tourism all raises the risk for Kerala.

Kerala may be a small state (38,863 square kilometres), but its population of 35 million makes it India’s eighth most densely populated state with 819 people per square kilometre.

An estimated 2.5 million form the Kerala diaspora, who travel frequently to their home state. International travel is a feature of Kerala, which is linked to the rest of the world through four airports that serve 17 million passengers annually.

The state that proclaims itself as “God’s Own Country” is a magnet for tourists who make a beeline to the backwaters, palm-fringed beaches, verdant hills of the Western Ghats, and the tea and spice plantations on the mountain slopes.

How did the Nipah virus experience help?

Given the high exposure, Kerala has done very well in reining in the coronavirus. The lessons in fighting the more lethal Nipah virus in 2018 came handy, although the COVID-19 is on a much bigger scale. Nipah infections were restricted to two districts, and there were no cases from outside. But that experience helped in activating the state machinery, mobilising the community and launching awareness campaigns.

Why’s Kerala’s healthcare system world class?

The three-tier system includes primary health centres at the lowest rung, followed by community health centres, taluk hospitals, district hospitals and general hospitals. The tertiary sector is composed of medical college hospitals, and research and treatment centres.

These are backed by an excellent pool of homegrown medical professionals: doctors and nurses.

Kerala healthcare ranks alongside some of the advanced societies in the world. lists three fundamental parameters that keep Kerala on top. Here’s what the site says:

Beds per thousand population: Kerala has 100,000 beds for a population of 35 million, around 2.9 beds for every 1,000. Italy has 3.2 beds, and the United States has 2.2 beds per thousand.

Doctor-people ratio: In five years, Kerala will have one doctor per 200 people, while the World Health Organisation stipulates only one doctor per 1,000. India’s national average is one doctor for 2,000 people.

Density of healthcare facilities: Kerala has 1.5 hospitals per 1,000 square metre. Tamil Nadu has more: 4 per 1,000 sqm.

How literacy helps

With a high literacy rate of 94 per cent, the awareness campaigns have good impact and information quickly percolates through the community. And community members take it upon themselves to drive the government campaigns. A literate society also helps in reducing the spread of rumours that rage across social media platforms.

We hoped for the best but planned for the worst...but we cannot predict what will happen next week.

- K.K. Shailaja, health minister of Kerala, India

Shailaja the ‘Coronavirus slayer’

Health Minister Shailaja is a superstar in the state cabinet. A former science teacher, her success in the handling of the Nipah virus endeared Shailaja to Keralites worldwide. When the COVID-19 crisis unfolded, the minister rolled out strict measures. A control room was set up in January, and that was followed by a state response team to coordinate with security personnel and government officials. Her swift and decisive actions earned her the moniker “Coronavirus Slayer”.

How the state fought the pandemic

The Kerala government headed by Pinarayi Vijayan declared COVID-19 a state calamity on February 3. A raft of measures followed. Here are some of them:

Social distancing and other precautions: The use of face masks was promoted from January 30. Schools and colleges were closed on March 10, and all religious groups were told to cancel gatherings to encourage social distancing. For school children who rely on free meals, food was delivered to their homes. When work from home became the norm, internet service providers were asked to improve bandwidth.

Identifying cases: Health workers, including doctors and other medical professionals, were trained to identify COVID-19 symptoms from viral fever and the common cold.

Testing: The National Institute of Virology, Pune, helped set up a facility in Alappuzha to speed up testing. The government also launched 12 testing labs for early identification of COVID-19 patients. More testing centres were opened later.

Tracking: High-risk people who were in contact with the infected were tracked and tested. Local government bodies were asked to scan people who had returned from the infected countries after January 14.

Quarantine: People who had returned from Wuhan and other Chinese territories were told to quarantine at home for 28 days. All contacts were tracked and asked to self-isolate at home. Today, anyone entering the state has to undergo a mandatory 28-day quarantine.

Helplines have been established in all districts. There’s a separate mental health helpline as well.

Isolation wards were set up in all medical colleges, general and district hospitals. Around 635 corona care centres were created in hostels, educational institutions and unoccupied buildings. Besides that, around 125,000 rooms were kept aside to accommodate suspected cases.

Lockdown: The state introduced a lockdown on March 23 before it hit the 100 infections mark. The 21-day national lockdown also helped the state.

Media campaigns: The ‘Break the Chain’ campaign was launched on March 15 to check the spread of infections and promote social distancing and encourage good hygiene. Social media played a pivotal role in the success of these campaigns.

Volunteer force: A 250,000-strong volunteer force was raised on March 26. Over three days, these volunteers (in the 22-40 age group) were trained to work with local government bodies. They include ambulance drivers, and nurses and paramedical staff to assist the 3,000-strong health workforce. Others are deplo¬yed to deliver food or surveilling those under home quarantine.

Migrant labour: From March 26, the state set up 18,828 camps for migrant labour. Over 300,000 people from other states are being hosted in the camps and provided free food and medical care.

Free ration kits of rice and essential items were given to 3.69 million families.

more on coronavirus

Was the curve flattened?

The curve has not yet been flattened. Nineteen more cases were reported on April 22 in Kerala, bringing the total to 427. Of that, only three died while 307 have recovered. That’s an encouraging piece of statistic. Because given the international infection rate each person should infected two to three others. Which means Kerala has the situation under control.

“We hoped for the best but planned for the worst,” said Health Minister Shailaja, “but we cannot predict what will happen next week.

All the planning seemed to have worked well for Kerala.