With low mortality and high recovery rates, there has been a ‘Kerala model’ in pandemic control too. But post-opening up, the coronavirus again stalks the coastal state. State health minister K.K. Shailaja—aka ‘Shailaja Teacher’—explains how they’re refocusing their strategy. Excepts from an interview with Preetha Nair
Kerala’s Covid curve is rising again....
We were expecting the rise after the influx of expats and those from other states—till now, 1,87,619 people have reached the state from outside. The majority of new cases are among them—total confirmed cases have crossed 2,096 now. We are not worried…the situation is not out of control yet. We have surveillance at airports, sea ports and state borders. But with lakhs coming in, institutional quarantine is difficult. People who come by road or air can go for 14-day home quarantine if they don’t have any symptoms. Only symptomatic patients are shifted to hospitals.
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What about Kerala’s famed contact tracing?
Though it’s an arduous task now, we are still following the method of contact tracing, quarantining, testing, isolation and treatment. Our motto is to flatten the curve and reduce mortality. We have strict panchayat-level monitoring in place to oversee people in quarantine. If we can control contacts, we can bring down the numbers too. People are following principles of home quarantine. But with lockdown relaxations, people have to behave more responsibly now…they sometimes behave as if they got freedom! We are running awareness campaigns on physical distancing. I read that police are filing charges against at least 500 people on a daily basis for not wearing masks.
Four deaths in May first week, now 17…still comparatively very low. How did you manage?
Most of those who died had come from outside; they were already in bad condition when they reached. One leukaemia patient, back from the Gulf, died before he was given treatment. Our fatality rate is low mainly because we took special care of the elderly, adopting reverse quarantine to protect them. We had a strong screening system at the airport since January; positive cases were immediately transferred to hospitals, non-positive cases put under strict home quarantine—ambulances were sent if they developed symptoms. The health department was in constant touch with patients and their contacts were meticulously traced and isolated. Every corona-designated hospital has a medical board of experts. Every patient was given extra care and attention, that’s how we brought them back to life—we could save even a 93-year-old patient with a heart condition and his 88-year-old wife. I would give credit to the exemplary dedication of thousands of frontline health workers, besides the police. Such care was possible because we stopped the spread from the beginning…it was a challenge! We may not have been able to give individual attention if 10,000 patients turned up at once.
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Is there a threat of community transmission?
I can say community transmission hasn’t happened so far. Out of the total cases so far, only 10-11 per cent got it via contacts. The rest is all imported cases. We don’t know whether community spread will happen now, post-opening up. Till now, most of the sources of infection have been traced. In three or four cases where the immediate source is untraced, we have identified distant source points.
Is Kerala testing enough?
We have adopted strategic testing. Instead of calculating testing rates only per million population (TPM), we should view it against cases per million (CPM)…relative to the size of the outbreak. When we calculate that way, we are much ahead of many other states. We are testing 67 times more than our caseload, Maharashtra only 25 times. Our daily testing has gone up to around 3,200 samples. Other than RT-PCR tests, we also conduct sentinel surveillance. We have conducted 20,000 rapid antibody tests and detected only 25 positive cases; all had a history of contacts.
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Are you prepared for a surge, the predicted ‘peak’ in July-August?
We are facing difficulties—people have been entering from hotspots, so the curve we flattened in April is rising again—but we are confident we will manage. The positive cases may go up to 25,000…we are trying our level best not to reach that. We are getting prepared with more hospital beds and Covid care centres. We have adopted strict quarantine measures to break the chain. Now, patients with mild symptoms are being sent to Covid first line treatment centres, since we don’t want to overwhelm the system. We have 56 Covid first line centres now. It will be difficult to handle if we face a situation like Maharashtra. Right now, we are in a good space.
What are the lessons you learnt in disease management?
Preparedness and pre-planning is the key. We need to fully understand the strength of the enemy and mobilise our forces on a war footing. We devised protocols and SoPs...for instance, hospitals are not to fill their beds to capacity. If a hospital has 500 beds, and they get 500 patients, they should transfer half the patients to the next Covid hospital. Half the beds should always be set aside for critical cases. Since January, we have had Plan A, B and C in place. Plan C is preparing for the worst. In case of a huge surge, we have plans to convert private hospitals, institutions and hotels into Covid-19 hospitals. We have estimated the number of beds and discussed it with stakeholders.
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What can India do better to contain the contagion?
Every state is doing their best. I would say India should invest more on health. Kerala’s strength lies in the strong foundation of the public health system, laid in 1957. In the last four years, our focus has been on transforming primary health centres (PHCs) into family health centres. Our taluk hospitals have been bought advanced machines, high-tech buildings are under construction in district hospitals. Our medical colleges have been upgraded with the latest machines, multi-specialty blocks and ICUs. This helped a lot during the corona crisis...we could keep 500-1,000 beds only for corona patients. Even in district hospitals, we can afford to set aside 200-350 beds for a corona ward. Simultaneously, non-corona patients are also getting treatment in the same hospital.
Is Kerala easier to manage, being a small state?
It’s not scientific to say Kerala has a low mortality rate because of its size. With a population of 34 million and density of 860/sq km, the proneness to a spread is in fact way more, so it’s more challenging. Kerala reported its first case on January 30. New York, with an 8 million population, reported its first case in March. Now New York’s toll has crossed 20,000.
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Are you on course to address monsoon-related diseases?
We are extra vigilant and have already taken steps to tackle dengue, malaria, viral fever etc. Local self-governments have been entrusted with the responsibility and we are conducting special video conferences with village medical officers in this regard. There are special officers in each district for surveillance on communicable and non-communicable diseases. Steps are also being taken for effective waste management and mosquito control across the state. In the last two years, we have brought down infection-related fatalities with effective intervention and campaigns.
A shorter, edited version of this appears in print