Migrants in Kerala
Migrants in Kerala|Photo credit: Free Press Journal

The Jury Is Still Out On Kerala’s COVID-19 “Success” Story

As migrants from abroad and from other cities return to the state, the virus rears up again

Naveen Nair

Naveen Nair

The first week of the month of May had been tremendous for Kerala in its fight against COVID-19.

From the first of May to the eighth, the state had seen five days with zero COVID-19 positive patients and on other days the numbers had not gone beyond three. Kerala was heaving a huge sigh of relief.

Chief Minister Pinarayi Vijayan who had by now made media briefings a part of his daily routine since COVID-19 struck the state, displayed a rare exuberance when he met media persons last week - of having gained an upper hand in the fight against the deadly virus.

In fact Vijayan had been at his boastful best for the better half of April as cases started coming down in the state, something which the critics had been calling out as early celebration and chest thumping.

Perhaps proving the critics right, over the last few days, to be precise since May 07 the picture in Kerala seems to have changed dramatically.

When this report was being filed, the number of cases on a single day on May 14 had shot up to 26. Compared to other states the figure may still sound mediocre, especially with neighbouring Tamil Nadu bursting at its seams and Karnataka too not far behind.

But the fact that Kerala had gone from a zero-patient period with even continuous days of having a single digit figure to a double-digit progression certainly rings alarm bells of a third imminent wave of the virus.

“In the last so many days we have had only single digit cases in a day. Yesterday it suddenly became ten and now there has been an exponential rise. It only shows of an impending crisis that the state is likely to face in the days to come. However we are fully confident that we will overcome this phase too with all our might,’’ Chief Minister Pinarayi told media persons during his briefing on Thursday.

So even when the state claims it had flattened the COVID curve, something on which the jury is still out, there are a number of worrying indicators that this could be reversed in no time and if that happens what awaits the state could be a disaster.

The biggest hurdle before the state right now which has the potential to push down all the gains that it had achieved over the last three months is the mass re-migration of non-resident Keralites back to the state.

The ‘Vande Bharat’ mission undertaken by the union government to evacuate stranded Indians from other countries back to their homeland has been the first spoiler.

Add to this the huge number of Keralites in other states, some waiting and some already crossing the land borders into Kerala, the state looks at a mass influx of people, the numbers of which could actually prove to be a nightmare for any health expert hoping to contain a pandemic.

“What we need to understand here is that we are back to square one, right where we started from. Yes, we may have been better prepared the last time when we got the student from Wuhan which was the first case in the country and even when those NRIs who returned from Italy or the expat who arrived in Kasaragod and then set off local transmission. But then the numbers were low which made it easily to contain the transmission. But here we are looking at a steady flow of people not just from other countries but also from the red zones of other states in India. Hence the challenge is huge. We are up for it, but the outcome is difficult to predict at this point in time,’’ admits Dr Sulphi Noohu, Vice President of the Indian Medical Association (IMA), Kerala Chapter told The Lede at Thiruvananthapuram.

Immense Strain On The System

Certainly this re-migration into the state has set the cat among pigeons. In one way there is nothing much the state can do about it because these are people who need to be brought back and they cannot be denied entry into the state, a fact everyone acknowledges.

But have the preparations for such a scenario been on track? That’s the worrying question.

The worry certainly stems from these figures. As this report was filed some 33,116 people had crossed over the state border by road from adjoining Tamil Nadu and Karnataka.

Another 1406 had already arrived by flights from the Middle East and elsewhere and more than 839 by ship of the Indian Navy from Maldives and the Gulf region. This is only the tip of the iceberg if one were to look at the diaspora awaiting evacuation from the across the globe. The flow is steady and on a daily basis and by the time you would be reading this article the figure would be much higher.

Ironically the old saying that “You will find a Keralite even on the moon” is no more a matter of pride for Kerala over the last week or so.

If the NRIs landing from abroad provided one set of troubles, what is perhaps doubling the state’s headache is the steady flow of Keralites from other states. Numbers could go anywhere north in the next few months.

The problem is not just with the number of people wanting to make their way back to the state which is understandable, considering the deteriorating COVID situation and the inability of many to continue with their livelihood not just in other parts of the country but also across the world.

But what makes the situation precarious is the areas from which these people are making their way back to the home state. These figures accessed from the website of the department of Non-Resident Keralites Affairs better known as NORKA should set the alarm bells ringing.

Out of the 33,116 who had crossed the borders, more than 19,000 are from the red zones of the neighbouring states where COVID-19 had wreaked complete havoc.

Dr PS Shareek is an infectious disease control expert. He says the task before the state is daunting to say the least.

“The large number of people coming in is certainly a challenge. But what makes this task more daunting is when several people try to bypass the rules and procedures set by the government. See even at the borders, there are many who are trying to somehow get it through by hook or crook which is a bigger challenge. That is the point when the system could get crippled,’’ Dr Shareek told The Lede.

Now look at the figures of those waiting to come in. As per records around 1,05,177 Keralites from other states have already applied for passes to return to Kerala. The state had made it compulsory for all those trying to reach from other states to have a pass after applying through NORKA.

Out of those who have applied 72,700 alone are coming from the red zones in those states.

Again, look at the data of the passes issued, and this information comes right from the Chief Minister’s mouth. Out of the 89,000 odd passes issued by the state more than 40,000 have been issued to those staying at the red zones, almost half of the population.

It is this high re-migration from the red zones of other states that makes it even tougher for Kerala.

It has simply opened up a new front for the state, the battle of which is just about beginning and which health experts now say cannot be fought without the active involvement of Kerala’s literate society. Many health experts are putting their onus on that.

“In Kerala unlike many other parts of the country the high literacy and other factors have helped in having a higher awareness about the virus and what needs to be done and what you should refrain from. From here on it is going to be a tough battle no doubt. But with cooperation of Kerala’s society we should be able to come out of it,’’ added Dr Shareek.

Onus On Home Quarantine

Kerala is no doubt still holding out against COVID-19. But the grip is becoming weaker with every passing day as the state is now confronted with not only more people rushing back, but also has to tackle the larger issue of having to assimilate them into a population that is by and large believed to be COVID free.

For starters, the state has refused to put everyone who arrives by flight from outside India on 14 days institutional quarantine as directed by the Union government. But it has its own reasons for it.

“We have said that in the beginning itself that home quarantine is what works best for Kerala’s social situation. You have a highly literate population which is aware of the situation. Now the problem with institutional quarantine is that you need to provide a room for each person which is close to impossible when people turn up in lakhs and if we do not do that people will easily mingle. In such situations it is best to have a home quarantine process for 14 days,’’ said KK Shailaja, Health Minister of Kerala.

“It is impossible to go for institutional quarantine. See you may have a check on the number of people flying in from abroad because they must bypass the airport. But what about the people coming from other states. There is hardly any control. The approximate number will be huge. After a point of time the system will not be able to tolerate the numbers,’’ added Dr Shareek.

The Minister and the health expert are logical to the ear, but the big question is whether home quarantine is effective in preventing a likely spread.

No doubt home quarantine under strict surveillance had worked in the past and by keeping likely patients away from healthy ones any possible community transmission had been contained.

But is there proof enough of this being a foolproof step in preventing an outbreak especially when a large population is put to the test? Certainly not.

In fact home quarantine is a double-edged sword and will depend a lot on the person in quarantine to ensure it works. No wonder not everyone is convinced about its effectiveness.

“The situation is different now. The flood gates have opened-up right now in the state for the first time after March 20. In such a situation institutional quarantine should have been the one and only option. The entire medical set up here had advised the government for it and strongly argued for. Now certain people are budging under political pressure and eating their words. Even the Union government and ICMR advocates it,’’ noted policy maker Joseph C Mathew told The Lede.

Will Home Quarantine Work?

Even though they are against home quarantine, people like Mathew do acknowledge the fact that providing institutional quarantine to such large number of people is perhaps an improbable task.

But then they question the tall claims made by the Chief Minister at more than one media briefing on such a very important topic.

“It was the Chief Minister who had openly said that state had already made close to two lakh beds available for quarantining those coming from outside. If so, why are they now shying away from sending everyone to institutional quarantine as asked by the Union government? Was the Chief Minister not aware of the ground realities when he was making such claims? No doubt there has been a lot of drawbacks with our preparedness for this phase of the crisis’’ added Mathew.

Mathew reiterates that the lack of preparedness is what is pushing majority of the people to home quarantine because these is no other option.

“The concept of home quarantine in Kerala has miserably failed and that the success of such a concept is nothing but a myth that we are biting into. You are coming home with a lot of uncertainty of whether you have the disease and again you are sharing a house with other inmates. Is that how you contain it?’’ reiterated Mathew.

Many say that even with very few people home quarantine was far from a total success during the second wave of the virus. When local transmission had started there were a number of incidents where people had jumped home quarantine leading to police reprimanding them. Such repetition now will prove very costly, given the higher number of people involved.

For instance, a motorist even met with an accident leading to his death while he was still supposed to be in home quarantine.

Meanwhile there are others who think the government might have managed it in a different way which could have even brought business opportunities to an absolutely dead hospitality industry in the state.

“There are hundreds of hotels of all ranges across every city in the state with thousands of rooms lying vacant. Government could have easily worked out a proposition by which they could have decided a rate slab for rooms and moved people to such institutional quarantine. Even medical staff could have been posted at such hotels that become quarantine centres to keep a watch. I am not criticising the government because they seem to have done a fine job so far, but many people feel certain things could have been done differently. Perhaps it would have worked out better,’’ former member of the Planning Board G Vijayaraghavan told The Lede.

Desperate Times, Desperate Measures

For all the detractors of ‘home quarantine’ the state is taking this to another level – ‘room quarantine’. From now on every individual who arrives from outside the state and does not show any visible symptoms of COVID-19 will have to undergo 14 days of not just home but room quarantine right inside their homes.

Those with any symptoms will anyway be moved to hospitals. How the state will ensure this is an unknown fact.

Doctor Shimna Azeez of the Manjeri Medical College is one of the frontline workers who has rich experience in this field right from the days of the Nipah virus and she says the time has certainly come for Kerala to move from home quarantine to room quarantine if the virus has to be stopped at this stage.

“It is not just home quarantine anymore. The mantra should be room quarantine where inside our own houses we stay in our own room and do not mingle with each other for 14 days. This is crucial. But this can only be done with people’s whole-hearted participation,’’ Shimna Azeez told The Lede.

But even Shimna has a word of caution. “After people started talking about ‘live with COVID’ strategy, I think a lot of our people have become complacent and that is happening at a very wrong time for us when so many people are coming to the state. Living with COVID does not mean you get out of your house for non-essential requirements. This must be clearly understood,’’ added Shimna.

While the onus is on community participation to ensure that the next few weeks and perhaps even months, depending on the arrival of people from outside, health experts feel the state will have to go the extra mile to infuse a sense of fear in the people. Moving from home to room quarantine is part of that well thought out strategy.

This is because a misadventure on the part of at least a few could turn the tables against it and if that happens it could end up paying a very heavy price.

“Driving fear is the key factor here. We have been very purposefully driving the fear of the virus into the society and now into the homes. This has been happening for some time now and the whole society is awake. For instance in the first few days after opening up the borders some 1093 people were tipped off by neighbours only in Kozhikode district. Why did they do it? It’s the awareness that is generated from the fear factor. This fear driven strategy will continue because government machinery has its limitations in such a scenario. The initiative must come from the society, no doubt,’’ added Dr Shareek.

Surprisingly, civil society too agrees this time round because desperate times call for desperate measures.

“See people are comfortable at home. But you need to put the fear of God into them when they are at home to make sure that they feel it - if they come out, they are finished. Such fear factor is important for this phase to pass out the way we want it to,’’ added Vijayaraghavan.

Meanwhile on Friday the Chief Minister made it clear that any break in home or room quarantine will not be appreciated at any cost and strict action will be taken. On Friday itself 65 cases were filed in the state for breaking home quarantine.

“We have decided to form a motorcycle brigade involving policemen who will move around on bikes to ensure that people who are in quarantine do not step out of their houses. If they do, cases will be slapped on them without fail,’’ Vijayan told media persons on Friday.

The next month or two will be absolutely crucial for Kerala and if it has to hold on to its gains then drastic measures will need to be implemented.

The Lede