Kerala had one of Covid-19 's earliest reported cases in January, but managed to escape death tolls and infection rates that marked other states in India (and around the world). In reality, India's coronavirus case count kept steady at three for weeks, because the three cases were in Kerala, and Kerala had controlled the virus so effectively.
But Kerala is successful not only because it sprang into action immediately on the learning of the virus, but also because of what it had done in the years leading up to it – decades of continued investment in universal healthcare, government devolution that gave responsibility to local communities, and early precautions.
The immediate action that it was taking mattered. By 24 January, the state's health minister, KK Shailaja, had already brought in protocols suggested by the WHO: monitoring, tracing, isolating and assistance. People flying into Kerala underwent airport screenings as far back as the end of January. Even so, a Malayalee family returning from Italy failed to comply with health checks at the end of February, and went about their daily business — and eventually tested positive for Covid-19. By the time, there were well into the hundreds of people they had been in contact with.
Fortunately, by then, Shailaja had a state response team coordinating national and state-level responses from different government bodies. The state government used an army of manual contact tracers, which began tracing the infection routes of this family using a combination of GPS data from their phones and CCTV footage from other public places. These routes of infection were then reported online along with a call number if you had been in touch. About 300 people finally got in touch.The team then proceeded to track the movements of those individuals, and instructed them to isolate themselves. Along with 28 days of quarantining, aggressive testing was crucial – it tested anyone who had been in contact with an individual with symptoms.
Kerala may have gotten a head start on Covid-19 preparations. That's partially due to its recent experiences. A Nipah virus spread across Kerala in 2018-it was viral and had no vaccine. Shortly afterwards significant flooding followed. During this time, the Kerala government mobilized several different sections of its infrastructure, working with village councils or panchayats to distribute information, supplies and medical assistance to everyone who needed it, developing GPS tracking maps with the assistance of engineering and medical students, and drawing on an established network of surveillance measures, such as CCTV footage and an app street.The state has now been able to draw on these resources, but it has always been able to depend on the social network that has been in place for almost 60 years.
As of 2018, the state government also took away other lessons, such as the effect on mental health of the people. A mental health helpline was set up this time around in March, encouraging people in quarantine or self-isolation to call – and occasionally, calling from counselors who want to follow up. The Government has created a Whatsapp helpline for domestic violence victims. All of these helplines operate 24 hours a day. Also, the state government has successfully used technology: a digital database has comprehensive information on reported incidents, deaths and infections, broken down by area.
But the pandemic preparedness of Kerala isn't just coming from recent years. For decades, Kerala has been a source of anthropological fascination. It is currently ruled by the Left Democratic Front, a coalition of socialist and marxist parties. In the 1960s one of the world's first directly elected communist governments came to power in Kerala and introduced a social change program.
The government passed a land reform act in 1969, and the public education system expanded massively. The State has also invested in infrastructure for public health. Every village today has a health centre, doctors , nurses and paramedics. Its literacy rate and life expectancy is India 's best. That's also paid off in a situation like this – for example, the chief minister, Piranyi Vijayan, hosts a concise daily briefing with the latest information and even posts figures on Twitter. People understand why they need to stay at home and most of them are sure the state can provide for them.
There was no violation of that confidence. The fourth item of the Covid-19 program, help from Kerala, has been crucial to ensuring that citizens are actually reducing group transmission. Kerala's compensation package amounts to about £ 2bn and the state has also gone ahead in other ways. Houseboats, mostly used for entertainment, have been seized and converted into isolation colonies, as have currently abandoned schools and colleges. Also crucial was a sense of civic responsibility; students around the state volunteered to help build test kiosks and take samples from people, which was directly inspired by what had been done in South Korea. They introduced a campaign for community handwashing, titled "breaking the chain."
Community government, community-driven village councils and a powerful social network within communities ensured that those seeking support could get it. Young men who go abroad, mostly to the Gulf, to work as migrant labourers are a major part of Kerala 's population. Once they returned they were housed during their mandatory quarantine in empty houses. Although schools were shut down, at their homes, meals are still being delivered to kids. Clear information was disseminated through Whatsapp and support lines from local government.Village councils took it upon themselves to enforce lockdowns in their local areas by ensuring that people who fought without food or money were able to rely on the people around them. Members of these panchayats ensure that by the next day anything people need is made available. Anyone in self-isolation is called to track their symptoms at least twice a day and to ensure they are provided for. Such groups are not unlike the networks of mutual aid that have developed elsewhere-the difference is that such links already existed in Kerala.
Speaking to The Guardian, KK Shailaja expressed bewilderment that countries like the United States and the United Kingdom fell far behind in research. I imagine that the situation is less bemusing than confusing for those who, like me, live in these countries but who, unlike me, are unfamiliar with Kerala! My grandparents are retired school teachers in Kerala who were able to live off their pensions and the state government moved up the monthly payout date for the pensions when they went into lockdown.Other members of my family still work as teachers, or as doctors and nurses in hospitals, all of whom regularly ask me if I am truly safe in the UK, given the high death toll here. I am never sure what to say.
To say that Kerala has "won" the fight against Covid-19 seems premature. Cases are beginning to rise again, and there are concerns over what will happen during the monsoon season, when dengue fever and malaria begin to affect the population. Hospitals are overstretched, too. These are not minor factors. But the last few months have shown that there are other, even greater, factors in Kerala from which the state could rely.
Most of all, there is the fact that both state and society recognize that any attempt to "flatten the curve" or manage Covid-19 can not be done by funding alone or by volunteers, but can only be accomplished by mutual recognition – on the part of the state and the people – that the only way forward is together. That is an easy thing for people to swallow in Kerala; they've lived it for a long time.