Thiruvananthapuram: It was not long ago that K.K. Shailaja was being hailed as “Kerala’s rockstar health minister” as the state appeared to have got a handle on the Covid-19 pandemic. A few months down the line, Shailaja finds herself facing a resurgence of Covid in Kerala, has just managed to defuse a doctors’ strike in capital Thiruvananthapuram, and is contending with accusations of not having listened to experts.
However, in an exclusive interview to ThePrint, Shailaja said there were demographic and epidemiological reasons that made Kerala vulnerable to Covid-19, and it is because she listened to experts early on — and prepared for the worst — that the state has managed to keep casualties low. That is the primary target at this point of time, she said.
“Kerala has unique challenges that are demographic, epidemiological and socioeconomic. The last actually favours Kerala because our human development index is high, our poverty reduction is high, literacy rate is high and we can spread awareness,” she added.
“The other two are vulnerabilities. In Kerala, the population density is 856 people per sq km. In India, the average is below 500. That is the most important thing for the spreading of the virus. We have epidemiological vulnerabilities because lifestyle diseases are more,” she said.
Explaining how Kerala’s socioeconomic situation was also a challenge, she blamed people’s unhealthy lifestyles. According to the last National Family Health Survey, for 2015-16, Kerala is the non-communicable disease capital of India.
“Because of the socioeconomic factors, lifestyle changed and, with development, exercise is less, (there are) more junk food habits. Kerala is most vulnerable to lifestyle diseases… Experts predicted that if Covid-19 spread in all states of India, most deaths would be in Kerala because of this. We knew that, so we worked hard. The second phase also, we gave good results,” Shailaja said.
Kerala currently has the highest growth rate of Covid in the country. In the last two days, Kerala has recorded 10,606 and 5,445 Covid cases daily.
However, its death rate is among the lowest in the country — 0.36 per cent against a national average of 1.54 per cent.
Shailaja said the “ultimate question” in the battle against Covid-19 is, “How much life did you save out of this cruel thing?”
“We are trying our best to reduce mortality rate. Spread we cannot stop… we can try through Break the Chain (the state government’s Covid awareness campaign) etc, but you cannot completely stop it. (We are) trying (our) best to save life. It is not an easy thing,” she said.
Also Read: Command centre, Uber-like ambulance service — how Kerala’s Ernakulam has kept Covid toll low
Has Kerala hit Covid-19 peak?
In the first phase of the pandemic — from January, when Kerala recorded its first Covid case, to May — Kerala had less than 500 cases and two deaths. As of 9 October, it had reported 2,58,850 cases, of which 90,630 were active. Covid-19 deaths in the state stood at 964.
Asked if this is the peak of Covid in Kerala, Shailaja said: “We cannot predict that. (But) the peak predicted earlier was almost like this. After the lockdown lifting, IIT people and other experts predicted more than 10,0000 cases per day in September-October. Same thing happened. I also warned the society previously that the prediction of experts is that daily cases will be 5,000-10,000.”
She is clear that she expects no immediate respite from the pandemic. Even if it goes down for the time being, she added, “it will come back”. “That is why Kerala has made saving lives the priority,” she told ThePrint.
“Scientists are saying this will last for the next year too, because they are saying we will only get a vaccine by 2021. Until a vaccine comes, we cannot predict how long this will last,” Shailaja said.
She cited Great Britain as an example, saying it recorded one lakh deaths, and then an apparent “flattening of the graph”, but is now getting ready for a lockdown amid a fresh surge in cases.
“This virus will not stop. When the graph flattens, we will think that it is over, but it will appear anywhere any time because it is in society… When human beings move, it will travel,” she said.
She added that the challenge is asymptomatic transmission, which makes Covid different from Nipah, whose outbreak was successfully controlled by Kerala in the summer of 2018.
“In Nipah, you can see the suffering of the patients, cough, encephalitis etc, and only then it transmits. Here, asymptomatic people give it to others. That is why it is not very easy to suppress or contain properly,” she said.
Did Kerala declare early victory?
Shailaja dismisses any suggestion that the state might have made some mistakes that triggered the present outbreak. Asked if the state may have declared early victory, she said the state’s current case fatality rate (CFR) — the share of fatalities among Covid patients — is lower than in the first phase.
“Our strategy is to trace, quarantine, test, isolate and treat. That is the scientific method. We are tracing the people, we are quarantining symptomatic people, and isolating, and we are testing properly and treating also. The first phase yielded very good results, the transmission rate was 33 per cent and CFR 0.5 per cent… We are not going back,” she said.
“Unlocking is happening and we have to let businesses open too. We have to save lives and livelihoods… this time CFR is 0.3 per cent, so how can you say we celebrated early?”
According to Shailaja, the state’s ‘Break the Chain Campaign’, which urged people to use masks and sanitisers, worked, but only about 80 per cent of the public obeyed the guidelines.
She said movement from neighbouring Karnataka and Tamil Nadu, and the free movement across borders, has added to the problems. “You need to remember that this virus is peculiar, it is a new thing. It cannot be contained in a short span or in a short space. It is spreading, spreading, spreading because of mobility of people,” she added.
“Kerala cannot show a wonder, but we are working hard, that is why the CFR is low. In other states, over 10,000 people have died. Here, it is still below 1,000,” she said.
Also Read: Video calls with loved ones, prayers — life inside a Covid centre in Ernakulam
‘State has spent a lot’
Covid-19 has come as a double whammy for most governments, with revenue losses and the additional expenses putting them in a precarious situation.
For example, the RT-PCR test is hailed as the gold standard of Covid testing, but just the reagents for 10,000 tests could cost upwards of Rs 1 crore. Only 15 per cent of Kerala’s tests are RT-PCR, but it faces other financial challenges.
“We have spent a lot… I have not done the calculations but logistics, collections, medicines, transportation, more than Rs 5,000-6,000 crore, or Rs 8,000 crore or may be more. We are getting PPE kits, setting up ICUs, buying ventilators,” she said.
“The government of India gave us Rs 350 crore under the NHM (National Health Mission), which was a blessing. But we want more. Rs 1,000 crore would be a great blessing,” she added.
Asked about the steps being taken to help people facing the heat of the economic crisis triggered by the pandemic, Shailaja said the state has already announced a Rs 20,000 crore package and is continuing with its practice of distributing food packets.
‘Deaths have gone down’
Across the country, focus on Covid-19 has resulted in an inadvertent neglect of other diseases like TB. Management of non-communicable diseases is a challenge in Kerala, said Shailaja. However, she added that a government audit has shown that the number of “excess deaths” — or the additional deaths reported over the average of previous years — has gone down from January to July.
“We counted the excess deaths from January to July. We found that deaths were reduced. That is a very favourable thing we are eagerly watching. For NCDs (non-communicable diseases) etc, we have separate committees at the grassroots level, with the help of ASHA (assisted social health activists) workers and junior public health nurses, health inspectors,” she added.
“They are visiting every house and inquiring about health conditions and supplying medicines at the doorsteps,” she said. “That is why other deaths are not increasing… infectious diseases like dengue, H1N1, all are low. That is a good thing because of precaution and preparedness,” she said.
But she conceded that NCDs have ended up getting neglected, with much of the state’s healthcare force dedicated to Covid-19. “That balancing is not very easy. Our health staff have been working hard for the last eight-nine months,” she added.
Also Read: Kerala not reporting ‘nearly half’ of its Covid deaths, expert panel says process ambiguous
Pseudo journalist Shivam Bij’s favorite state for Covid control