• With reporting India’s first case on  January 30, Kerala has consistently stayed ahead of the coronavirus curve, with its 70% recovery rate being the highest in the country. 
  • Kerala has so far tested 20,821 samples, also the highest for any state.

What sets its containment strategy apart?

Legacy of public health: Much before Kerala became a separate state in 1956, the region had seen several pathbreaking public health interventions. 

  • Pre-independence: 
    • In 1879, the erstwhile Travancore rulers made a proclamation making vaccination compulsory for public servants, prisoners and students.
    • In 1928, a parasite survey, done in association with the Rockefeller Foundation, led to the control of hookworm and filariasis.
  • The community health legacy got a boost as the state’s focus on literacy and women’s education helped it attain near 100% vaccination levels and develop a culture of personal hygiene. 
  • The World Health Organization, in a survey held in 12 countries in 2005, found that hand-washing with soap after defecation had a prevalence of 34% in Kerala, the highest among the states/countries surveyed. 
  • During COVID: So when the state began its ‘Break the Chain’ campaign during the COVID-19 outbreak to promote hand-washing and use of sanitisers, it only served to reiterate some of those best practices.

Health infrastructure: A critical factor in Kerala’s COVID-19 battle has been its robust healthcare system, considered on a par with those of many developed countries. 

  • In June 2019, Kerala topped all states on the NITI Aayog’s annual health index with an overall score of 74.01, more than 2½ times that of the least-performing state, UP (28.61).
  • Though Kerala has only been investing 5% of its total state plan outlay on healthcare (roughly equal to the national average spending in the sector), its focus on healthcare at the level of Primary Health Centres and Community Health Centres has made it stand apart. 
  • With the management of these centres in the hands of three-tier local bodies, many of these have modern diagnostic facilities and offer tele-medicine services.
  • The state’s private health sector, once dominated by the Church, has grown rapidly on the back of investment from NRIs and corporate healthcare groups mainly. 

During COVID-19 outbreak:

  • Building infrastructure:
    • Started with no testing facility (until late January), over the last two months Kerala’s COVID-19 testing facilities have grown to 13, ten of those in the government sector.
    • The state also stepped up its medical facilities, turning defunct hospitals into COVID-19 facilities. 
  • Lessons from Nipah
    • Kerala has put in place a rigorous surveillance network based on protocol set up by the Indian Council of Medical Research (ICMR), that had been fine-tuned to perfection during the outbreak of the Nipah virus in 2018 and 2019.
    • Besides tracing contacts of positive cases, Kerala strictly enforced 28 days of home quarantine although the general incubation period of the virus is 14 days.
  • Role played by local bodies:
    • The village committees kept the health department informed about fresh arrivals from abroad and ensured they remained indoors. 
    • In hotspots of Kasaragod and Kannur districts, some village panchayats launched call centres, connecting those quarantined with the authorities.
  • Use of technology:
    • Route maps of positive cases, drawn through GPS data, were released to help people self-report if they suspected they might have come in contact with an infected person. 
    • Geo-mapping of those under observation enabled better cluster management.
  • Appeal to isolate:
    • Those who reached Kerala from other states and their contacts were asked to isolate themselves.
    • This strategy helped the state rein in infections from participants of the Tablighi Jamaat event in Delhi. 
  • Social, political participation
    • Despite the largely bipolar nature of Kerala’s politics, almost the entire state would stay tuned to watch the Kerala government's daily press briefings on the state’s tackling of the situation. 
    • Coordination among different branches: It is evident in the Kerala government holding daily meetings with district medical officers and with other departments such as police, revenue, electricity, etc. 
    • The Kudumbashree Mission which is the state’s poverty eradication and women empowerment programme, has been at the frontlines with volunteers pitching in to make masks and launching community kitchens.