There could be no disagreement that the challenges faced by the government in the health sector in the past five years have been unprecedented or that these have tested the health system’s capacity, responsiveness and resilience, like never before.
The State managed the Nipah outbreaks in 2018 and 2019 admirably. It also sounded the first warning signals that the health system had to prime itself to deal with many unknown and dangerous pathogens in future.
Understandably, the manner in which Kerala has gone about COVID-19 containment is something that the government is immensely proud of and is one of the strong electoral planks on which the current Assembly elections are being fought. Kerala based its initial containment strategies on the lessons it learnt from Nipah, but it was soon evident that the engagement with COVID-19 was going to be long, agonising and unlike anything the State has dealt with before.
After an year of COVID, when one takes stock of the year that was, there is no doubt that Kerala did alright and much better than many other States too.
Initial stages
“There was some bungling in the initial stages of the pandemic, when the State seemed to take many irrational steps as far as testing protocols, quarantining, etc., were concerned, but a lot of things were done right also. It did contact tracing and isolation to a fault, followed up patients, provided free treatment to everyone, equipped hospitals and its biggest success was that at no point during the pandemic did the cases exceed the health system’s surge capacity,” points out Arun N.M., an infectious diseases physician.
The government also succeeded in getting across to the people the vital message on how COVID prevention was important. In fact, it was almost 100% public compliance of COVID protocols, especially masking, that won half the battle for the Health Department.
People who were used to stories about the dismal state of public health were impressed at the meticulous manner in which the back-end team at the Health Department worked.
“I was quite impressed by the fact that I was called almost on a daily basis by someone from the Health Department or the urban public health centre. In fact, the mental health care team must have made more calls to me than my family did,” says a city resident who had been admitted to a private hospital for over a fortnight after he tested COVID positive.
There were possibly many things that could have been done better but it is to the government’s credit that even when nations with better resources faltered with COVID containment, Kerala never allowed the epidemic to run riot. None died waiting in ambulances or because of lack of care as it did in the West.
Data management
Even when appreciating COVID control, public health experts and the academicians are quite unhappy about the high-handed manner in which the government handled many decisions relating to COVID, the abysmal data management and how the scientific community was never heard during the pandemic.
Anthony Fauci was the voice of sanity and the face of pandemic management in the U.S. and Sir Patrick Vallance in the U.K. In Kerala, the scientific community had no role at all.
“The government could have been more transparent and scientific in its approach to the pandemic. The people who were considered experts in public health or epidemiology were never seen and no explanations were given as to the decisions made. The epidemic was always dealt as a political issue by both fronts,” points out K. Ramankutty, renowned public health expert.
The government discouraged all clinical research and beyond generating daily reports, disaggregated data on the pandemic were never shared with the scientific community. All attempts by clinicians and epidemiologists to enlighten the government on proper COVID death reporting and making it more scientific were stonewalled by the government because it was unwilling to upset the narrative that the State had the lowest case fatality rate.
“It is alright to be proud of our achievements but unless we explore our weaknesses, we cannot grow in strength. But what drove the government all through the pandemic was this irrational urge to boast to the world that we were one step ahead. Not only was it unrealistic, it also prevented us from bettering ourselves,” a senior public health expert says.
