Padmini Murthy MD, MPH, Vikas Grover PhD
The state of Kerala in India has gained national and international attention for its proactive role in address the COVID 19 crisis effectively and continuing to maintain the low rates of infection and mortality. In January 2020 The Health Minister of Kerala, Ms. K.K. Shailaja contacted one of her physician deputies after reading about the virus affecting people in China. After consultations with her team, she began her proactive and state-wide measures which, eventually, resulted in the success story in Kerala. In examining the timeline of action in Kerala: On January 24th the Health Minister’s rapid response team set up a control room and the instructions were passed on to the medical personnel in Kerala’s 14 districts. This timely action was in line with the WHO protocol of test, trace, isolate, and support to help identify and isolate the first case of the virus in the state who arrived from Wuhan.
Fast forward to February, the alert surveillance and contact-tracing helped to trace those who came into contact with a family (COVID positive) returning from Venice. The contact tracing in Kerala used social media and advertisements which was successful in identifying the 6 positive cases from the encounter with this family.
In a recent interview, the health minister Shailaja indicated that a COVID test in Kerala produces a result within 48 hours. She also stressed the importance of testing, quarantining, and hospital surveillance. She added that people in many countries do not have access to the measures put into place in her state. Expatriates from her state living overseas are in regular touch with her and her team. She is kept abreast of the situation overseas.
As of 23 May 2020, there have been 794 confirmed cases with 515 (64.86%) recoveries and 5 deaths in the state of Kerala. There are many factors related to this success. Understanding and accepting the threat, timely planning, effective communication, smart use of the available resources, and execution of the planning are the most talked about factors. Comparatively exceptionally low population density in Kerala was a crucial aspect. Once the population density is low, the efficiency of the measures taken increases. Other states in India like Mumbai, Chennai, and Delhi could not demonstrate the same dynamic movement. Even if the other states used the same strategy of blocking inward movement of people, it would not have been as simple as in Kerala.
The housing infrastructure in Kerala is one of the best in India, and hence home quarantine worked better as compared to many other states. In a city such as Mumbai, where the inequality of living space available to its citizens is so high (e.g., Dharavi, the largest slum in Asia), a Kerala model is almost impossible to replicate. The relevance of effective communication using various portals with the residents of the state has proven effective in public health messaging and contact tracing. To be effective it is crucial that authorities, and healthcare providers issue clear guidelines for their residents and Kerala was on target. This essentially means a strong collaboration between the government and the residents of the state. The strength of communication, and collaboration can influence the effectiveness and the efficiency of the measures. The intentions behind the decisions matter, i.e. political vs. saving lives, rigidity vs. adaptability, waiting vs. a timely action, and an evidence-based approach vs. a non-evidence-based approach. The state of Kerala chose an approach to save lives by being adaptable, acting on time, using an evidence-based approach, and communicating with its people. It is interesting to note that there was hardly any community transmission in Kerala as compared to the USA and UK where it is rampant.
Social distancing and PPE use in public transport in Kerala.
COVID 19 Hot spots mapping in Kerala
Example of effective COVID Contact Tracing
Padmini Murthy, M.D., M.P.H., FAWA, FRSPH, is a professor and director of global health at New York Medical College’s School of Health Science and Practice.
Vikas Grover, Ph.D., CCC-SLP, is an assistant professor in the department of speech language pathology at New York Medical College’s School of Health Sciences and Practice.