IT was in the latter half of December 2019 that the cause of an illness that was spreading across Wuhan city in the Hubei province of China was ascertained to be a novel coronavirus, SARS-CoV-2. Now, almost three months later, the coronavirus disease, COVID-19, has affected 195 countries and territories across the world, ie, the entire world has been gripped by the pandemic. We are warned by the World Health Organisation that the ‘pandemic is accelerating’, with it taking 67 days to reach 100,000 cases, 11 days since then to reach 200,000, and just four days after that to reach 300,000.

EARLY PREPAREDNESS
Between January 18 and 22 itself, the Government of Kerala shared directives and guidelines issued by WHO and the Ministry of Health and Family Welfare, Government of India, with all 14 districts. A state level Rapid Action Force met and prepared guidelines on observation, labs, treatment and training, which was also shared with the districts. District level public health systems were prepared to face any eventuality. Subsequently, all passengers arriving from China were screened at the Kochi airport. Peripheral health teams were prepared to strictly monitor all passengers from China. District Integrated Disease Surveillance Programme Cells began monitoring contact tracing and line listing of all possible cases.

With the disease spreading further internationally and with an increase in the number of people coming to Kerala from foreign countries, the possibility of COVID-19 being reported in the state was taken seriously. All district medical officers were instructed to prepare isolation facilities in medical colleges, general hospitals, district hospitals and major private hospitals in their respective districts. Directives were issued on the requirements pertaining to hospital isolation and home quarantine as well. On January 24 itself, a control room was set up in the directorate of health services. On January 25, required guidelines were issued to health officials and local self governments on the measures to be adopted. By January 28, control rooms were set up in the districts as well.

INITIAL CASES

It was on January 30, that the first COVID-19 case in India was confirmed in Kerala, by MoHFW. It was a student who had returned from Wuhan and was undergoing treatment in isolation in the General Hospital, Thrissur. Subsequently, the second and third cases were confirmed on February 2 and 3 respectively. They were also students who had returned from Wuhan. A ‘State Disaster’ was declared and emergency responses were initiated. During this initial phase itself, the health minister, health secretary and director of health services met to decide upon the emergency interventions required. Meetings of the state and district level Rapid Response Teams were convened. On February 1, the National Institute of Virology’s unit in Alappuzha was prepared to test samples. State and district level control rooms started working round the clock. Isolation facilities were further strengthened in all designated hospitals. At least two hospitals in each district were prepared to handle those with symptoms and requiring treatment in isolation. As we were prepared in advance, Kerala was able to stop the spread of the disease to others, from the initial cases. All the initial cases were cured and discharged, by the third week of February.

ADDITIONAL MEASURES

In all movie theatres, awareness videos on COVID-19 were screened. In television and radio FM channels, information regarding the disease was publicised. Awareness campaigns were taken up on social media too. At the same time, those who peddled fake news on social media were penalised. The health department imparted awareness to 40 lakh school students through smart class rooms. Stringent screening was instituted in airports and ports. With the spread of the disease being reported in Italy and Iran, screening was made further stringent. Home quarantine of 14 days was mandated for those coming from China, Hong Kong, Thailand, Singapore, Japan, South Korea, Vietnam, Nepal, Indonesia, Malaysia, Iran or those with travel history to such countries since February 10, 2020.

The cabinet secretary conducted a video conference with all the states in the wake of new cases being reported in other states too. He appreciated the efforts of Kerala’s health department and requested the principal secretary to make a presentation. Other states were directed to follow the Standard Operating Procedure developed by Kerala. Kerala was asked to support other states in their efforts in combating the virus as well.

LATER CASES AND RESPONSES

Being home to a large migrant community, Kerala has Malayalis coming in from around the world into the state, on a daily basis. Being a popular travel destination, the state attracts a lot of international tourists as well. The current set of cases that we have seen in the state since March 8, are primarily of those who have come in from abroad, especially from Europe and the Gulf. There are a few instances of cases being reported because of contact with such individuals as well. Apart from these primary and secondary cases, we are taking extra care to ensure that no tertiary cases are reported in the state.

As of March 24, 109 cases of COVID-19 have been reported in Kerala. Of these, four have been cured and sent back home, and 105 are undergoing treatment in various hospitals across the state. 72,460 are under observation of which 466 have required hospitalisation. 4,516 samples have been sent for testing, and the results of 3,331 have been negative. Special mention is required of the fact that, not a single death has been reported in Kerala, due to this pandemic, despite the state experiencing a progressive swell in the number of positive cases. We have taken strict measures to ensure that there is no community spread in Kerala.

At the same time, we have also ensured that additional facilities are readied to handle any eventuality, including emergency situations. Emergency recruitment of 276 doctors has been done in the health department to ensure adequate human resources in tackling the pandemic. Other paramedical staff will also be appointed as required. All such appointments are being made from the existing PSC lists. Buildings have been identified which can serve as isolation wards. They have been sanitised and prepared to serve their purpose, with the help of youth and voluntary organisations.

The public sector units in the state like Kerala State Drugs and Pharmaceuticals Ltd and Kerala State Industrial Development Corporation have also taken a lead in ensuring the availability of essential medicines and materials like sanitisers and masks. Even jail inmates in Kerala have made their contribution in this regard. Many RWAs, voluntary organisations and political outfits have also taken it up as their social responsibility to produce and distribute sanitisers and masks.

Advice from international health agencies and experts is to maintain a safe distance between individuals as well to ensure personal hygiene, so that the spread of the novel coronavirus can be curtailed. A ‘Break the Chain’ campaign was taken up, creating awareness among the general public on washing their hands with soap and the use of sanitisers. Government offices, public offices, local self governments, private enterprises, celebrities and so on took up this campaign, making it a huge success and creating awareness through innovative methods, including the creative use of social media.

LOCK DOWN

A safe distance between people could be ensured only by imposing certain restrictions on the movement of and interaction between people. To enable that, the entire state has now gone into a lock down. Schools and colleges have been shut, exams have been postponed, movie theatres have been temporarily closed down, people have been advised to not travel, gatherings and religious congregations have been disallowed, public transport facilities have been discontinued and the state’s borders have been closed. At the same time, emergency services, hospitals and medical stores are functioning as usual. Stores selling essential articles are allowed to open for a fixed period of time. Restaurants are allowed to offer take away and delivery facilities. We are ensuring adequate stock of grain and allowing movement of goods from across the state’s borders to facilitate supply of food as well. Personnel are being deployed in a phased manner to ensure that government offices are functioning.

COVID-19 PACKAGE

When there is restriction on the movement of and interaction between people, it affects social and economic life. Well seized of this, and much before going into a lock down, on March 18 itself, the Government of Kerala announced a package to the tune of Rs 20,000 Cr to tide over the ensuing crisis. Rs 1,320 Cr has been set apart to disburse welfare pensions in advance, for two months, in March itself. Rs 100 Cr has been set apart to provide assistance of Rs 1,000 each for families that are not eligible for welfare pensions. In the next two months, loans to the tune of Rs 2,000 Cr will be disbursed through the Kudumbashree scheme. The interest component will be borne entirely by the state government. Rs 2,000 Cr will be utilised to provide work under the employment guarantee scheme.

Rs 500 Cr has been set apart for the additional expenses incurred in public health on account of COVID-19 care. Food grain worth Rs 100 Cr will be distributed to eligible families through the public distribution system. Rs 50 Cr will be utilised to provide meals at just Rs 20, as part of the Hunger Free Kerala project. 1,000 food stalls will be set up in April itself to enable this. In the state budget, it was declared that they would be set up in September to provide meals at Rs 25. Rs 14,000 Cr will be utilised to clear all pending payments of the state government to institutions and individuals. Thus, Rs 20,000 Cr is being infused into the state’s economy on an emergency basis.

Fitness fee for auto rickshaws and taxis have been relaxed. Relaxation of one month will be provided in the quarterly taxes of stage carriages and contract carriages. Concessions worth Rs 23.60 Cr is being allowed in this manner. Electricity and water bills can be paid with a delay of up to one month without any fines. Entertainment tax on movie theatres have been waived for a month as well. Apart from the emergency infusion of cash into the economy, relaxations are also being provided to help people to overcome the crisis.

Discussions have been held with organisations of traders and businessmen to ensure adequate availability of essential materials during these times. Online facilities are being set up to ensure delivery of essential articles, including vegetables and pulses to families during this lock down. Voluntary services of organisations are being ensured to assist people in need. Books are being made available to those in quarantine with the assistance of publishing houses. Sufficient internet bandwidth is also being ensured, following discussions with service providers, so that while people stay at home, they have sufficient means of communication and entertainment.

A meeting of the State Level Bankers Committee was held, to persuade them to not undertake recovery proceedings during this time of economic turmoil and to provide relaxations on interests and repayments. Even the Kerala High Court had made a favourable verdict in this regard. But, on the centre’s insistence, the Supreme Court has stayed it. Even while moving towards a lock down, we were taking all measures to ensure the protection of life. For life to sustain, it requires health and economic activity. The Government of Kerala has continuously worked to ensure both, in these challenging times. We did not simply ask the people to stay at home, we even ensured that they would be able to sustain themselves, while staying at home.

CONCERNS RAISED WITH CENTRAL GOVT

Experience from China and South Korea as well as WHO directives suggest that it has to be accompanied by large scale testing so that virus can be detected and infected persons can be treated, so as to prevent further infections. Accordingly, Kerala has resorted to large scale testing. Yet, there are limits to what a state government can do. Unless such large scale testing is done across the country, we will not be able to accurately estimate the spread of the virus and the prevalence of the disease. Any miscalculation regarding this will push the country into a serious health emergency. Hence, we have requested the Government of India to allow more centres to conduct tests.

Throughout the course of fighting SARS-CoV-2 and COVID-19, Kerala has experienced many constraints while also gaining new knowledge. We have tried to share them with the central government, by means of letter addressed to the prime minister, health minister, finance minister, external affairs minister and so on. A key aspect is that with the limited resources available to state governments, it is a herculean task to tackle a pandemic of such gargantuan proportions. Without allocating more resources to the states, this fight cannot be won comprehensively. Accordingly raising the borrowing limit of states, reducing the interest rate, allowing for advance borrowing, allowing for a hike in work days and wages under NREGS, roping in PSUs for the production of medicines and other essential items like masks and sanitisers, increasing testing facilities, providing more medical equipment, flexibility in utilising DRFs and so on are some of the measures the central government needs to implement on a priority basis.

PHYSICAL DISTANCE, SOCIAL UNITY

As far as Kerala goes, the repeated onslaughts of viruses and contagious diseases have increased the resilience of our public health system. It has helped us to understand our pitfalls and undertake remedial measures. Experience from around the world in combating COVID-19 underlines the necessity of robust public health care systems. Imbibing that lesson, we have taken adequate measures to strengthen Kerala’s public health system. It needs to be noted that the capacity building undertaken through the Aardram Mission has helped us immensely at this time. 

We have also ensured that the society moves forward as one, to survive this crisis. Our motto in dealing with COVID-19 has been ‘physical distance, social unity’. To keep the society together, we are keeping them informed at every turn, through press meets and official channels of communication. Social media is being used effectively to share authentic and scientific information and to counter fake news and false information. Government machinery is being used to provide relief to the people. To enable that, we have promulgated the Kerala Epidemic Diseases Ordinance, 2020, so that the government can effectively and proactively intervene as the situation demands during this epidemic.

We are facing a very extraordinary challenge. All our systems, commitment, love towards fellow human beings, are being combined for us to move forward. This pandemic has brought many developed countries to a standstill. Kerala is giving a tough fight, to curtail the spread of this virus. In order to stop it, we are working together. The LDF Government of Kerala is leading this fight right from the forefront.