Though an early covid-19 hotspot, parts of Kerala are now out of a full lockdown. How did the state do it?
The fight is still on. The state is already preparing for a possible second wave. Scores of overseas workers are likely to return from hotspots in the Gulf once travel restrictions ease
One morning in March, a woman in Kerala’s Kasaragod district suddenly developed a fever, along with fits of coughing. Her husband had recently returned from a Gulf country, but he had been quickly isolated after being detected with the novel coronavirus. The couple claimed they had not even had a chance to meet each other as they were both in quarantine. So, how did she get the disease?
Public health investigators in the district began to get nervous. If the woman had acquired the infection from someone else other than her husband, it could indicate community transmission. And that would be a nightmare, especially because Kasargod has the weakest public health network in the state.
What happened subsequently offers an instructive glimpse into how Kerala mounted a fightback against the virus—by paying attention to the minutest of details.
A list of people the woman had come in contact with over the previous week was drawn up, but the source of her infection remained a puzzle for the district’s team of six virus detectives, who were led by a doctor. Finally, they passed on the case details to 20-odd neighbourhood-level health workers who got in touch with the woman’s relatives. In the detailed interviews which followed, it came to light that she had been talking to everybody about some new saris. “We deduced that the husband, as is the local tradition with gulf returnees, may have brought back some gifts," said one of the virus detectives, requesting anonymity.
By following the hints hidden in those conversations, they discovered that the husband had passed on a suitcase to his wife before going into quarantine. Along with that suitcase, the detectives concluded, he may have shared the coronavirus too.
The fact that some Kasaragod district officials could figure out the mystery behind this one case may be the result of several factors—some of which exist perhaps only in Kerala. It gives a peek into what academics call the “Kerala Model" of governance.
When the coronavirus threat began to trail every single individual, so did Kerala’s society and government. After becoming India’s first hotspot in early-March, Kerala launched a large-scale medical manhunt, akin to the Kasargod case, in order to trace, test and isolate infected people. More than 100,000 people were traced and placed under quarantine by 26 March, a day before the nationwide lockdown. Kasargod, the most-affected district, has been testing more than 200 samples each day over the past month.
While the rest of India worries about the rate at which new cases are doubling, that question has become almost irrelevant in Kerala. Active cases are plummeting, not doubling. And only two patients have succumbed to covid-19 so far.
On 13 April, the state crossed a significant barrier: the share of fully recovered patients exceeded the number of active covid-19 cases. In a clear sign of victory, seven districts, or half of Kerala, exited the lockdown partially on Monday. The mood has clearly shifted, with the police having a hard time enforcing social distancing. Evidently, the fight is still on. The state is already preparing for a possible second wave. Scores of overseas workers are also likely to return from hotspots in the Gulf once international travel restrictions ease.
For now, however, Kerala’s template offers three important pointers for the rest of India: the value of diverting significant state resources every year towards building public health infrastructure, trusting village-level bodies with autonomy and funds, and promoting shared values that encourage social cooperation.
“Health and education have always been a priority in state budgets, irrespective of the governments," said K.P. Kannan, a development economist and former director of the Centre for Development Studies. “Kerala’s performance is the result of a long-term process of strengthening the public healthcare system, in which people’s planning and Panchayati Raj institutions have achieved an important role at the grassroots-level," added Kannan.
Fear and panic
Around the same time that the Kasargod woman began displaying early signs of the infection, what happened in another part of Kerala reflects the societal response and the role of non-state actors.
A large group of people had gathered with thick wooden logs in their hands in Kumarakom, a tourist hub surrounded by scenic backwaters and paddy fields. It had been only hours since local television channels had reported that a three-member family who had returned from Italy were found to be covid-19 positive in the neighbouring Pathanamthitta district.
Kottayam resident Robin, and his wife Reena, had gone to the airport to receive the family, and now, the neighbours had begun to make a ruckus about the threat posed by the duo. Plans were being made to attack one of their shops in the neighbourhood.
Former Kottayam MLA and the ruling Communist Party of India (Marxist) district secretary V.N. Vasavan had watched the same news report which had resulted in a mob outside Robin’s home. Like most politicians in Kerala, Vasavan was part of a number of public groups and associations. He immediately called the local panchayat president, got Robin’s contact details and dialled him.
“Robin, I saw the news. Don’t be afraid. This is not a deadly disease. Many have recovered. We are all with you for any help you need," Vasavan recalled telling Robin. “Brother, everybody who has called so far has only scolded me," responded Robin, who happens to be a former worker of Vasavan’s political nemesis, the Congress party. Robin said he then broke down inside his washroom where he was holed up.
It happened to be a Sunday. Many of the major public officials were not in town. The district collector P.K. Sudheer Babu was in Kannur. But the public health office moved quickly. Vasavan himself took an ambulance from the district hospital, in which he is a board member, and sped towards Robin’s house.
The house was in a densely populated corner of the village, surrounded by poor as well as middle-class families. Vasavan is a popular local leader, but he said: “Nobody came to the street. When we reached the house, the neighbours were peeping through the windows. I realized everybody was gripped with fear."
Vasavan and others held a meeting at the Kumarakom panchayat office, bringing in a small fraction of the people who were gripped with fear. He started the meeting by recalling a catchy line from a play called Aswamedham that is etched in the public imagination: “Is having a disease a crime?"
He then added: “Couldn’t this happen to any of us? If you attack their shops, it will be global news (sic) and bring shame to all Malayalees. Do we really want this?" The public meeting brought the crowd under control. But the district needed more than that. Roughly 600 residents were required to stick to measures aimed at containing the virus. Many of them weren’t cooperating at first. They asked how they would survive without stepping out of their homes.
“In the next one hour, we got groceries and vegetables delivered to their doorsteps and they got their answers. In the following weeks, 500 books were arranged for them to read," Vasavan said. “Social media groups were started with art competitions and yoga classes. Once their basic needs were met, they stayed inside their homes," he added.
To be sure, Vasavan is only representative of a broader political culture that cuts across party lines. “A politician in Kerala is rooted in a number of public groups and associations. He cannot unplug. He has to be seen as discharging his public duties," Kannan said.
Meanwhile, the scene inside the hospital in the neighbouring district had become edgy. Handling Reena’s grandparents, the 93-year-old Thomas and 86-year-old Mariyamma (two of the three who had returned from Italy and tested positive), was a real challenge and they were transferred to the Kottayam medical college from Pathanamthitta for better care. Thomas suffered a heart attack, but his life was saved as doctors from the cardiac, nephrology and urology departments were pulled together as a team.
Even after he was out of danger, the job was gruelling, said a nurse, requesting anonymity. The 93-year-old Thomas was resolute about his morning routine. For instance, he told the nurse treating him that he wants to start his day with a glass of milk “procured from a local dairy farm".
The nurses emptied milk from a retail packet on to a dairy farm’s bottle every day and served Thomas. They also allowed the duo to be unencumbered by face masks while talking, as it made them uncomfortable—even though it placed additional safety requirements on the health staff.
At the end of Thomas’ hospital stay, following his recovery on 23 March, he was too emotional to talk to reporters. He said he was treated by the nurses as family. By then, a nurse who had treated the elderly duo, Reshma Mohandas, was infected. While Thomas became one of the oldest people in the world to have recovered from covid-19, Mohandas became the first health worker in Kerala to be infected.
The news could have set off ripples of shock and despair among the state’s health worker community. But Mohandas posted a personal note to colleagues on WhatsApp, brimming with confidence and urging other health workers to not let the guard down, which went viral. “I will leave this room within a week after defeating you (the coronavirus)," she vowed in that note.
And she did. By 3 April, she tested covid-19 negative and was sent back home for 14 days of self-quarantine. “I’ll be back soon," she told reporters while leaving the hospital.
Attention beyond health
Before the pandemic, the health department in Kerala had already received much acclaim for its successful handling of the Nipah virus, another vaccine-less, deadly virus.
But over the past few weeks, the concerns were not just confined to the realm of public health. The health success story could not have been scripted without working on livelihood protection in parallel. The state government had announced India’s biggest regional stimulus (of ₹20,000 crore) two days before the lockdown.
The state also ran community kitchens which fed lakhs of isolated people every day. Chief minister Pinarayi Vijayan formed a volunteer force to run the kitchens and it grew to more than 250,000 people in a week.
The planning also took into account the people who otherwise face tragic hardships: domestic migrants, who set off on foot along highways in many other states. They were offered free food and shelter. If they didn’t like the food, they were offered dry rations instead. The state as well as voluntary organizations arranged call centres in at least five languages commonly spoken by migrants.
Vishnu Narendran, a Sussex university graduate who ran one of those call centres for distressed migrants, said that at its peak, he was getting 40-45 calls every day. One such call came during the break in a prime-time television debate on migrant issues on 29 March. Since he was a panellist on the show, Vishnu said he was in a meeting. “‘By the time your meeting is over, I’d have died’ said the caller," Vishnu recounted.
“I became all emotional. When the debate resumed, the anchor asked some questions and I broke down saying there are people still starving in the streets," he said. The panel had in attendance the finance minister Thomas Isaac and former labour minister Shibu Baby John. Vishnu quickly connected the caller to a community kitchen.
“The sensitivity of people in the top of the governance chain in Kerala is way ahead of other states," said Benoy Peter, an expert on internal migration and executive director of the Centre for Migration and Inclusive Development. “Initially, it was a shock for the migrants in Kerala, like anywhere else in India. Now, they have accepted that the state is serious about them."