secondIn mid-May, the Indian state of Kerala contained the first wave of Covid-19, which earned praise for the quick thinking and joint response of its health minister, KK Shailaja, and his team. In July, however, it was suggested that such applause had been premature and that Kerala’s Covid-19 response had taken off. I had it?
Shailaja Teacher, as the 64-year-old minister is affectionately known, expected an increase in infections once the blockade of India was lifted in late May. Kerala, home to 35 million people, has the strongest health systems in the country, but it is one of the poorest states in India, with one of its oldest populations. Roughly 17% of workers leave to look for work in neighboring states, and it was feared what would happen when these migrants inevitably returned. The authorities knew they could not keep Kerala’s borders closed or, since the state is dependent on imports, keep it isolated from its neighbors.
Realizing how vulnerable its population was, Shailaja’s strategy was to delay the coming peak, giving the state time to prepare so that that peak was less. Speaking in a panel of the World Health Organization on June 23, said their goal was to limit the CFR to below 2% and the basic reproduction number (also known as the R rate, a measure of the ability to spread the disease) to below one. “This is to ensure that we do not have a local epidemic, so that we can use the capacity of our care system primarily to treat imported cases,” he said.
It was impossible to keep the rate of R below one, and within a month he had a local epidemic, one that keep growing. However, Shailaja now says that “even after being the first Indian state to detect a Covid-19 case, as early as January, Kerala is the latest state to peak.” He had time to double the number of ventilators in government hospitals and to train an army of front-line workers he calls the “Covid brigade.”
These workers test and locate, monitor those in quarantine and isolation, and provide social and psychological support to the vulnerable. They have fed almost 9 million people through 1,300 community kitchens and continue to deliver food packages to more than 8 million households.
These measures, plus a financial support package worth £ 2 billion, have paid off. Fewer Covid-19 patients have died in Kerala than anywhere else in India. The CFR peaked in May at 0.8% and has since fallen by roughly half, compared to a national average of 1.5%. “Kerala is one of the few places in the world where the CFR actually decreased while the epidemic was at its peak,” says Shailaja.
At no time has more than a quarter of its ventilators been taken care of, and fewer than one in 10 intensive care beds were filled on December 1. That gives Shailaja the confidence to say that whatever happens next, the system is likely to come through.
Infections are certainly not being reported correctly in Kerala, as they are, to varying degrees, throughout India (and the world). One particular problem is that 80% of Covid-19 tests are rapid antigen tests, which give quick results but are less reliable than PCR (polymerase chain reaction) tests. Deaths are also reported significantly less, says health economist Rijo John of the Rajagiri College of Social Sciences in Kochi. “However, even if we allow for 50% underreporting, the state’s death rate would still be well below the national average,” he says.
“Kerala has done the best it could,” says Ramanan Laxminarayan, an epidemiologist at the Center for Disease Dynamics, Economics and Policy in New Delhi. Jaideep Menon, a public health expert at the Amrita Institute for Medical Sciences in Kochi, agrees: “Kerala has done nothing extraordinary,” he says. Quite simply, he adds, it has shown that limited resources, proactively deployed, can limit the spread and impact of Covid-19 on a vulnerable population.
Shailaja dipped her finger into the dam, speaking metaphorically, knowing that if the dam broke, a much greater disaster would ensue. For that, Vogue India named her leader of the year last month, an honor she claims to share with her predominantly female workforce. She is still waiting for reinforcements in the form of a vaccine, whose stocks the richest countries are busy. But that is another story.
Digsmak is a news publisher with over 12 years of reporting experiance; and have published in many industry leading publications and news sites.