COVID-19: Why home quarantine may work in Kerala, not in other states

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While the current COVID-19 cases are mild, waning vaccine immunity and new variants necessitate monitoring and preventive measures.

In the fight against COVID-19, Kerala has opted to home quarantine or room quarantine those returning from other countries and states. Institutional quarantine is offered on a free-of-cost and paid basis to those returnees who do not have facilities like separate bedroom with attached toilet in their home or for those with vulnerable population like elderly with comorbidities at home. The arguments put forward by the state are that returnees will not jump quarantine, as they would not like to expose their family members to the potential risk of contracting COVID-19, and would be happier in their home environment rather than in an institutional facility. Information from the government of Kerala dashboard shows that on June 27, 2020, there 1,65,515 persons under home quarantine out of which Malappuram (26,639), Kannur (19,658), Thiruvananthapuram (19,064) and Thrissur (17,700) districts had the largest numbers.

Using data from National Sample Survey (NSS) 76th Round on Drinking Water, Sanitation, Hygiene and Housing Condition in India 2018, this note examines housing condition in Kerala and its suitability for home quarantine, looking at information on household size, average number of living rooms, condition of structure, type of dwelling, type of structure, ventilation, exclusive access of household to drinking water, treatment of drinking water, households access to latrine and bathroom within premises and availability of water and soap in latrine. In fact, the US National Bureau of Economic Research has developed an index — Home Environments for Protection (HEP) to gauge household protection against COVID-19.

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In Kerala, the average household size was 3.8 persons when compared to 4.3 at the all-India level. For a person under home quarantine in the state, this number should not pose a problem if the number of rooms are sufficient to accommodate the returnee’s requirement for a separate room (Table 1). The average number of living rooms (rooms used as bedroom, sitting room, prayer room, dining room, servant’s room) in the state was 3.81 and there was hardly any rural-urban differential. Thus if 3.8 persons live in the household, it should be possible for the returnee to get a room to herself/himself for quarantine purpose.

In Kerala, 93.8% of households lived in independent houses, 88.4% in pucca houses and the condition of structure was good in 74.1% of households. The share of those living in independent houses was nearly 7 percentage points higher in rural (97.2%) than urban (90.3%) areas. The share of households living in pucca households was higher in urban (92%) than rural (85%) areas of the state. A larger share of houses in good condition were in urban than rural areas. More than four fifths (84.5%) of houses were well ventilated. While these conditions can ensure physical distancing norms during home quarantine, it is also important to look at access to water and toilets.

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The availability of water in the house for the exclusive use of the household is important for a person under home quarantine. In the case of 82.5% of households, the primary source of drinking water was for their exclusive use in Kerala when compared to 51.7% in India. Only 2.7% of households in the state had to use public taps to source drinking water. Dependence on well water remains high in Kerala, with 71% of households reporting it as their primary source of drinking water. Nearly 86% of households in Kerala and 7.7% in India boiled drinking water before consumption indicating good hygiene practices in the state. Majority of households in Kerala (95.6%) had latrines and bathrooms within premises for their exclusive use with hardly any rural-urban differential.

The report does not provide information on the number of bathrooms in the house or the number of bedrooms with attached bathrooms. Most of the households in Kerala, both rural and urban had water and soap in the latrine (87.8%) when compared to 76.6% in India. Hand wash with soap is one of the COVID-19 prevention strategies. Information from NSS demonstrates the suitability of home (room) quarantine for returnees, as the condition of houses in Kerala met the requirements of government guidelines. Although the availability of a house with provision for room quarantine of returnees to Kerala is one pre-condition for home quarantine, what makes this approach workable is the attention to decentralised governance in Kerala.

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To handle the surveillance of returnees, besides the use of technology, the state government has implemented a coordinated response with different departments and Local Self Government Institutions (LSGI), which include ruling and opposition parties. A ward level team, which includes members from health, LSGIs, police, revenue and animal husbandry departments are involved in surveillance. Data from National Family Health Survey (NFHS) 4, 2015-16 shows that 97.5% of households in Kerala owned a mobile phone. Returnees must have access to a mobile phone, which they would have had in order to register on the Kerala government website for an e pass. So, they can call helpline numbers in case of emergencies and the health team can also periodically contact them and arrange for testing in case the returnee has symptoms.

In addition to physical health, the state has tried to address mental health issues among returnees due to quarantine, with a psychosocial support team who have handled calls to 5,17,723 persons in quarantine as on June 27, 2020. The processes that a returnee goes through after entering Kerala has been described by Sajan Gopalan. Apart from the availability of home/room quarantine option and effective surveillance, another indispensable factor in managing this is cooperation from the returnee, family members and neighbourhood. It is due to these factors that spread of COVID-19 through contact is relatively low in the state. However, there is a need for free-of-cost institutional quarantine for those returnees who do not have access to decent housing. In addition, the state has to think of mechanisms to safely dispose of garbage generated by those under home quarantine.

(Dr Gayathri Balagopal is an independent researcher based in Chennai. She works on social protection and health)