Why has Kerala been so successful in tackling coronavirus?

Smart strategies and decades of investment have helped the Indian state in the fight against Covid-19. 

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As governments around the world scrambled to respond to the pandemic, unlikely examples of relative success have emerged. There’s New Zealand, where Prime Minister Jacinda Ardern locked down early in February, after one confirmed death. There’s Slovakia, where President Zuzana Caputova has matched her masks to her outfits in public, setting an example for citizens. And then there’s Kerala, a small state in the south of India, which has been governed by a coalition of left-wing parties since the Sixties. 

Kerala had one of the earliest confirmed cases of Covid-19 in January, but has managed to avoid the death tolls and infection rates that have come to characterise other states in India (and around the world). In fact, for weeks, India’s coronavirus case count held steady at three, because the three cases were in Kerala and Kerala had so effectively contained the virus. 

But Kerala is successful not only because it sprung into action immediately on learning of the virus, but because of what it had done in the years leading up to it – decades of continued investment in universal healthcare, the devolution of government which gave responsibility to local communities, and early precautions.

The immediate action it took did matter. By the 24 January, KK Shailaja, the state’s health minister, had already put in protocols recommended by the WHO: test, trace, isolate and support. People flying into Kerala underwent screenings at the airport as far back as the end of January. Even so, at the end of February, a Malayalee family returning from Italy refused to comply with health checks and went about their regular business — and eventually tested positive for Covid-19. By that time, the number of people that they had been in contact with was well into the hundreds.

Fortunately, by then, Shailaja had a state response team coordinating responses from various government bodies at a regional and state level. The state government used an army of manual contact tracers, who started to trace this family’s infection routes using a combination of GPS data from their phones and CCTV footage from other public places. Those infection routes were then posted online along with a number to call if you had been in contact. Eventually, around 300 people got in touch. That team then went on to trace those people’s movements and instructed them to self-isolate. Along with quarantining for 28 days, aggressive testing was crucial – anyone who had been in contact with an individual with symptoms was tested. 

Kerala may have had a head start on preparations for Covid-19. In part, that’s because of its recent experiences. In 2018, a virus called Nipah spread through Kerala – it was parasitic and had no vaccine. Severe flooding followed soon after. During this period, the government in Kerala mobilised several different parts of its infrastructure, working with village councils, or panchayats, to distribute information, supplies and medical help to whoever needed it, seting up GPS tracking maps with the help of engineering and medical students, and drawing on an existing network of surveillance measures, such as CCTV footage and an app called GoK (Government of Kerala). The state has been able to draw on these resources now, but it was also able to rely on the social infrastructure which has been in place for nearly 60 years.

The state government took away other lessons from 2018 too, such as the impact on people’s mental health. This time around, a mental health helpline was set up in March, with people in quarantine or self-isolation encouraged to call – and sometimes, called by counsellors who want to check up. The government also set up a Whatsapp helpline for victims of domestic abuse. Both of these helplines operate 24 hours a day. The state government has also used technology effectively: a digital dashboard has detailed information about confirmed cases, deaths and infections, broken down by region.

But Kerala’s pandemic preparedness doesn’t only come from recent years. For decades, Kerala has been a source of anthropological curiosity. It’s currently governed by a coalition of left-wing and Marxist parties, the Left Democratic Front. One of the world’s first democratically elected communist governments came to power in Kerala in the 1960s and implemented a programme of social reforms.

In 1969, the government passed a land reform act, and massively expanded the public education system. The state also invested in public health infrastructure. Today, every village has a health centre, as well as doctors, nurses and paramedics. Its literacy rate and life expectancy are the highest in India. In a situation like this, that’s paid off too – for example, the Chief Minister Piranyi Vijayan hosts a concise daily briefing with the most recent information and even posts figures on Twitter. People understand why they need to stay at home, and for the most part, they trust that the state will provide for them. 

That trust hasn’t been broken. The fourth element of Kerala’s Covid-19 plan, support, has been crucial to ensuring that people actually reduce community transmission. Kerala’s relief package is around £2bn, and the state has stepped in other ways as well. Houseboats, often used for tourism, were appropriated and turned into isolation wards, as have schools and colleges that are currently empty. A sense of civic responsibility has been crucial as well; students around the state volunteered to help build testing kiosks and take samples from people, which was directly inspired by what had been done in South Korea. They introduced a community handwashing campaign, titled break the chain. 

Local government, village councils which are driven by the community and a strong social network within municipalities meant that anyone who needed assistance was able to get it. A huge amount of Kerala’s population is young men who go abroad, often to the Gulf, to work as migrant labourers. When they did come back, they were housed in empty buildings during their mandatory quarantine. Although schools were shut, meals are still delivered to children at their houses. Clear information was disseminated via Whatsapp and local government helplines. Village councils took it on themselves to enforce lockdown in their local areas, by making sure that people who were struggling without food or money could rely on the people around them. Members of these panchayats make sure that anything people need is provided by the next day. Anyone in self-isolation is called at least twice a day to track their symptoms and ensure that they’re provided for. These groups aren’t unlike the mutual aid networks that have sprung up elsewhere – the difference being that, in Kerala, these ties already existed.

Speaking to The Guardian, KK Shailaja expressed bemusement that countries such as the United States and the United Kingdom have fallen far behind in testing. I imagine that for those who, like me, live in these countries but who are, unlike me, not familiar with Kerala, the situation is less bemusing than confounding. My grandparents are retired school teachers in Kerala who have been able to live off their pensions, and when they went into lockdown, the state government moved up the monthly payout date for pensions. Other members of my family still work as teachers, or in hospitals as doctors and nurses, all of whom regularly ask me whether I’m really safe in the UK, given the high death toll here. I’m never certain of what to say. 

It seems premature to say that Kerala has "won" the fight against Covid-19. Cases are starting to rise again, and there are worries about what will happen during the monsoon season, where dengue fever and malaria start to affect the population. Hospitals are overstretched, too. These are not small factors. But the last few months have indicated that there are other, perhaps greater factors in Kerala that the state has been able to draw on.

Most of all, there is the fact that state and society alike recognise that any attempt to "flatten the curve" or manage Covid-19 can’t be done with funding or volunteers alone, but rather can only be achieved with a mutual acknowledgement – on the part of the state, and the part of the people – that the only way forward is together. That’s an easy thing for people in Kerala to swallow; they’ve been living it for a long time.

Sanjana Varghese is a journalist and writer based in London. She writes about technology, culture and politics, and has written for outlets such as WIRED UK, The Observer, VICE, and elsewhere.

Sanjana Varghese was previously a Wellcome scholar at the New Statesman. She writes about science and technology. 

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