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India’s densely populated state breaking coronavirus chain

Southern Kerala state has some lessons for South Asian countries to tackle pandemic without affecting livelihood of people

Iftikhar Gilani   | 24.03.2020
India’s densely populated state breaking coronavirus chain file photo


As the coronavirus pandemic is posing a challenge for South Asian countries in the wake of their large populations and poor health infrastructure, India’s southernmost state of Kerala, which reported the country’s first COVID-19 case, has some lessons for the region and their leaders.

Experts believe that poverty and illiteracy are also hampering the processes of detection, testing, isolation, and quarantine in South Asian countries. The leaders of all these countries are also in a big dilemma as enforcing a complete lockdown like China and Italy may break the virus chain, but will have cascading effects on the food chain.

On the shores of the Arabian Sea, the province of Kerala houses a population of 35.4 million and is one of the densely populated regions. Against India’s nationwide density of 420 people per square kilometer, the state inhabits 860 people per square kilometer. Moreover, 3.5 million inhabitants are employed abroad, mostly in Gulf countries.

There was every possibility that the region will get affected by the epidemic in large proportion, says Amar Fetle, former health secretary, who handled last year's floods and 2018 Nipah virus epidemic in the region.

After declaring an alert as early as on Jan. 17, the state announced a medical emergency on Feb. 3. The screening at the airports was also started quite early. According to the state’s Health Department, 40,000 people have been kept under surveillance, mostly at their homes. The state has so far reported 95 confirmed cases of COVID-19.

Speaking to Anadolu Agency on phone, State Health Secretary Dr. Ranjan Khobragade gives credit for controlling the epidemic to airport screening and largely to the cooperation by the public.

More so, before locking down or asking people to self-quarantine, the government had announced 200 billion Indian rupees ($2.6 billion) package to address economic distress and loss of jobs arising out of the epidemic.

“We are disbursing free rations to whole population irrespective of economic criteria for this month of March, “he said.

Unlike its neighboring provinces, Kerala lacks economic and industrial development, but tops in the human development index. It is the only region in South Asia with 100% literacy rate and a remarkable gender ratio, according to the last census conducted in 2011.

Surveillance system at airport

According to Khobragade, the first case was detected on Jan. 31 because of the surveillance system put at the airports. The history of all those, who return from abroad, is maintained and shared with multiple agencies -- including primary health centers near their homes.

“Those who had come three months prior to when screening actually began, were traced and tested. Furthermore, without disclosing their identity, their travel history within the province was advertised, so people from those areas come forward for testing and take precautions,” he said.

“The Bureau of Immigration is sharing the data with us. That forms the key basis to trace people to go with the screening at airports. There is a system of voluntary disclosure at the airports. We have asked our local civic bodies and field workers from the health department to keep a tab on communities for people who have returned from abroad,” said Khobragade.

Meanwhile, the 800-member strong State Medical Association volunteered to send squads of doctors to district headquarters to lessen the burden on the state’s health apparatus. The scarcity of masks and dispensers was addressed in the way that all prisons in the state were asked to manufacture them.

“We provided the raw material and within three days they manufactured 6,000 masks and thousands of liters of the dispenser,” said the health secretary.

While educational institutions are closed, but 375,000 children are provided mid-day meals at their homes. It is mandatory for all government schools in India to provide free midday meals to students. But sending meal to their homes is a novel experiment.

A network of women’s self-help groups called Kudumbashree, launched almost a decade ago, has been tasked to handle community kitchens to cook food for school children and for restaurants. The government has asked restaurants not to sell food for more than 20 Indian rupees ($0.26). 

Moreover, telecom operators were asked to strengthen the broadband system to allow people to work from home. The state libraries are also working overtime providing books to those in quarantine. Besides engaging psychologists for infected persons put under quarantine, the patients have been allowed to use laptops and other communication devices. Two robots have been deployed to distribute masks and dispense sanitizers by spraying it on people's hands in Kochi, the largest city in the province.

Complete lockdown to hit economy

According to a World Bank report, about 24.6% of the South Asian population falls below the international poverty line of $1.25/day. According to the 2011 census, India accounted for 21.9% population living below the poverty line. Pakistan houses 24.3% below the poverty population, as per figures available with the Asian Development Bank.

Leaders in these countries are asking people to observe self-quarantine, as they fear that a complete lockdown will hit the economy below the belt and will lead deaths due to hunger. Pakistani Prime Minister Imran Khan put it quite succinctly that he cannot afford a lockdown as it would have an adverse impact on daily wagers.

There was almost a similar message from Indian Prime Minister Narendra Modi in his address to the nation. He said the burgeoning crisis of coronavirus is not an ordinary occurrence for a nation like India with a population of 1.30 billion, striving for development.

According to data collected by India’s Health Ministry, there is one isolation bed per 84,000 Indians, and one quarantine bed per 36,000 Indians. The data, collected in the wake of the coronavirus outbreak, stated there is one doctor per 11,600 Indians, and one hospital bed per 1,826 Indians.

Also, there are just 40,000 ventilators all over the country.

According to the National Health Profile 2019, there are 1,154,686 registered doctors in the country and 7,39,024 government hospital beds. The situation is quite similar, or even worse, in some South Asian nations. But there are definitely lessons for these leaders to take from Kerala provincial government and its steps to break the chain of the virus, and in the same breath to keep the food chain intact so people do not start suffering from hunger.

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