The official pandemic response in Kerala (January – September 2020)

Graph 1: Comparing Kerala’s Epidemic response to National guidelines issued (January – September 2020)

Kerala was lauded for being both, the most responsive to the pandemic, as well as the most effective in its state response to the pandemic. Oftentimes, the state’s response was seen as more restrictive than the national response, especially in the early days of the pandemic. As we will see, subsequent state action was aligned to national directives. Although there was initial success, Kerala’s case numbers have steadily climbed. Recent case numbers show that Kerala has at times even overtaken Maharashtra in its case numbers. This blog traces the pandemic response of the state with the four ‘Lockdown’ phases and four ‘Unlock’ phases of the Government of India comparing responses and finally demonstrating the impact in numbers from the state’s own dashboard. From March to September 2020, the Government of India issued 61 orders and letters to states regarding the pandemic; in the same period, the State Government of Kerala issued 68 government orders and circulars. This blog reviews those orders, juxtaposing state action with national action for pandemic response.

Kerala started early, earlier than most national governments the world over. Within a week of the WHO notification of the novel Coronavirus on 14th January, a Primary Control Room was set up with comprehensive guidelines on screening, testing, and admission issued. All airports followed pandemic protocols, isolation wards were set up in hospitals near these airports, and education and entertainment centres were closed. The machinery established to respond to the Nipah virus was now mobilised in all 14 districts of the state. By early February, with large numbers of workers returning home from the Gulf states, testing in state laboratories was now functional. At the national level, in January, early travel advisories had been issued and only passengers from China and Hongkong were being screened at three international airports.

The Kerala’s response in the pandemic’s first three months was a combination of the rapid action described above, combined with concerted action from March 2020 onwards. The first order issued ensured centralised control under the office of the Chief Secretary; in short, all action was to be coordinated directly by the Chief Secretary’s office and unified communication was to be issued. The second pillar of response was the War Room. In its original avatar, the War Room was a 24/7 contact centre for complaints, transportation, and logistics. The War Room was restructured in August to include a focus on increasing testing (including by private labs), ensuring the availability of health professionals, medical equipment, PPE, and adequate treatment facilities, and monitor the flood situation int the state. Finally, movement and safety protocols were issued, controlling behaviour to prevent community spread.

From March to May 2020, invoking the National Disaster Management Act, 2005, the Government of India had four successive Lockdowns, preceded by a national travel ban. From the first to the fourth lockdown, the strategy moved from complete containment of movement of people to defining hotspots or containment zones where people’s movement would be completely curtailed. In these periods of lockdown, movement of people was restricted to essential trade and orders to protect migrants on the move. From June to September 2020, each month had a successive “Unlock” period where restrictions of people’s movement were gradually relaxed, except within the containment zones (red). With the fourth “Unlock” period, free travel of people across states was permitted, and states were permitted to specify geographies smaller than districts such as wards or blocks for containment. By early May, states were ordered not to dilute the centre’s guidelines, and in August, states were no longer permitted to restrict inter-state movement, or issue special permits for movement of goods and persons.

From April 2020 onwards, Kerala launched its “Break the Chain” campaign. A reading of government orders and circulars shows that there were five pillars of this campaign. First, the state government aligned its action with national government orders. Often within 24 hours of the Central government issuing an order (or clarification), the state government would issue its own order, appending the national order, and clarifying how those orders would play out at the district and local levels. Second, Kerala placed strong emphasis on border control. Within the state, this translated into guidelines for the movement of people into and out of containment (red) zones, and across district boundaries. Within districts and cities, various restrictions were in place: For May and June, Sundays were under strict lockdown; Even in September, a night curfew (9pm to 5am) was still in place; All banks were closed on weekends; and for an entire month, Thiruvananthapuram district was shut down. The state also issued detailed guidelines for the movement of people into and out of the state, including through international borders (air and sea ports). Here, the state’s Covid19Jagratha portal, initially developed to trace people coming in from international ports, developed over the months to a comprehensive information and contact tracing portal. The state even made special requests to the Indian Missions in the UAE, Qatar, Kuwait, Oman, Saudi Arabia and Bahrain to test returnees before they boarded the plane.

Third, the state adapted existing facilities for COVID19 use. Given the strong tourism and hospitality infrastructure in the state, in May, Kerala ordered that at least 10 hotels per district be offered to international returnees to quarantine in. Initially Kerala Tourism Development Corporation (KTDC) hotels were assigned; district administrators would add to the list with private operators subsequently. In addition to hotels, Kerala ordered the setup of COVID Firstline Treatment Centres (CFLTCs) and Reverse Quarantine Facilities with at least 100 beds each to isolate the vulnerable from possible infection if quarantine facilities are not available to them at home. Fourth, these actions were accompanied by publicity campaigns and the establishment of helplines in each district.

Finally, the state issued two related ordinances. First, on 27th March, the Kerala Epidemic Disease Ordinance was published, followed by the Kerala Epidemic Disease Corona Virus Disease (COVID-19) Additional Regulations, 2020 was issued on 2nd July. This specified eight main restrictions, including mandating facemarks in public and while traveling, maintaining a six feet distance, the maximum number of participants at weddings and funerals (50 and 20 people respectively), banning social gatherings larger than 10 people, banning spitting in public, mandating that all travels register on the Covid19Jagratha portal, and finally, suspending interstate carriage road transport.

Graph 2: Kerala’s COVID19 Numbers from the state government dashboard (January – September 2020)

From the numbers above, it is obvious that for the first half of the year, when the state government was in complete control of the pandemic response, the numbers were under control. There appears to be a strong correlation between the rise in Kerala’s COVID19 numbers from July onwards and the Government of India’s Unlock phases. Given that so much of Kerala’s response was predicated on the control of people’s movement, having to surrender that strategy has resulted in the freer movement of people, and subsequently the spread of the virus.

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About Kimberly Noronha