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| SHORT COMMUNICATION |
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| Year : 2020 | Volume
: 2
| Issue : 2 | Page : 167-168 |
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Coronavirus Disease 2019: The Success Story from Kerala, India
Roy Abraham Kallivayalil1, Arun Enara2
1 Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Thiruvalla, Kerala, India
2 Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| Date of Submission | 20-May-2020 |
| Date of Decision | 29-May-2020 |
| Date of Acceptance | 01-Jun-2020 |
| Date of Web Publication | 14-Aug-2020 |
Correspondence Address:
Prof. Roy Abraham Kallivayalil
Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Thiruvalla - 689 101, Kerala
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/WSP.WSP_42_20
Kerala, a state in the southern part of India, has recently been in the news for its successful handling of the coronavirus disease 2019 pandemic. Here, we briefly share the various factors leading to this success so that these can be learning points for others. The successes of the State's strategies are attributed to a multitude of factors. A firm rooting on evidence-based public health, the high rate of literacy among its population, the investment in universal health care, the unique sociocultural and political fabric, and the strict but humane approach of the bureaucrats and civilians alike are some of the factors that played a key role. It is a reflection of the consistent efforts of the State in diverting significant resources every year toward building public health infrastructure, trusting village-level bodies with autonomy and funds, and promoting shared values that encourage social cooperation. The multidisciplinary teams provided counseling and psychosocial support for people in isolation and quarantine. The focus was also on tackling the stigma surrounding the virus. There are also lessons to be learned from how Kerala treated its migrant population of workers, rechristened as “guest workers.” Thus, a multipronged approach, based on a combination of science and social–humanitarian values, was successful in meeting this challenge.
Keywords: Coronavirus disease 2019, health strategy, Kerala, public health, values
How to cite this article:
Kallivayalil RA, Enara A. Coronavirus Disease 2019: The Success Story from Kerala, India. World Soc Psychiatry 2020;2:167-8 |
Kerala, a state in South India, has been in the limelight for its effective strategies in tackling the coronavirus disease 2019 (COVID-19) pandemic.[1],[2] The successes of the State's strategies are attributed to a multitude of factors. A firm rooting on evidence-based public health, the high rate of literacy among its population, the investment in universal health care, the unique sociocultural and political fabric, and the strict but humane approach of the bureaucrats and civilians alike are some of the factors that played a key role. The first case in India was detected in Kerala on January 30, 2020, in a student returning from Wuhan, China. Taking inspiration from its own success story of containing the Nipah virus outbreak in 2018,[3] Kerala was quick to respond to this challenge by scaling up services and firmly rooting its policies on “testing and tracing” as per the WHO recommendations. This was in stark contrast to the strategies based on herd immunity, which reflected in the policies of many developed countries. Kerala's immediate plan involved tackling of emergencies, contact tracing, case isolation, quality care, district monitoring, risk communication, and community engagement. The fundamentals were solid and the State relied on testing aggressively with excellent contact tracing strategies.
The success of the Kerala model did not happen overnight. It is a reflection of the consistent efforts of the State in diverting significant resources every year toward building public health infrastructure, trusting village-level bodies with autonomy and funds, and promoting shared values that encourage social cooperation.[4] Throughout its efforts in containing the pandemic, Kerala prioritized the care of the most vulnerable sections of the society and also placed mental health at the forefront of its agenda during the pandemic. Various projects such as District Mental Health Program, “DISHA,” a 24 × 7 tele-health helpline under the Department of Health and Family Welfare, were brought together to strategize and implement mental health initiatives. The multidisciplinary teams provided counseling and psychosocial support for people in isolation and quarantine. The focus was also on tackling the stigma surrounding the virus, and this was evident when the State requested the members of the public not to stigmatize COVID infections since this would potentially lead to under-reporting, misinformation, and lack of cooperation. This facilitated an open approach not only in clarifying queries but also in sharing concerns. The State machinery also announced loan assistance, welfare pensions, free food grains, subsidized meals, tax relief, and arrear clearance in the face of this epidemic much before the rest of the country.
There are also lessons to be learned from how Kerala treated its migrant population of workers. Rechristened as the “guest workers,” the State prioritized the care of this special group and placed their security and well-being at the forefront of its initiatives. This involved making brochures and short videos in the “guest workers” native language and also redeploying members of the staff who could converse in these regional languages to improve engagement with these particular groups. The “guest workers” were also offered free food and shelter. The State as well as voluntary organizations arranged call centers in at least five languages commonly spoken by migrants.
When some people around the world tweeted about miraculous cures and medicines, the State leadership told the public that there were no miraculous cures yet and also urged them to “let science do its job.” In the heart of all, this was a society rooted in humanistic values and an approach that is community oriented to deliver and implement health services. On May 17, when COVID-19 death toll was 312,000 in the world and 2872 in India it was only three in Kerala.
The State also took measures to reduce the boredom and loneliness experienced during the isolation, with a view to fostering mental health. The internet network capacity was increased by 30%–40% to meet the surge in demand. Leading newspapers published scientific articles from leaders in the field. There were also collaborative initiatives to distribute books on the theme of mental wellness and motivation. To tackle the growing public fear and panic regarding the outbreak, resulting in discrimination against families and acquaintances of quarantined and isolated people, the State took measures to spread awareness, monitor social media for the spread of fake messages, and fact-check and ensure the services remain transparent and people-friendly.[5]
There are things that Kerala could have still done better. The sudden banning of alcohol led to withdrawal complications including suicide which was not fully anticipated. Moreover, the new challenge is the returnees coming from overseas as well as from other states in India, many of whom may be infected. Kerala can be expected to face this difficult task as well, although it poses a formidable challenge.
The Kerala COVID experience also questions the prevailing notions of expertise in global health. More than 80% of global health leaders are nationals of high-income countries, and half are nationals of the UK and the USA. Post-COVID-19, the claimed expertise in global health calls to be re-examined. This pandemic has exposed the lie that expertise is concentrated in, or at least best channeled by, legacy powers and historically rich states.[6] Kerala model throws light on many neglected and often overlooked ideals, especially in the face of a pandemic. It also offers a peek into the ideals on which the state was built on.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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| 3. | Ajith Kumar AK, Anoop Kumar AS. Deadly Nipah outbreak in Kerala: Lessons learned for the future. Indian J Crit Care Med 2018;22:475-6.  [ PUBMED] [Full text] |
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| 6. | Dalglish SL. COVID-19 gives the lie to global health expertise. Lancet 2020;395:1189. |
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