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Coronavirus State Report

Kerala’s COVID-19 Journey: From Being One Of the Worst-Hit To Becoming One Of The Best Performing States

Kerala Health Minister KK Shailaja has received praise and honour from the United Nations for her management of the COVID-19 crisis in the state

Kerala’s COVID-19 Journey: From Being One Of the Worst-Hit To Becoming One Of The Best Performing States
  • First positive cases of coronavirus in India was were reported from Kerala
  • Currently, the states’ recovery rate is 53% and the mortality rate is 0.51%
  • India’s recovery rate is 57.4% and the mortality rate is 3.15%

New Delhi: June 23 is observed as United Nations’ Public Service Day, and this year, amid a full-blown global pandemic the organisation honoured the Health Minister of Kerala, KK Shailaja, for her achievement in the state’s fight against COVID-19. Ms Shailaja was the lone speaker from the country at the webinar streamed on UN Web TV, to talk about the strategies adopted by the Kerala in managing COVID-19. According to her, the focus, since the beginning of the outbreak, was set on minimising the spread and mortality by adopting the WHO recommended strategy – “Trace, Quarantine, Test, Isolate and Treat”.

Also Read: Coronavirus Explainer: 15 COVID-19 Related Terms And What These Mean

At the UN webinar, the health minister received international recognition for her stewardship of the state’s response to the pandemic that has seen Kerala effectively flatten the curve during the first phase of the outbreak. The panel also praised the health infrastructure of the state, with which the government was able to control the situation.

This wasn’t the first time that Ms Shailaja has received praise for her COVID-19 response as various international media outlet Guardian, BBC named her as the ‘coronavirus slayer’ and many international experts like the WHO Director-General Dr Tedros Adhanom Ghebreyesus have lauded her successful planning ahead of the first case ever reported in the nation.

A government official in Kerala’s health department told NDTV that the government had made the preparations to deal with the outbreak, if at all, well in advance. He explained,

We set up the primary control room to monitor the COVID-19 in mid-January, with instructions given to medical officers in all of 14 districts to do the same. By the time, the first case arrived, we had already implemented the pandemic protocols issued by the World Health Organisation – long before the Indian Council of Medical Research recommended them.

Furthermore, medical teams were dispatched to all airports and all passengers had their temperatures checked. Those found to be running temperatures were immediately isolated and moved to dedicated isolation wards with separate entry and exit routes at nearby hospitals. Educational institutions and entertainment centres were immediately closed, and large gatherings banned. Religious leaders were also taken into confidence and informed of the gravity of the threat, all of this was done before there were any cases reported IN the country.

Also Read: Increase Rapid Antigen Testing, Upload Result Data On Central portal: ICMR To States, Union Territories

The first positive cases of coronavirus in India were reported from Kerala when three students travelled to the state from the Wuhan province of China, which is where the initial cases of the outbreak were first reported. The students were from Thrissur, Alappuzha and Kasargod districts of Kerala and following the detection of positive cases, the government of Kerala declared issued a ‘state calamity warning’. Over 3000 contacts of the affected individuals were placed under quarantine, out of which 45 were placed in hospital quarantine.

The three positive individuals later recovered from the infection following hospital care. The ‘state calamity’ warning was withdrawn after 4 days, when no further cases were reported. A government official from Kerala health department explained to NDTV,

China was a popular country for students from Kerala to pursue medicine. Several students who got stranded in China due to the lockdown were evacuated and flown into Cochin International Airport. They were quarantined at isolation wards in Kochi Medical College and none of them were tested positive for the COVID-19.

By March 15, Kerala and Maharashtra had the maximum number of COVID-19 cases out of the total 115 cases reported in India. While Kerala had 22 cases, Maharashtra had confirmed 34 cases of the novel coronavirus by March 15.

However, three months down the line in June, while Maharashtra is struggling to control the virus with close to 2 lakh cases, Kerala is not even in the top ten worst-hit states of the country. It is the early and immediate response by the state that has received praise and recognition for Ms Shailaja.

Ms Shailaja told NDTV in April,

What Kerala did differently at an early stage and which proved to be beneficial for the state is that we followed a strict quarantine rule of 28-days instead of 14-days for the high-risk cases. When the symptoms of the infection in the patients started doubling up that’s when we started sending them to hospitals and took swab testing for COVID-19 infection instead of sending them all together, as then the chances of spreading the virus would have been more.

Also Read: 99 Doctors Died Due To COVID-19, Top Medical Body Issues “Red Alert” Asking Doctors To Raise Their Guard

By May, while nearly one lakh people in the state were quarantined, the state government deployed 26,000 Accredited Social Health Activists (ASHA workers), police, health inspectors, among other health officials to visit each and every quarantined person. These workers were being regarded as foot-soldiers, who would go to each house, to follow up on people’s symptoms and condition, and further carry out any contact tracing that is needed.

Contact tracing in Kerala was then and is still being done both physically – visiting people under quarantine and also through phone calls, ensuring regular updates. One of the Kerala residents who was in home quarantine Arvind Soju, in a video he shared in May, lauded the efforts by the foot soldiers as he shared his experience,

I’ve been in institutional quarantine ever since I got back from Chennai, and now I’m in strict home quarantine. My day starts with a call from ASHA workers enquiring about my health and asking me if I need any kind of support. I think at these times, such calls give immense confidence and a feeling that we don’t have to worry about anything.

Furthermore, amid the nationwide lockdown, the state decided to take other positive steps such as feeding the most vulnerable group so that no one stays hungry. According to the government, the state has been home delivering free mid-day meals to the beneficiaries as the Anganwadi centres, schools and colleges across the state have been shut since March-end.

Around 33,115 Anganwadi centres in Kerala, are delivering free mid-day meals to around 3.75 lakh children at their homes.

Also Read: 6 Months On, A Recap Of How the Coronavirus Pandemic Unfolded

The state government is also providing nutritional services to around 4.75 lakh children under 3 years of age and around 3 lakh pregnant women, reaching nearly 13 lakh people at home.

On May 21, a mass handwashing campaign called “Break The Chain” was launched by the Kerala Health Minister to sensitise the people about the importance of public and personal hygiene. As part of the campaign, cartoons characters were used to convey important social messages like wash hands regularly using soap or sanitiser, wear masks and continue to keep social distancing. The cartoons were painted by well-known cartoonists of the state on the walls across the state.

Back then Ms. Shailaja had stressed the importance of personal hygiene to be able to prevent the COVID-19 from infecting self as well as the community. She had also appealed all to promote ‘break the chain’ campaign as a safety measure.

We are able to minimise the spread of the deadly virus with early surveillance and people’s support. Now we need to follow personal hygiene as a healthy habit and wash our hands and face whenever we are in public contact. By doing it, we will be able to break the chain of virus infection. We have introduced the campaign in five cities and the main aim is to spread the awareness of these new-normal habits in one’s life with the help of this campaign, she had stated while launching the campaign.

With these initiatives and headstrong approach to the handling of the virus, Kerala was able to flatten the curve, which essentially meant the state observed slow down in the spread of the pandemic.

Also Read: Precautions To Take Till Airborne Transmission Of COVID-19 Is Further Researched And WHO Assesses The ‘Emerging Evidence’

Kerala’s model on fighting the COVID-19 were lauded by Indian Council for Medical Research which said it would “continue referring to the Kerala model” for testing and containment strategies. Government data shows that COVID-19 cases in Kerala’s was always under control and well below the rate of infection level of 1.

With nearly of 7.5 lakh cases in India(as on July 8), the doubling rate of the country at present stands at 20.1 days, while Kerala’s doubling rate, with nearly 5,000 cases, is 18 days, as per the Health Ministry data. Doubling rate is defined as the number of days it takes for the count of cases to double. Dr Praveen Danee, a senior Doctor working with COVID Hospitals in Madhya Pradesh explains,

When you compare Kerala’s doubling rate with India it is exceptionally good, because remember Kerala is doubling in 18 days with its 4,000 something cases while India is doubling its 7.5 lakh cases in 20 days. This is a huge difference. Kerala is doing exceptionally with it’s control of the virus and we can tell that just by comparing the doubling rate with the national average.

While in May, the situation in the state seemed under control, as the lockdown eased, the Kerala saw over 70,000 people returning from various parts of the world, which led to a sudden spike in the number of cases, as per the state government.

At present, the COVID-19 cases in the state continues to spike, with authorities concerned that the situation could be moving towards community transmission. Of the 488 fresh cases reported in the state on July 11, nearly 50 per cent (234) people contracted the infection through primary or secondary contacts, while the sources of infection of 20 people remain unknown, as per the government data.

Also Read: Coronavirus Outbreak Explained: What Is Antibody Test And What Role Does It Play In The Fight Against COVID-19?

The state government has come out with special strategies and action plans for districts like Thiruvananthapuram, Alappuzha, Malappuram, Ernakulam, Kasaragod, Kollam and Wayanad, where the spread of infection is concerning.

The Government has imposed an enhanced triple lockdown in these districts, which have been declared as critical containment zones. The lockdown will continue till July 23, wherein shops that sell essential items are allowed to function from 10 am to 6 pm. The state government-central government, private offices, and other institutions in these areas will remain closed till July 23. No movement of people will be allowed to and from the containment zones except for medical emergency and exempted services.

Apart from containment zones, there are 111 hotspots in Kerala, the official said. A hotspot being defined as an area in a district where six or more people have been tested positive of coronavirus infection.

As of June 30, 4,441 people have tested positive in the state out of which 2,057 are currently active and undergoing the treatment. Furthermore, 2,361 people have recovered which took the recovery rate of the state to 53 per cent (all India recovery rate as on June 30 is 57.4 per cent). On the other hand, 23 people from Kerala succumbed to the infection, taking the mortality rate to  0.51 per cent in the state (all India mortality rate is 3.15 per cent, as on 30 June.)

Kerala’s COVID-19 Journey: From Being One Of the Worst-Hit To Becoming One Of The Best Performing States

As of June 30, 4,441 people have tested positive in the state out of which 2,057 are currently active and undergoing the treatment

Also Read: 6 Months On, What Do We Know About The Coronavirus Pandemic

The government official also informed NDTV, that till date, 2,31,570 samples have been tested in Kerala of which, 47,994 samples belonged to priority groups like health care workers, persons with high social exposure, among others. Kerala’s is performing 4,664.5 tests per million population while the national average is 7,550 per million population.

There are 40 labs in the state, 24 government labs and 16 private labs, that conduct testS for COVID-19.

Kerala’s COVID-19 Journey: From Being One Of the Worst-Hit To Becoming One Of The Best Performing States

Kerala’s is performing 4,664.5 tests per million population while the national average is 7,550 per million population

Moreover, about 1,84,657 people are placed under quarantine in Kerala, out of which 1,81,876 are under home quarantine and 2,781 are admitted in designated isolation facilities or hospitals.

Government quarantine facility in the state is only available for those who can’t isolate themselves at home.

Kerala’s COVID-19 Journey: From Being One Of the Worst-Hit To Becoming One Of The Best Performing States

Most asymptomatic and people with mild symptoms are encouraged to isolate themselves at home.

Also Read: Coronavirus Prevention: How To Wash Fruits, Vegetables And Other Perishables To Safeguard Them From Virus

Kerala has the third-highest number of isolation beds in the country after Maharashtra and Delhi. The over one lakh beds (1,13,028), which includes ICU beds, and ventilators for the critical patients. This also includes the paid quarantine facility for those individuals who wish to isolate somewhere other than government facility. There are 356 hotels which have has been identified by the Kerala government as paid quarantine centres. A government official explained,

A lot of NRIs returning to the state may not have easy access to isolation at home and might not be comfortable at government facilities. In this case, they can avail quarantine facilities in 356 hotels of the state and pay them on per day basis. They have all medical and housekeeping facilities at the hotel and we have seen that most NRIs have opted for these paid facilities, offering rooms in the range of Rs 2,000-Rs 10,000/day.

The official also said that the state has a total of 4,961 ICU beds in the state of which, 1,900 are in government hospitals and 3,061 are in private hospitals. When it comes to the availability of ventilators, they have 950 ventilators in government hospitals and 1,531 in private which makes a total of 2,481 ventilators. The state has also procured an additional 5,000 ventilators. however, the official didn’t agree to classify the placement of these.

Kerala’s COVID-19 Journey: From Being One Of the Worst-Hit To Becoming One Of The Best Performing States

Kerala has a total of 4,961 ICU beds in the state of which, 1,900 are in government hospitals and 3,061 are in private hospitals

Also Read: Coronavirus Outbreak Explained: What Is Convalescent Plasma Therapy And How Effective Is It In Treating COVID-19 Patients?

NDTV reached out to an expert from the Kerala Government Medical College Teachers’ Association (KGMCTA), who lauded Kerala government’s preparedness as well as alertness in handling the pandemic. He said,

There’s no doubt Kerala has performed exceptionally well in this pandemic crisis. From being the first state to report cases, to one of the worst-hit states in the initial stage to being one of the best performing state, it wasn’t an easy task. Things could’ve gone either way as we have observed in the last couple of months in states like Maharashtra and Delhi, and internationally in the USA and UK.

Dr Sugathan M.E, Former State President of the Indian Medical Association (Kerala), also lauded the state’s “excellent” efforts, he told NDTV,

What we have seen in play here is the excellent performance by the Kerala government. I believe that it was because of the strong healthcare infrastructure and the efficient Public Distribution System with the decentralisation of power in the local governments, that Kerala was able to successfully manage the situation. As we continue the fight against the virus, it is important to acknowledge that we have reasonably good facilities in the form of Personal Protective Equipment (PPEs), Masks, sanitisers, Hypochlorite solution along with ICU care with adequate number of ventilators as well as sufficient quarantine facilities. So we are always preparing to make things better and not letting our guard down.

However, KGMCTA expert said the sole credit can’t be given to the government as people of the state and healthcare workers deserve credit as well. He said,

It is all about codependency. If the government had the will and the citizens and healthcare professionals didn’t care nothing would’ve worked. If citizens were alert but the government was not responsive enough, or if there were no appropriate facility, nothing would’ve worked. But the fact of the matter remains that citizens, government, authorities, healthcare workers, everyone joined hands and imposed and followed regulations which helped the state in the long run.

Also Read: Coronavirus Outbreak Explained: What Is A Cytokine Storm And How Is It Fuelling COVID-19? Experts Answer

Dr Sugandhan, however, says that one thing that can be improved in the state, just like any other state or the country at this point, is to ramp up their testing. He said,

In my opinion, at this point when things are comparatively under control, testing has to be stepped up to at the least 100 per lakh population on a weekly basis. Our current strategy of testing, contact tracing and quarantining is surely working and this ramp-up in the number of tests should be applied along with it. Also, I think the cost of COVID-19 tests should be brought down and more private labs should be roped in the state to perform the tests. Anyone who wishes to get checked or tested should be able to do so without any limitations.

Lastly,  Dr Sugandhan said that we can expect for the cases to rise in the coming weeks or months and what needs to be ensured at this point is not just Kerala but across the nation is to provide optimum treatment so that the cases don’t become critical.

As cases continue to rise, we need to remember on an average 85 per cent cases are mild to moderate or even asymptomatic. Our testing strategy, number of tests per day, strict implementation of quarantine, roping in services from the private healthcare system can help us to increase this figure of 85 per cent. We at State IMA are in constant touch and dialogue with the state government regarding this.

He signed off asserting that we have to step up research and come out with the compilation of the scientific data available until now, so that it paves the way for further management of COVID-19 pandemic.

Also Read: Coronavirus Outbreak Explained: Different Types Of Tests For COVID-19 And Their Efficacy

To be able to control the situation in the state, the Kerala government has made it mandatory for people to follow COVID-19 safety guidelines for a year, under the ‘Kerala Epidemic Disease Corona Virus Disease (COVID-19) Additional Regulations, 2020’. These regulations will be effective until July 2021, a government official has told NDTV.

NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (WaterSanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollutionwaste managementplastic banmanual scavenging and sanitation workers and menstrual hygiene


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