Nipah lessons helped; there is no one-stroke flattening of the curve: Kerala Health Minister

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Published: April 28, 2020 2:40:49 AM

Covid-19 is a new virus, whose behaviour is yet to be unravelled. Mutations cannot be ruled out. It is no one-stroke flattening of the curve.

Anticipating Nipah again, we had been on guard, with mock drills, says Kerala Health Minister KK Shailaja (File image: ANI)

Kerala’s handling of the Covid-19 outbreak is wining it praise across the board. But the true test of its mettle will be how it handles the lifting of the lockdown. FE’s M Sarita Varma spoke with KK Shailaja, minister for health, social justice and woman and child development of Kerala, on the state’s Covid-19 response and what lies ahead. Excerpts:

You had donned the virus-tamer mantle earlier, during the Nipah outbreak. Has this head start helped?

We were the first to set up a Covid-19 control room, as early as on January 24. This is partly because of Kerala’s learning from its brush with the deadly Nipah virus outbreak. We had evolved our virus protocol, with the WHO’s hand-holding. Anticipating Nipah again, we had been on guard, with mock drills. The coronavirus deaths in Wuhan in China put us on alert about the homecoming of Kerala medical students in Wuhan. So we kept rapid response teams ready. When three students from Wuhan turned positive, we were able to manage them, without more contact infections. We did not withdraw the airport health squads.

So far, we have tested more than 21,000 samples; 458 were infected. Of them, 333 have been discharged. There have been only three deaths (the Union ministry of health and family welfare lists four). This was not by chance. It was with humongous effort that we were able to keep the Covid-19 mortality rate as low as 0.5%. From over 1.5 lakh people under observation, through relentless testing, the watch list has slimmed to 21,215 people last week.

How handy was the state’s legacy of high health indices?

Currently, Kerala has a robust mix of public and private hospitals. And the state’s public health model, well-honed by the recent Nipah crisis, rose to the challenge. The game changer was a culture of grassroots democracy, with proactive village councils. Even students in the state chipped in, building a 2.5-lakh pool of volunteers. We set up walk-in kiosks for taking samples. Besides the centrally-procured RT PCR testing kits, Kerala was the first state to buy rapid test kits from Pune-based Mylab.

Kerala expats returning would mean a more complex round of surveillance, quarantine and hospitalisation. How prepared is the state to meet this situation?

The evacuation priority would be given to pregnant women, visiting visa holders stranded abroad and old people without Covid-19 infections. They will have to undergo 28-day quarantine, some at home, and some at the arranged camps.

In addition, we have readied about 1.6 lakh beds in anticipation as part of plan A. In plan B, we have identified beds from private hospitals. And in plan C, we may also rope in public halls and houseboats. The state is mulling reverse quarantine plans for senior citizens and is revving up its food security. Meanwhile, we are also alert to the asymptomatic spread of Covid-19, which we had avoided so far.

Kerala had been an early bird in pandemic-fighting, as the first in India to zero-in on Covid-19 cases. And you had donned the virus-tamer mantle earlier, during the Nipah outbreak. Has this head start helped?

Preparedness gave a head start. We were the first to set up a Covid-19 control room, as early as on January 24. This is partly because of Kerala’s learning from its brush with the deadly Nipah virus outbreak, two years ago. We had evolved our virus protocol, with the WHO’s hand-holding. Anticipating Nipah again, we had been on guard, with mock drills. The coronavirus deaths in Wuhan in China put us on alert about the homecoming of Kerala medical students in Wuhan. So we kept rapid response teams ready. When three students from Wuhan turned positive, we were able to manage them, without more contact infections. We did not withdraw the airport health squads.
In the second round, we had one case of a Keralite family from Italy, which failed to reveal infection history at the airport.

So far, we have tested more than 21,000 samples; 458 were infected. Of them, 333 have been discharged. There have been only three deaths (the Union Ministry of Health and Family Welfare lists four). This was not by chance. It was with humongous effort that we were able to keep the Covid-19 mortality rate as low as 0.5%. From over 1.5 lakh people under observation, through relentless testing, the watch list has slimmed to 21,215 people last week.

There is this ‘Kerala human development model’. It showcases a little Indian province that enjoys tall health indices, on a par with those of Canada, but disproportionate with its relatively modest GDP. Was this legacy handy?

Currently, Kerala has a robust mix of public and private hospitals. And the state’s public health model, well-honed by the recent Nipah crisis, rose to the challenge. The game changer was a culture of grassroots democracy, with proactive village councils. High literacy levels, too, helped in rigorous contact tracing and mass quarantine. Even students chipped in, building a 2.5-lakh pool of volunteers.

We set up walk-in kiosks for taking samples, picking a leaf from South Korea. Besides the centrally-procured real-time polymerase chain reaction (PCR) testing kits, Kerala was the first state to buy rapid test kits from Pune-based Mylab.

The state’s Covid-19 mortality rate is amongst the lowest in India. Kerala is also the first to get the ICMR nod to test plasma therapy. What were the challenges you faced?

Early referrals and well-oiled teamwork helped in minimising morbidities. It was hard work. One of the most gratifying moments was when we discharged two senior citizens—a 93-year-old man and his 88-year-old wife—after treatment. As a tourist state, we also undertook treatment of several foreign tourists, from Germany, the UK and Italy. A British citizen, who was in severe respiratory difficulties, before going back said that he could probably not have gotten better care in his home country. One situation that had kept us worried was a 62-year-old woman asymptomatic patient in isolation ward, who stayed Covid-19 positive for as long as 45 days. Even medical journals like Lancet haven’t come across such cases.

We had only one Covid-19 testing lab initially. Currently, the ICMR has mandated 14 local labs to do the testing. From 1,500 samples per day, we will soon be able to test 3,000 per day. As far as plasma therapy is concerned, it is too early to talk of results.

There are allegations that the Kerala government breached the privacy of people in quarantine by signing up a US-based firm to handle their data. How do you see this?

We made an agreement to ensure data privacy. Political allegations often crop up. It doesn’t affect our pandemic management. Even when the Centre extended the lockdown, the Kerala government made some relaxations. At the behest of the Union Ministry of Home Affairs, the relaxations were later rolled back. Does this mean the state is not in sync with the Centre’s anti-pandemic curbs?

Indeed, there is no conflict with the Centre on anti-pandemic curbs. On the contrary, we are going fully in tandem with the social distancing plan. Kerala put in place a strict lockdown before the national one. Gatherings, even prayer meets, are banned. Kerala’s quarantine has been longer than the nationally prescribed one.

We matched it with welfare outreach. Supplies are home delivered, midday meals are sent to students at home, even when schools are shut, and mental health helplines are set up. In fact, 1,255 community kitchens were set up for migrant labourers from other states.

After the first phase of national lockdown, chief minister Pinarayi Vijayan pointed out that we need to consider not just lives, but livelihoods, too. Economy needs to be rekindled. That’s why we considered relaxations in zones free of Covid-19 cases.

We have now abandoned the green zone concept, since the infiltration of infected cases from neighbouring states changed the picture. We will also go by the central directive to keep the state borders closed.

Kerala has over 20 lakh expats. Their homecoming would mean a more complex round of surveillance, quarantine and hospitalisation. How prepared is the state to meet this situation?

We are keen to have the expats back as soon as the Centre allows flight services. The evacuation priority would be given to pregnant women, visiting visa holders stranded abroad and old people without Covid-19 infections. They will have to undergo 28-day quarantine, some at home, and some at the arranged camps.

We have readied about 1.6 lakh beds in anticipation as part of plan A. In plan B, we have identified beds from private hospitals. In plan C, we may also rope in public halls and houseboats. The state is mulling reverse quarantine plans for senior citizens and is revving up its food security. Meanwhile, we are also alert to the asymptomatic spread of Covid-19, which we had avoided so far. A good many of the infected seem asymptomatic.

Covid-19 is a new virus, whose behaviour is yet to be unravelled. Mutations cannot be ruled out. It is no one-stroke flattening of the curve. As of now, we need to review the dynamics of this highly contagious virus, every single day. The pandemic is not over yet. We need to think of livelihoods, but cannot leave human lives to luck. This is not yet the hour to rest our oars.

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