Kerala Health Minister KK Shailaja, better known as Shailaja Teacher, has been praised for the way in which she has been leading the state’s response to the Covid-19 pandemic. In an interview with Indulekha Aravind, she talks about the factors that helped Kerala in the Covid-19 battle and the challenges that lie ahead. Edited excerpts:
What are the advantages Kerala has over other states in tackling the novel coronavirus outbreak?
At the time of the Nipah virus outbreak, we had come up with a protocol and standard operating practices based on WHO guidelines, looking at Ebola and other infectious diseases, which were very helpful. We had been doing mock drills in case there was a third wave of Nipah — we remain on alert from December to June. Then, over the last four years, we have been strengthening the health department by bringing about basic changes such as creating family health centres, focusing on preventive healthcare and conducting regular training sessions for the public health division. That was our background. As soon as we heard about the spread of a new kind of coronavirus in Wuhan, we became alert in Kerala, without anyone telling us. We established a control room in the state as early as January 24 and told each district to be on alert, to convene a meeting of their rapid response teams and to be ready to set up a control room. Three of the people we screened who returned from Wuhan turned out to be positive but thanks to our preparations, not a single person who was in contact with the three people caught the infection.
What were preparations like since March, when cases began to rise?
At the state control room, we formed 18 different divisions, including surveillance, isolation, treatment, mental health training and counselling. Each division would be headed by an officer, with teams reporting to them. Each district had a team of 15 divisions. Very swiftly, we were able to transform district hospitals into corona hospitals. But with the number of cases increasing, we are taking over some private hospitals and hotels, in preparation for the coming days. Planning and vigorous training have been key.
Does Kerala have enough personal protective equipment (PPE) for healthcare workers?
Protecting our healthcare workers is one of our biggest concerns because if they fall, who will treat the patients? At the time of Nipah, we got PPE and other equipment from the Gulf via a chartered flight, thanks to VPS Healthcare (headquartered in Abu Dhabi). But this time, no one can really help us because every country needs it. The situation is so dire that (Malayali) nurses in the US are calling and asking me if we could send them some gloves and masks. What we did was to collect as much masks and PPE as we could when we heard about the spread of coronavirus. We have not reached a state where we cannot treat patients because we don’t have the necessary equipment. We are continuing our attempts to collect as much protective equipment as we can.
What about ventilators?
Coronavirus is spreading fast but so far, those who are facing difficulties and need ventilators are those with comorbidities. The rest are stable; we have been able to treat and discharge them. But as part of preparing ahead, we have taken a count of the ventilators we currently have and we know we will be able to get over 2,500 ventilators through the government route. We have given orders to purchase another 5,000 ventilators but they are hard to get because the entire world is rushing to buy them. We hope to get them little by little. At the moment, we have enough ventilators. If we face a situation where a lot of people, particularly the elderly, have to be admitted in hospitals, we will need more. To prevent this, we have launched a separate campaign to protect the elderly under the social justice department.
What are the plans to ramp up testing?
We are making rapid strides. As of now, nine labs have been given permission to test. Currently we are able to test 1,000-1,500 samples a day. The Rajiv Gandhi Centre for Biotechnology (in Thiruvananthapuram) was the last to get permission, and once trial tests there are done, we should be able to run 2,000-3,000 tests a day. There are also discussions about starting rapid testing, with random checking, to see if there is community spread. The machine has arrived, we are waiting for the kits.
What do you see as the biggest challenge in the days ahead?
Throughout Kerala, we have kept over 1.2 lakh beds ready to admit patients. Of these, about 5,000 will be ICU beds with ventilators. So that aspect is taken care of. The challenge will be if community spread begins. Contact tracing will become tough since Kerala is a state with a very high population density. It is to prevent this that we started the ‘Break the Chain’ campaign and made social distancing compulsory. It has done well, but there will always be one section of people who doesn’t want to abide by the law, who wants to defy it. We are taking very strict action against those defying norms.
How much sleep are you getting these days?
(Laughs) Well, I have all kinds of meetings every day. Each district has different problems. Unless there is good coordination, the work in districts will go awry. Even as we handle Covid, hospitals at the periphery need to continue doing regular treatment. Those with lifestyle diseases should not be denied their medicines. Patients on dialysis should not have to miss it. There are many concerns like this. Then, the morale of doctors should not dip — we have to let them know we are with them, always. We also have to have reviews and meetings every day to plan for the next day. By the time I leave office, it’s past 11 pm. When I get home, I’ll have to call a few DMOs personally. Apart from all this, I get lots of calls throughout the night, some from abroad, some from people seeking solace, wanting to share their troubles. I attend what I can — by the time I get done with all of this, it’s very late. I try and sleep a little. The next morning, it will be time to become absorbed in work again. And this is not just me, it’s all of us.