The new coronavirus outbreak has claimed nearly 1,00,000 lives worldwide, most of them in advanced economies. The deadly virus has exposed the chinks in the public health systems of powerful nations such as the United States. Some of the poorer countries such as Cuba managed to hog the limelight because of the robustness of their public healthcare infrastructure. India is fighting the disease by proven methods such as social distancing and is currently under a 21-day lockdown.
The Covid-19 outbreak has brought the focus on the Kerala Model of economic development. The southern state of Kerala been scoring consistently high in human development indices despite its low GDP per capita. The tiny state was in the forefront of the country’s fight against coronavirus. Since the first case of the disease was detected in the state on January 29, the state has seen only two deaths due to the disease. Between March 9 and 20, the state had a recovery rate of 84%. The state seems to have flattened the Covid-19 curve with a fall in the number of confirmed infections.
Kerala is not a rich state by any stretch of the imagination – it doesn’t have a flourishing industry, successful agriculture or abundance of minerals. Many states fare better in terms of people to doctor ratio, number of hospital beds and the count of medical institutions. Still Kerala did well in countering the global pandemic. Many ‘experts’ make sweeping references to its high literacy rate and the leadership, while some others emphasise on healthcare facilities, experienced nursing staff, and the state’s experience in handling the Nipah virus. All these may have contributed, but there is more to the state’s ability to counter health emergencies than all these.
At the core of Kerala’s success in its fight against Covid-19 is the decentralisation of power and the efficient functioning of local bodies in the state. The fight against coronavirus pandemic would not have been successful despite a resourceful government, good leadership, and sufficient medical facilities, had the state failed to reach out to the people. Primary health centres, sub-centres, taluk hospitals, district and referral hospitals have to work in tandem to control pandemics. In normal conditions, these hospitals treat patients with symptoms or direct them to referral hospitals. In the case of a pandemic like Covid-19, such treatment systems are not sufficient and require the support of different agencies.
The state successfully enlisted the help of health inspectors, junior health inspectors, ASHA workers, and anganwadi staff who reach out to people even in remote locations. They are the first line of defence in the fight against any contagious disease. They observe the developments in their localities, gather information from households and report to the higher authorities. This chain ensures that information reaches the decision-makers at the highest level.
What happened in the case of Covid-19 outbreak is the involvement of local bodies and elected members to panchayats, municipalities and corporations. They supported the health workers by interacting with the patients and their families, creating awareness among communities against mass gatherings. With their help, the state government under chief minister Pinarayi Vijayan managed to make the fight against the virus a social movement.
Participation of law-enforcement agencies also plays a significant role in the state government’s efforts. The infection invites social stigma, panic and trauma and this could lead to violence. It may also bring the social faultlines to the fore and lead to hate and violence against certain communities. Intelligence gathering, vigilance and involvement of police can create a conducive environment for the health workers and other social activists to engage with people.
Kerala’s efficient tracking system succeeded in containing the second stage of coronavirus infections. The state government managed to create this system with the help of health workers, local authorities, and the state police. The action starts at airports, railway stations and major transit points by testing temperature, identifying possible patients and advising them to undergo quarantine. The work does not end here. The information collected is passed on to the state government and local bodies simultaneously, ensuring the involvement of local authorities even before the possible patient lands up at his destination. The local level health workers help in arranging quarantine facilities and advise the patient’s family members on the procedure they should follow.
Living in isolation and continuing lockdown can create discontent among people. Instead of going for a sudden lockdown, the Kerala government assessed the condition prevailing in the state and prepared well before the declaration. Most importantly, it made arrangements to ensure food supplies for all residents including migrant labour. It ensured steady supply of essentials through PDS outlets and started community kitchens by Kudumbashree self-help groups of women to provide food for people who need support.
Starting early also helped the state in its fight against Coronavirus. The state government machinery cranked up into action even before the three students returning from Wuhan were tested positive. The state started preparations to deal with a possible spread of the virus. The experience in handling the Nipah virus helped the health ministry assess the possible scale of the pandemic. The first wave started with the three cases from Wuhan, but when the second wave started in mid-March with people returning from infected nations in Europe and West Asia, the state was battle ready. The number of cases increased, and the situation was accentuated by the irresponsible behaviour of some infected people.
A large part of the credit in controlling the situation goes to the top leadership of the state government. The chief minister and the health minister opted for a transparent operation to tackle the outbreak with effective crisis communication. The frontline health workers, police force and elected representatives at different levels play a stellar role in executing a well laid-out plan to curb the spread of the deadly virus. All these factors have made the fight against the new coronavirus a popular movement.
There could be another wave of infections when the lockout is lifted and people from different parts of the world come back to the state. A committee constituted by the government has already come out with a plan to lift the lockdown in a phased manner. It’s too early to predict the impact of the outbreak when it peaks in the state and the country, but Kerala is offering an efficient, low-cost way to fight the deadly disease that other states can emulate.
(Dr P Ravindranathan teaches at the department of geopolitics and international relations of Manipal Academy of Higher Education.)