Saturday, May 9, 2020

The Kerala Model – Testing, Isolation and Contact Tracing
How the model compares to Vietnam and California

 Zach Zachariah, Ph.D., M.B.A., Associate Professor Emeritus, Ohio University
May 9, 2020
Kerala, the state where I was born lies on the Southwest coast of India on the Arabian Sea near the equator. It is the twenty-first of the twenty-eight Indian states in land area and has one of the highest population densities.

 Two other areas of the world chosen to compare Kerala’s success in mitigating the Covid-19 pandemic are Vietnam and California. Vietnam that borders China, where the novel-Coronavirus originated, was able to contain the spread of he virus and not a single person has died from the disease. California is ten times larger than Kerala in land area; but has only six million more people living there. Both Kerala and California encountered the first novel coronavirus case by the end of January 2018. While Kerala has only 504 reported cases and just 4 deaths so far, California has reported 63,700 cases and over 2600 deaths.
Experience: The deadly Nipah virus infection was first detected in the Kozhikode district of Kerala in May 2018. The state government responded quickly, within days traced, and isolated everybody who had contact with the infected. The outbreak was contained in just two districts. It claimed seventeen lives and by the end of June 2018, Kerala was declared Nipah-free.[1] Virus is a Malayalam movie set against the backdrop of the 2018 Nipah virus outbreak in Kerala and is available on Amazon Prime.
Preparedness: Based on the lessons learned during the Nipah outbreak, Kerala government has strengthened the disease response infrastructure by putting in place a 24-member task force coordinating with police and public officials around the state. Operating procedures and protocols were set in place in anticipation for the next epidemic. When the state became aware of the new Coronavirus disease spreading in China, the health minister, K.K. Shailaja, a former science teacher set in motion the government machinery as the first person, a student from Wuhan, China arrived. She was immediately isolated and when tested was found to be Covid-19 positive becoming India’s first Coronavirus case (K. K. Shailaja interview on NDTV)[2]. On February 2, 2020, the government of India issued a travel advisory asking people not to travel to China and said that anyone with travel history in China could be quarantined.
Investment: Kerala has been ruled by left and center-left parties. The left-leaning governments maintained its focus on social welfare. RT America TV interviewed the historian and author, Vijay Prasad about Kerala’s response to Covid-19 and the video on YouTube[3] can be viewed from this link. The state has also invested heavily in education and public health initiatives. It has a 94% literacy rate, the highest in India. Its government run health-care system consisting of primary health centers in rural parts of the state, specialty district hospitals and a number of medical colleges and teaching hospitals is ranked the best in India. Kerala has a vibrant local media that disseminated Covid-19 information without regard to political affiliation. Most people in the state realized the seriousness of the situation, followed government guidelines on social distancing, personal sanitization and sheltered in place during the lockdown.
Response to Covid-19: A family of three, who arrived from Italy on February 29, skipped the voluntary screening for Covid-19 at the airport and traveled to their hometown. They developed the disease and infected two elderly grandparents.The District Collector, a career public servant who belongs to the prestigious Indian Administrative Service (IAS), resorted to the WHO recommended plan of contact tracing, isolation, and surveillance. He mobilized a team of law enforcement and public health officials, paramedics, and volunteers to retrace the family’s movements through cellphone data and interviews, tracked down the contacts, and isolated them. He also set up a call center in his office, bringing in more than 60 medical students and staff from the district’s health department, whose job was to call everyone isolating, every day[4]. All the five persons survived including the two
elderly relatives. One child and three adults died in Kerala of the disease; two of the adults were in their sixties and one was 71. More than 50% of the deaths in the United States and Western Europe occurred in the nursing or eldercare homes. A recent headline in the Washington Post says, “America doesn’t care about old people.”[5] Unlike the more developed countries, Kerala cared about the old.

When an outbreak of new cases occurs, thousands of state-employed health workers and volunteers equipped with maps and flowcharts conducted aggressive contact tracing and brought the situation under control. As the number of Covid-19 cases grew to 15, the state chief minister, Pinarayi Vijayan, ordered a lockdown, sealed state borders, restricted public and private transportation, closed schools, and banned gatherings larger than ten including religious services. The government also quarantined hundreds of thousands of migrant workers in camps and provided them with free food.

 Kerala promulgated an Epidemic Disease Ordinance on March 29, 2020, days before the central government instituted a harsh lockdown. It included an economic package worth $2.6 million (₹20,000 crores) to fight the pandemic. The government entrusted the task of implementing the economic package to the nationally acclaimed poverty eradication and women empowerment program known as Kudumbashree[6]. This organization that is spread throughout the state has over 5 million members in 430,000 ward level units. They organized community kitchens to cook and deliver food to the needy, especially to the families of schoolchildren. Kudumbashree volunteers also assemble grocery kits and deliver them to 8.7 million families. It formed 200,000 WhatsApp groups to provide Government instructions regarding Covid-19 to dispel fake news. Mental health helplines were also established across the state[7]. The state liaised with service providers to increase network capacity for Internet and promised two months of advance pension.

 In an interview  with TimesNow[8], the chief minister of Kerala detailed how the government harnessed the resources of the state’s Innovators and entrepreneurs to design and manufacture PPFs, respirators and ventilators. According to him, hotel rooms, hostels, and additional buildings were being identified to accommodate a surge if that happens. As the Indian government is easing travel restrictions, Kerala expects tens of thousands of Keralites to return from overseas. While still keeping the social distancing guidelines in place, the state is preparing to quarantine returnees for seven days after which they will be tested for the disease and only those found negative will be released for an additional week of quarantine at home.

Update (May 11, 2020): 
On May 10, 2020, the government of Kerala has issued new guidelines on quarantining the returnees[1].  Every returnee will be screened on arrival for Covid-19, asymptomatic persons will be required to adhere to strict home quarantine rules for 14 days and those who show symptoms will be admitted to specially designated Covid hospitals. Those under home quarantine show symptoms, they will be tested and if found to be positive to the virus, will be transferred to a hospital for treatment.



 
[1] Lessons from Kerala’s bold fight with Nipah https://www.orfonline.org/expert-speak/42270-lessons-from-keralas-bold-fight-with-nipah/
[2] Health Minister K. K. Shailaja Interview on NDTV, https://youtu.be/q9xQljHg21c
[3] RT America, the Model State, https://youtu.be/7AGI6qVVmpo
[5] Washington Post, America doesn’t care about old people, https://tinyurl.com/y9jzk6l3
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1 comment:

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