By Dr George Jacob

Kochi, June 2, 2020: Since late December 2019, the world has been at the mercy of a tiny microbe. The 120 nm-sized virus, SARS-CoV-2 that allegedly originated in the wet markets of China’s Wuhan has been wreaking global havoc, infecting and killing many through ‘pneumonia-like’ infection which the WHO christened COVID-19.

After SARS-CoV-2 was done with the dragon, it clambered up the Great Wall to target Europe. After taking apart Italy for starters, it caused death and damnation across Western Europe. Later it sailed the Atlantic to knock on American doors. The doors of the White House too opened wide to welcome this tiny visitor, which had the man of that house dance to the ‘microbial tune’!

Many Americans weren’t lucky to watch that dance. They were dead by the time the dance and the tune reached their zenith! In January, the virus had decided its next destination-India. The densely populated South Asian nation had no choice but to turn prey. The sitting duck was easy meat for the seemingly ruthless virus. The first case in India was reported among three students studying in Wuhan. They had returned home to Kerala, with the virus in their luggage.

Kerala was no stranger to viruses. The state had spectacularly staved off the Nipah Viral epidemic in May 2018. 23 had contracted the dreaded disease transmitted by fruit bats, and 21 succumbed. There were no more infections. No more deaths. Kerala had vanquished the viral villain. The weapons employed? Meticulous tracking of contacts, effective implementation of quarantine, educating the public about the strange viral infection, humility and ego-free attitude to coordinate with nations familiar with the virus like Malaysia and Singapore. Kerala was accorded standing ovation by the world, rest of India and her own relieved citizens.

Kerala didn’t want to take chances with this new viral villain, as the following timeline suggests; with reports of the very first few cases, the state government declared a ‘state calamity warning’. Contact tracing which had helped Kerala win the Nipah war, had her trace 3000 contacts of the affected and had them quarantined, 45 of them in the hospital.

By February the three COVID-19 positive students from Wuhan had recovered. With no more cases reported, the state withdrew the calamity warning, and even evacuated her citizens, most of them medical students stranded in Wuhan. They flew into Kochi international airport, and were quarantined in Kochi Medical College. Kerala’s war with COVID-19 had just begun.

The Kerala government had to swing into action soon. It declared high alert starting March 8, as more cases were reported. The state had isolation wards with 40 beds each set up in 21 major public hospitals. March 9 saw 4,000 in home or hospital quarantine. As of March 4, 215 healthcare workers were deployed across Kerala and 3,646 tele-counseling services were conducted to provide psycho-social support to families of the infected, proved and suspected.

March 10 had the government shut colleges and schools up to grade 7. People were instructed against undertaking pilgrimages, attending functions with large gatherings like weddings and funerals, and frequenting cinema halls and places of worship. Salons and workout centers downed shutters. Clearly, Kerala was many steps ahead than rest of India in the fight against COVID-19.

The same day saw Kerala set up special isolation wards in prisons across the state! The government launched a mobile App, GoK Direct that provided information and updates about the new virus. March 15 saw another milestone in Kerala’s battle against the Coronavirus. An initiative, ‘Break the Chain’ was introduced by the government to educate people about the importance of public and personal hygiene.

The campaign had the government install facilities for hand washing in public places. On March 19, the state chief minister announced a stimulus package of 200 billion rupee to help Kerala cushion economic hardship caused by the emerging pandemic. The breakup- 5 billion for healthcare, 20 billion for loans and free rations, 20 billion for creating jobs in rural areas, 10 billion for families in financial straits, 13.20 billion for paying two months pension in advance.

The chief minister ordered a state shutdown from March 23 to 31. This was a step ahead by a day than the first national shutdown ordered by the prime minister for 21 days. The saying, ‘What Kerala thinks today, India does tomorrow’ indeed was fructified. Public transport ground to a halt. Private vehicles were permitted to ply on production of an affidavit of the purpose of travel, and IDs. Shops were allowed to function within constricted timings. Kerala became the only Indian state that mandated quarantine for 28 days, as against the national policy of 14 days.

With sanity apparently restored in Kerala as the viral pandemic was tearing through the rest of India, the state had another task of humongous proportion and responsibility to perform-that of opening her doors to her citizens residing abroad and in other states –citizens, who wanted to return to the apparent safety of their home state.

The state government adopted this responsibility as its policy. It owed it to Malayalee expatriates, who had contributed substantially through remittances to the state’s economy by turning blood to sweat in the arid and unkind deserts of the Persian Gulf nations, war-ravaged Iraq, Syria, Libya and Yemen, and peacetime Europe, North America and Australasia. Keralities working in other Indian states also had to be welcomed into the state.

Challenges were huge; the most prominent- most of the Persian Gulf nations and other Indian states were, by then viral hotspots. Bringing in people from those places meant bringing in possible carriers of the virus- a sure recipe for the much-feared community spread of the virus. The government did not dillydally on its decision, and the people in Kerala kept their doors open for their brethren in distress.

At least 427,000 Non-Resident Keralites registered on the NORKA (Department of Non-Resident Keralities Affairs) portal, of which about 169,000 constituted those who lost jobs, those released from prisons, the pregnant, the elderly and students who had completed their courses, those whose visa and employment contract had expired.

The government formulated pre-arrival and post-arrival protocols. A sea of humanity was to reach Kerala’s shores by air, road and water. As of May 27, Kerala received its fold 9,416 who came by air, 1,621 by water, 5,363 by rail and 88,968 from other states by road. Kerala which had days with no new COVID-19 cases to report in early May, and had been trumpeted ‘as the only Indian state to have flattened the viral curve,’ saw a flurry of cases by late May.

The ‘reverse migrants’ made up the bulk of cases that ran to double figures daily. May 28 had the biggest spike in a day in Kerala with 84 testing positive, and one succumbing.

Kerala’s chief minister in his daily press briefings once again needed to speak about COVID-19 cases in Kerala grow by double digits. Five days into the second half of May saw 273 new cases, the majority comprised of people having returned.

This is no glad tidings for Kerala, a state which stood at the threshold of recounting to the nation and the world another success story of having vanquished yet another virus; SARS-CoV-2. Almost.

What needs to be done?

• Serious lacunae in testing and rampant flouting of Standard Operating Procedures while allowing expatriates from the Gulf Nations board homebound flights have caught the government’s attention. It has been largely alleged that testing of ‘reverse migrants’ is compromised big time, and inferior testing methods employed. The federal government needs to step in to ensure through Indian High Commissions that nations from where ‘reverse migration’ commence adhere to stringent and quality testing standards.

• Those returning to the state must, without compromise and reservation observe quarantine as prescribed by Kerala health authorities. There have been reports of returnees’ reluctance to observe quarantine formalities. This cannot be condoned. If there’s one measure that will stand in good stead for the state, with people returning from viral hotspots, it is quarantine. The police force must be employed to ensure people stick to quarantine requirements religiously. If people cheat on home quarantine, institutional quarantine must be adopted stringently. Those compromising on quarantine must either be fined heavily or quarantined in prisons, spruced up for the purpose.

• Kerala’s priority in taking on the pandemic seems to have taken a detour overnight. The state seems to be more involved in restoring health to a flagging economy by opening the shutters of bars and beverage outlets-traditional all-weather geese that lay golden eggs into the state’s coffers, much to the glee of the denizens of the ‘tippler Indian state’. The government, intending to limit rush at liquor outlets, decided to have Malayalees form virtual queues using an app-Bev Q. Happiness of the average Malayalee knew no bounds as the App was made available for download from Google play store. Initial teething troubles had the ‘spirit’-starved Malayalee fret and fume, as confusion reigned in the functioning of the App. ‘spirit’-starved Boozers had patience run dry as OTPs never made it to their mobiles. Corona, or not, the Malayalee had to have his daily ‘spiritual’ reinforcement; there was no compromise on that. Visual media on May 28, which had Kerala record highest number of COVID-19 positive cases per day, ever- 84 showed long queues, with no distancing between people- social or otherwise, before bars of hotels where people were being quarantined. Knowing Kerala, and her citizens’ liking for the ‘spirits’, it wouldn’t be surprising if people, out of sheer desperation observe quarantine by queuing up before bars!

The Kerala government’s priority right now is not to have its citizens ‘spirit-happy’, to spruce up its economy by having citizens queue up before bars flouting social distancing. Though the end appears credible, there’s sheer madness in the means. Kerala must examine other healthy means to revitalize her economy.

Attempting to do so by having her citizens guzzle down liters of the damaging ‘spirit’ has been Kerala’s traditional modus operandi. The humble request of Kerala’s healthcare providers who are on the frontlines braving the virus is to abandon that time-tested methodology in these apparently inflammable ‘Covidian’ times.

Alcohol will have crime and road accidents spurt, burdening overburdened shoulders of the police and healthcare providers. The need of the time is to prioritize on wholesome health of citizens, rather than economic health. Economic health has always been traditional hand baggage of states with healthy citizens. The priority shall be to tame the virus with whatever it takes.

The government must legally make punishable non-use of masks, spitting and smoking in public, being found inebriated in public, and flouting social distancing. It seems the virus is here to stay.

(The write is a Consultant Surgical Gastroenterologist in Lakeshore Hospital, Kochi, Kerala)