The world had just bid a roaring goodbye to 2019 and waltzed into 2020, with plans to start afresh. Kerala and its people had their eyes set out for the new year with solid plans on their mind after fighting the epidemic Nipah in 2018 and two back to back floods in 2018 and 2019. 2020 was supposed to be a year full of hope. Of course they were not ready for what was about to hit them in the days to come.
There were some ominous signs emanating from China’s Hubei Province when on New Years Eve the Wuhan Municipal Health Commission reported a cluster of cases of pneumonia which had its epicentre in Wuhan. It was later identified as a novel coronavirus. Keralites were aware of what was brewing in China. Memories of Nipah had prepared them to be alert to fast spreading viral infections. Just a month after the report from China, India detected its first case of coronavirus infection in a student who had returned to Kerala from Wuhan. While mild traces of panic had set in, the Kerala government was up and ready.
Under the leadership of the then Health Minister KK Shailaja, the State’s public health authorities were quick to set up a protocol to contain the new virus. The tried and tested system that they had developed to contain the Nipah outbreak was put in place and with it came strict quarantine rules, extensive surveillance and contact tracing measures. Institutional quarantine, testing, and treatment facilities were free at the outset to calm the frayed nerves of its citizens, while clear messaging on the do’s and don’ts were widely publicised using all means of communications. The rules were so taut that even asymptomatic patients were taken to first-line treatment centres. These measures by the government were used to build trust among citizens, and to make them cooperative partners in the fight that lay ahead.
Quick Turn of events
A case that was reported from Pathanamthitta on March 7, 2020 was a deciding factor in the way COVID-19 took over Kerala, the first time around. Despite the robust protocols, there were a few tense situations, like when a family that had arrived from Italy, which was then a hotbed of COVID-19 cases, skipped surveillance by hiding their travel history at the airport. They had reportedly gone about visiting families and attending functions instead of following the 28-day quarantine regime. They ended up transmitting the virus to two of their family members, the first case of secondary transmission that was detected by a physician at Ranni Government Hospital in Pathanamthitta. While this behaviour earned the family the wrath of the public, they were shifted along with their elderly parents to the hospital for treatment. Meanwhile, the district administration set out to trace their movement and released a route map through which it was able to identify more than 3000 people who had come in contact with the family. The route maps would be a prominent feature in identifying contacts of people who tested positive upon arrival in the state from outside and skipped quarantine. From this point on people’s curiosity peaked, they were asked to stay alert and the public did deliver, though it took them some time to get used to curbs and restrictions of such a large scale. There were few unfortunate incidents where people under quarantine faced ostracisation from their neighbours. The government through its Chief Minister Pinarayi Vijayan and Health Minister KK Shailaja were quick to condemn such behaviour and delivered messages that allayed the fears and instilled confidence in the people’s minds, that they needed to trust each other and stand together if they were to collectively defeat the virus.
All the right moves
One of the first major steps the state took was to declare a State-wide emergency after the first three cases were reported on February 3, 2020. Control Rooms and quarantine centres were opened in all districts. Soon, all those who returned from abroad were monitored. The route map became a go-to guide for the public, to stay alert and for the State to curb an outbreak. Every person who reported symptoms got their travel history traced, their primary and secondary contacts were zeroed in and asked to go into quarantine or moved to quarantine centres for 28 days. Those in home quarantine were under surveillance, with police and health officials regularly enquiring about their wellbeing. There were stray cases of people refusing to quarantine, and cases where health workers had to drag people back into quarantine centres after they ran away. The health department also initiated dedicated helplines to make available psycho-social support to address the mental health issues being faced by those under isolation.
The World Health Organisation recommends the strategy of find, test, trace, isolate and treat (FTTIS) to contain the spread of the coronavirus. Kerala was able to maintain a very high rate of testing from the beginning, which along with tracing helped identify the correct contacts, thereby also avoiding indiscriminate testing and wastage of test kits that were in short supply initially. To aid increased testing three more centres were opened in the month of March to augment the capacity of National Institute of Virology’s Nodal lab in Alappuzha. As the pandemic progressed, 47 other labs were opened in the Government sector, while 113 private labs approved by ICMR, the premier agency for biomedical research in India helped chip in. The health ministry made sure to have a clear understanding of ground realities, for which meetings were convened twice a day and exhaustive daily bulletins with all relevant information were published on the ministry’s website.
As the COVID-19 cases increased, a lockdown was inevitable. Patronage of public transport had dwindled, and businesses that risked virus transmission like cinema halls shut down voluntarily. Educational institutions were closed; examinations were postponed, while large social and religious gatherings were curtailed. Care was afforded in providing students of Anganwadis with their mid-day meals at home, while special nutrition kits were provided to students through their schools. Essential rations were also distributed in the form of kits to all sections of society, including the guest workers, to prevent panic buying and support those who could not travel to earn their daily wages due to the lockdown. Local Self Governments were tasked with running Community Kitchens that would provide freshly cooked food to those who couldn’t afford a meal and those who couldn’t cook due to their quarantine isolation. Helplines were open round the clock and emergency services performed above and beyond the call of duty.
On the economic front, Kerala was still on the road to recovery from the twin floods of 2018 and 2019 when the pandemic struck, which was a big punch in the gut. To overcome this, the LDF Government announced a `20,000-crore economic support package on March 19, 2020 to revive the fortunes of the different industries in the state. “The pandemic has destabilised our public life and business community,” said Chief Minister Pinarayi Vijayan before revealing the details of the package which covered the health sector, loan assistance, welfare pensions, rural employment, subsidised meals, clearance of arrears, and tax waivers.
An amount of 2,000 crore in soft loans were provided through the Kudumbashree Mission to the families that ran businesses under it. Mahatma Gandhi National Rural Employment Guarantee Scheme (MNREGS) was also allotted a similar amount for disbursal, with a thrust to creation of livelihood assets in poultry, dairy, animal husbandry and aquaculture under the Subhiksha Keralam initiative to improve food security and sustainable livelihood. A one-time financial dole was provided to workers in the different unorganised sectors from their respective Welfare Fund Boards. In addition to the Community Kitchens, hotels that provided meals at subsidised rates were also set up for those willing to pay.
Communication is the Key
A key step that the state government took was to open up outreach programmes and maintain transparency to tackle mass hysteria that comes with a pandemic of this magnitude. Through regular press conferences held by the Chief Minister and the Health Minister, the government was able to create a window of transparency and trust. Apart from providing details like the daily COVID-19 statistics, availability of hospital beds, and helpline numbers, instructions for COVID appropriate behaviour, suggestions to reduce lockdown induced stress and a few nudges to adopt progressive social practices were also delivered. As part of this, the state government set up the ‘GoK-Direct’, an app that sends real-time updates and announcements issued by it to subscribers in various languages such as Tamil, Kannada, Bengali and Hindi apart from Malayalam and English. This was to ensure that the large population of guest workers from other states could be kept well informed about the government’s measures for their welfare during the lockdown.
Break the Chain
A campaign that called for maintaining physical distancing to break the spread of the novel coronavirus turned out to be a massive success. Makeshift taps with hand wash or soap were set up outside all the government offices, hand sanitizers and hand washes were mandatorily placed outside places that were frequented by people. The civil society too took it upon themselves to Break the Chain of transmission by being proactive. Celebrities and influencers were roped in to spread the word. Social media platforms were used extensively to communicate in simple yet effective means through videos and trolls. Regular hand washing and masks became a part of everyday life.
While many asked if Kerala was overdoing with its responses, the ‘Kerala Model’ as it was hailed, was slowly putting the little state on the world map. By May 2020, there was a steep decline of new cases even as a nation-wide lockdown was announced on March 24 for 21-days initially. The lockdown that was extended in phases till the end of May 2020 was relaxed in phases beginning June 2020.
Unlock protocols were issued by the Central Government from June 2020 onwards, and this led to a gradual uptick in the number of cases. Even as the cases peaked across the country during the month of September 2020, Kerala managed to ‘delay the wave’. However, lockdown fatigue had set in by then among the public, who had been scrupulously following the instructions from the government till then and were itching to get about their normal lives. Onam was round the corner in August, and people flocked the markets and in the process let their guards down. The months of July, August and September saw a lot of protest programmes, some of which had a huge public participation in odds to COVID protocols. Sure enough there was a sharp surge in cases from the middle of August through to the peak in mid-October.
There were fears that the elections to the Local Self Governing bodies in the state scheduled for December might lead to a spike in cases, but that fear didn’t materialise. However, the peak never reduced during this period as it plateaued on account of stagnation in testing from October through January 2021. Moreover, compliance to COVID protocols from the public waned as they realised that they might have to ‘live with the virus’ for a foreseeable future.
Increased testing in February helped bring the plateau down until the end of March, even as the different political fronts were gearing up for the State Assembly elections on April 6, 2021. The final days saw lax implementation of COVID protocols, as large crowds gathered for political rallies, meetings and road shows. The messaging that had helped the state tide over the first wave was lost in the cacophony, as cases began rising sharply during this period to see new records being broken each day. Mortality also increased as the hospitals were oversaturated and almost reached breaking point. As this article is being written a lockdown has been implemented from May 8, 2021 to help the overwhelmed hospitals tide over this wave.
Testing has increased during the second wave but that alone may not be adequate at this point to really crush it. The vaccination drive which began in mid-January has failed to pick up due to vaccine shortages across the country. However, despite this, Kerala has done exceptionally well to vaccinate 21.08% of its population with at least one dose and 6% with both the doses with close to zero wastage. It has won praise for vaccinating more people than the number of doses that were provided. This unique achievement is a result of its highly skilled healthcare staff, and its previous investments in healthcare. With vaccination opening up for all adults, the state has promised to provide it for free to all availing it from the government’s health centres.
The way ahead
The re-elected LDF government with a refreshed cabinet has its task cut out in bringing the state from the pandemic and jump starting a flailing economy. It needs to carry forward the momentum with its vaccination drive to get the majority of the population vaccinated and protected from a third wave that has been predicted by experts for later this year. Another strategic intervention the government needs to make is in making mental healthcare more affordable to large sections of a population that has been reined in by the strains of the lockdown and its consequences like joblessness and the pressures of Work from Home. Students have been sorely missing the platform afforded by schools to bring out their creative side and vent out their frustrations. They too will be looking ahead to a brighter future, just like the massively overworked healthcare workers, from the ASHA workers on the ground to the nurses and doctors at the different healthcare centres. Businesses are looking for a stability that will allow them to innovate, create more value to their products while creating more jobs for the seekers. The future will be bright, if the government that has been refreshed manages to take the state ahead with a lot of creative and farsighted thoughts and actions.
By Deepthi Sreenivasan