“Watch out for influenza-like symptoms and report to public health officials if you have them. We have to wear masks, use sanitisers and each person must try to not spread the infection to another person. If everyone is vigilant, we will be able to contain the spread,” is the advice that Shailaja Teacher, as she is affectionately known in the state, has for everyone.
The Health Minister of Kerala, a former school teacher, is a household name in the state and has been talked about in glowing terms in international media for spearheading the successful campaign against the pandemic, something that more powerful and more prosperous countries and states within India have failed to do. The very disarming KK SHAILAJA spoke to ASHLIN MATHEW
When there were just 500 cases in the country, we went into a lockdown; but now that cases are spiking and are over 200,000 we are opening up. Does it make sense?
Locking areas where there are a large number of positive cases is the best way to contain the virus. The maximum number of cases currently have been reported from 17 high-density cities such as Chennai, Delhi,Lucknow and Mumbai. Travelling from these cities to other states now will cause problems and spread the virus in those states. While travel from these cities should be restricted, people in these cities should be looked after,given food and medicine, tested, quarantined and isolated systematically.
Kerala had requested the Central government to prioritise travel and allow pregnant women, people who had lost their jobs and had no one to take care of them and people who had planned to visit Kerala for medical treatment to travel first. We also said that all those who wanted to travel to Kerala had to register on the NORKA(Non-Resident Keralite Affairs) website.
Around three lakh people registered from overseas and four lakh registered from across India. We requested the central government to instruct our embassies in foreign countries to issue travel passes to those who had registered online. But the embassies did not pay any heed to our request. So, a lot of people who needed to travel to the state urgently were not able to.
Those who were travelling by road had to get a pass from the state they were coming from and also a pass from Kerala. But several people came without passes. At several check posts there were more than 5,000 people with and without passes clamouring to be allowed in. But it was not possible to screen all of them without advance notice.What is problematic in the guidelines released by the Centre is the opening up of religious institutions. But no mass gatherings or festivals can be allowed. If we don’t follow physical distancing, we will have to bear the consequences.
How do you explain the success of the Kerala model?
I don’t know why the Central government didn’t act sooner. But in Kerala, we started preparations even before we had a single case. Political parties asked us why we were creating panic, but I explained in the Assembly that containment was the only solution.
Initially the virus did not spread to the villages. It was detected in certain epicentres and if we had controlled and contained the epicentres, we could have stopped the spread of the virus into the villages and rural areas. But now everyone has gone back to the villages and that is a cause of concern.
In Kerala, if we find a COVID-19 positive case in a village, we lock down the village. We do not let anyoneenter or leave. But we ensure that all their needs are taken care of. In nearby villages all activities – farming,construction -go on as usual. We need to ensure livelihoods not affected while following guidelines.
Reports suggest you are now seeing an upsurge in cases as more people are returning to the state. How do you plan to cope?
Until May, we had only 512 cases and we had only three deaths. We treated all the others successfully and the survival rate was 93%. We will be able to handle up to 25,000 cases, but beyond that it will become difficult for us.Let us hope that will not happen.
We have three plans – Plan A, B and C. In Plan A we decided when a smaller number of patients come, where would they be admitted; Plan B is when 5,000 patients have to be dealt with and Plan C is for a number higher than that.
We have identified 600-700 beds in medical colleges,isolation wards, district hospitals and taluk hospitals. We have asked ourselves what would we do if number of positive cases increase to 50,000. That would be an extremely risky situation. Now the medical team has an answer to these questions- we will take over primary health care centres, hotels and auditoriums. They will all be converted to COVID hospitals.
We also keep reminding the staff about these plans so that they immediately know what to do when the situation reaches a certain stage. If the number crosses 100 in a district, they know where patients will have to be admitted. If we fill medical colleges in the beginning itself,what will we do if the next patient requires ventilator support. We won’t be able to move the serious patients then to the medical colleges. So, we will move patients to near by hospitals first before filling up a COVID speciality hospital.
We encourage home quarantine for all those who can afford it. If a person turns positive for Coronavirus, it is fine, but more people should not contract the virus from that person. That is Kerala’s policy.
The Chief Minister Pinarayi Vijayan had requested for volunteers and almost 2.5 lakh people registered online.These volunteers were trained how to engage and deal with people who were under quarantine. They were trained on how to deliver food and other necessities to these households.
We are checking for pneumonia and SARI (severe acute respiratory infections) cases in the state and according to reports, there has been no spike in their numbers. We are sending all SARI patients and all those with respiratory illness for COVID-19 tests. We found a few positive cases amongst them.
We are only afraid if all of a sudden more than 20,000 COVID-19 positive people reach Kerala at a time. We are hoping that will not happen. Another worry is that all those working in COVID specific hospitals are likely to be tired. But so far they are all working enthusiastically and going strong.
What worries you at this point?
What we have to be worried is not the number of rising cases, but the vulnerability of patients who are testing positive. We have to take care to ensure patients who are older, differently abled and with comorbidities are safe.
If they get affected, they will need ventilators, ICUs. All these are not limitless. There is a limit to these resources.If such cases cross 5,000, we will reach a situation where we may not be able to provide ventilators and ICU care to all of them. This number is including the ventilators in both private and government hospitals. We are confident of being able to use a maximum of 3,000 ventilators. We do not expect the numbers to reach this high.
Currently, most patients who are positive are stable.Only 10 of these require extreme care and attention. None of them are on ventilators. They are mostly people who have comorbidities such as diabetes, hypertension.
Kerala only had only three deaths till May 21 but the number is 11 at the beginning of June. Are a lot of critical patients reaching or returning to the state?
Yes. People are coming for treatment from high-density places. Several people who tested negative in the Gulf, test positive when they reach here. A woman drove with her family from Maharashtra to Thrissur. But by the time she was taken to the medical college, she died.
A person from Rajasthan reached Thiruvananthapuram by mistake. We admitted him in a COVID-care facility, but he passed away. Another death was of a severely affected cancer patient. We were surprised he reached here. He was admitted in the cancer hospital but he too died.
A lot of the people reaching Kerala are in a critical state. They should not be travelling, but maybe they are coming to see their family members. Travel is a risk. We have also heard of pilots and cabin crew testing positive.
Kerala has stopped testing asymptomatic patients. Shouldn’t we be testing them? Are we being wise about our testing strategy?
We have to keep in mind the number of test kits and resources that we have. If we exhaust what we have now,when more serious cases come, we will not have testing kits for them. Still, we are testing 3,000 people every day.
So, we are testing all symptomatic patients. We are sending all the asymptomatic patients to be quarantined.If they develop symptoms during their quarantine period,we will test them. But we are also testing random samples from people who have no symptoms.
Instead of looking at the number of tests done, we should be looking at the number of positive cases per every million people. Kerala acted early to trace and contain the virus, so cases have not spiked. The number of our tests are low because we have scientifically been able to trace and isolate patients.
How many RT-PCR test kits does Kerala have? What is the cost per test or per kit for Kerala?
We have only enough kits to last us 15 days if we do 3,000 tests a day. ICMR gives us a share of the kits they have ordered and the rest we are buying after putting out tenders. The Kerala Medical Services Corporation is handling this.
It costs Kerala around Rs 4,000 to conduct an RT-PCR test. This includes the cost of the test kit, reagent, the lab technician and several other costs. Kerala is not charging anyone for this. It is free.