Livelihood has to be taken care of. But we cannot accept the approach, espoused by some world leaders, that deaths are inevitable in the Covid war
Published: 19th May 2020 04:00 AM
The coronavirus is going to be with us for a long time, at least till the end of the year. We have to learn to live with it. The economy has to be opened. But the threat to life must be contained. We cannot accept the approach, espoused by some world leaders, that deaths are inevitable in any war, especially the Covid war that can be concluded only after the population achieves herd immunity or a vaccine is discovered.
Kerala’s strategy so far has been distinct in providing the best treatment for patients and ensuring the case mortality rate remains at a low level of 0.5%. There are two conditions for maintaining this record during the next wave of infection that has started with the arrival of Kerala’s expatriate population. One, the infection spread should be limited well within the hospital capacity, particularly ICU beds. Second, vulnerable sections such as the aged and those with co-morbidity complications must be provided total protection. And this is the exit strategy of Kerala for the coming months.
Test, trace, isolate and support: How do we control the disease spread within manageable limits? Fortunately, the last two months have provided valuable experience. And Kerala’s tested formula is now world-renowned: test, trace, isolate and support. The Economist has characterised it as a “bargain” strategy and The Guardian has called the health minister “Kerala’s coronavirus slayer”.
Kerala’s test rate was high in the initial weeks. Now the test rates in some other states have picked up and Kerala has been coming down the rank. More than money, the unavailability of test kits is responsible for this trend. But this has not affected the outcome, as Kerala has been effectively tracing every entrant from the hotspots outside, isolating them and testing everyone who shows symptoms. For those who are asymptomatic, two weeks of quarantine will ensure their infectious period has been spent
Around 70% of Kerala’s confirmed cases are entrants from outside. All their contacts are traced and put under observation mostly in their own houses. On April 4, as many as 1.7 lakh were in home quarantine. These practices ensured medical care was given to everyone infected within 2.5 days of the symptoms while in the rest of India it is reported to be above 6.5 days.
The chance of social spread was very low as almost all the cases were from contacts who were either quarantined or under house observation. Though there has been no scientific sentinel surveillance programme, the available data indicates that in Kerala the R0 value is at a low of 0.4 while globally it is 2-3. The R0 is the number of cases expected to occur on average in a homogeneous population due to infection by a single individual. If the average R0 in a population is greater than 1 the infection will spread exponentially. The successful containment strategy in the state prevented this.
The return migration: However, there is one impediment in pursuing the above strategy into the new phases—the influx of Malayalees into the state and the large number of interstate migrants who might have escaped the quarantine net at the border checkposts. This arose due to the failure of the Railway authorities and Centre to appreciate the elaborate surveillance and tracking system instituted in the state. The Railways and embassies insisted on their own priorities ignoring bookings in the Kerala portal. To compound the confusions, the scenes created at the checkposts by certain respectable political leaders protesting against the insistence of passes also created an atmosphere of permissiveness.
Large numbers of people have entered the state through bylanes or walking along rail tracks. There is only one way to track them— tracing them at their residential localities. Local governments have to take initiatives to identify the new entrants in their localities and quarantine them.
Operation shield: The next challenge is to isolate the vulnerable sections. This would require the close coordination of local governments and the primary healthcare system. I can briefly narrate the reverse quarantine procedure adopted by panchayats in Alappuzha constituency that I represent. We have been lucky that an integrated health project is being implemented in these panchayats in Aryad block with the help of Alappuzha Medical College. The blood sugar, pressure and cholesterol level and other selected characteristics of every citizen in the area have been collected and digitised. We have also been screening the population on the basis of this data for some of the chronic diseases. A health volunteer per 20 families has been recruited and trained.
The panchayats are now listing out the aged and chronically ill persons from this database. Formal letters would be delivered to every household asking the vulnerable to stay indoors. Community leaders would also visit each house and explain the procedures. An elaborate system of telemedicine has been instituted. Drugs would be delivered home. The palliative care system is being expanded. Already the destitute bed-ridden patients, nearly 600, are supplied with meals every day at the doorstep for the last two years. A team of counsellors has been constituted. Activities such as kitchen gardens and online competitive festivals are also planned for entertainment and relaxation. This is the package for reverse quarantine. Though not all panchayats have such an elaborate database all have started experimenting on how to protect the vulnerable.
The exit strategy: Once the above is accomplished the economy can be opened. Agriculture, small-scale industries and small shops can be opened even under lockdown conditions. All economic sectors would have to ensure that social control norms are fully observed—physical distancing, masks, sanitisers, regular sanitisation of workplaces and rest rooms and so on.
Utmost vigilance is required regarding the emergence of new clusters and such centres will have to be triple locked down. Red zones will become green zones and green zones may become red zones. A flexible control policy has to be adopted. Those to be tested will have to be aggressively pursued and those tested positive will have to be assured quality treatment.
The number of confirmed cases may continue to grow. The curve may not flatten immediately. But the recovery rate would be high and the fatality rate kept at a very low level. Opening up without shielding the vulnerable sections, substantially expanding medical facilities, increasing the testing manifold and transferring a minimum income to the people can spell catastrophe.
T M Thomas Isaac
Finance Minister of Kerala.
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