Podcast: Dr Vishwas Mehta, Kerala's Chief Secretary, tells the story of state's fight against COVID-19
In this podcast interview, Asiaville speaks to Dr Vishwas Mehta, the top bureaucrat of Kerala, who has been leading the battle against COVID-19. You can also read the edited transcript.
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With more than 300,000 cases reported so far, India is currently struggling to contain the novel coronavirus pandemic. Globally the country is at the fourth position in terms of the spread of the disease. But amid all this, one state in India has gained wide appreciation from across the globe for the way it managed the pandemic: Kerala.
More than 4 months ago, Kerala— where 10% of its 33 million people reside outside the country — was in fact, the first state in India to report a COVID-19 case. Here we have with us the man who led the fight against the pandemic from behind the curtain. Hi, I am Sruthin. Joining me today in Asiaville Special Podcasts is Dr Vishwas Mehta, the chief secretary of Kerala. Just before becoming the head of the state bureaucracy, Dr Mehta was handling the responsibility of coordinating the state’s response against COVID-19.
Welcome, Dr Mehta. Let’s start with the question that everybody has in mind these days. What makes Kerala’s response different and what you guys are getting right?
Dr Mehta: One thing we have to understand is that the health infrastructure of any place cannot be developed overnight. In Kerala's history, [this] started [over] 100 years ago. Its first primary health centre was set up by the royal family 100 years ago and the first vaccination in the country happened much before independence. Secondly, the missionaries who arrived early in Kerala much before independence brought education and health. So the monarch, missionary... And the third is the matriarchal system which brought education to women. Now it has vanished. But it empowered women.
We are 20 years ahead of any other state in terms of education and health because we started very very early. We have that basic advantage.
Now how do we use this advantage to ensure that the epidemic is under control? For that, we largely relied on the decentralised platforms, i.e. the local bodies. And as you know, people here have high health-seeking behaviour, they won't compromise on health.
[In a nutshell,] lakhs and lakhs of people working at ground level, serious coordination by us [in] various departments, and the top policymaker to ensure that the decisions are taken. This is Kerala's model.
Sruthin: In the previous 2 years, Kerala was fighting a battle against an even deadlier virus: Nipah. While only 19 people caught the disease in 2018, 17 of them died. Compared to that, only 19 of the 2407 patients, as of June 14, have died of Corona in the state. Here Mr Mehta explains how the experience of fighting Nipah helped Kerala in its response against COVID.
Dr Mehta: So as soon as the first case came in India around 30th January -- when this girl from Wuhan landed and it was found that she was positive -- there were no protocols, nobody knew about COVID that time. In January, there were only speculations about the spread in Wuhan. There was not much idea, and nobody knew anything.
So all we did at that time was to start with the protocol which we had experimented with during Nipah virus. The [fight against] Nipah virus is a success story. We knew how to do contact tracing, and quarantine; how primary and secondary contact should be located and kept under watch [because of that]. So all we did was, on 30th when we found this person, we contacted everybody who she came in contact with and ensured that they are kept under watch, and ensured that they don't spread further. This is what we had done with Nipah around 2 years ago.
Nipah virus has a high mortality rate, COVID doesn't. But the numbers are scary. The mortality rate isn't high. So, this is how the 30th January issue was handled. Then on 8th March, some people from Italy returned. By the time it had spread in Italy, in the UK. And as you know after 8th march, cases started getting reported everywhere including India. And finally, we had the national Lockdown on 25th march. Since we had this decentralised planning in play, we started planning at ward level committees, going beyond the panchayats. Wherever cases were reported, isolation. Wherever primary or secondary cases were located, we asked ward level committees to watch it.
Local bodies, health volunteers, health workers and police everybody was involved. People were told to confine themselves in their houses. [They were communicated] that there's no vaccination, the only way is to let the body kill it.
People followed the protocol, and therefore when we enforced it during the national Lockdown -- from 25th march to 30th April -- the cases started coming down. On 30th April we had the best recovery rate in the world: 96%. There were only 3 deaths and 15 active cases. On 1st, 2nd and 3rd we had zero cases. Then the next influx started on 4th May when the borders were opened and the people started coming in from other states. The second influx started when the flights [started operating] from the Gulf. So the scenario changed after 4th and 7th May. We again put a protocol in place. The focus was again on the fact that we must ensure that every person who comes in, their contact details, house, address, was known to us and was under watch. They were contacted on a day-to-day basis.
Generally, people are responsible here, they do not hide it. So, lakhs of workers, during the lockdown ensured that these people who keep coming in and who were tested positive do not spread it to others.
Sruthin: Kerala is predominantly a consumerist state. It has to depend on neighbouring states like Tamil Nadu, Karnataka and so on foodgrains, fruits, vegetables, poultry, oils. Just to give you an example, let's take eggs. The state consumes 1 crore eggs per day. Only a fourth of that is produced within the state. So, managing the supply chain during the lockdown period was a major task for the government.
Dr Mehta: So we had to ensure that the industrial movement of things did not stop. We didn't want any panic buying, and prices to go up. We didn't want anyone to hoard the stocks. We also wanted to ensure that the supplies are coming in. So, what we did was, besides the health control room -- which was started with the first COVID case -- we also set up a COVID war room. And we deployed several officers hailing from neighbouring states, who can speak Kannada, Tamil etc. And they were interacting with their counterparts in other states for interstate movements of essential goods and supplies. Simultaneously, we also ensured that there was no dearth of equipment and medical supplies. For example, before lockdown, we didn't have enough kits and labs. So we were running around the country to find out whatever we can get. So the Lockdown helped us to build up our stocks, and simultaneously to increase the [number of] labs so that tests can be increased.
Sruthin: While a tenth of the state’s population resides outside the state, Kerala also has a large number of migrant labourers, mainly from the Eastern part of India. And most of them are engaged in blue-collar jobs. Studies have put their numbers at least 3 million. How did the state manage them, I asked the chief secretary.
Dr Mehta: Much before they came out on streets [in other states], the Chief Minister called me and told me -- please ensure that these people do not starve, do not suffer, and ensure that they are fed well and they are given what they want. So we quickly activated the third control room, which was for migrant labourers.
Now what was most surprising to me -- I am from Rajasthan, and I have [been working] in Kerala for a long time -- was the word the Chief Minister used: Athithi Thozhilalikal (guest workers)… I had not heard this anywhere. Everybody calls them migrant labourers. We call them guest workers. That itself [gave] us a different perspective. That they are our guests and they have to be taken care of.
So, we set up these control rooms, to communicate to them in their language and these helplines to let them communicate to us about the difficulties that they are facing. We started Community kitchens and local level committees to give them supplies and keep them happy, and to ensure they are being taken care of. This ensured that nobody came out on the roads. There were a few incidents where the media had spread rumours about buses and trains and they came out in small numbers. But they were quickly [dispersed.]
I generally don't talk to the media, but this time I spoke in Malayalam channels, I spoke in Hindi to assure all the people that don't worry, we’ll make arrangements for you.
Now you remember what happened when we opened up in the second stage. They said these people can go back in buses- how do I send 1.5 lakh people from states like Assam and West Bengal by buses from Kerala? So, we wrote to the railway ministry, Home ministry, Prime Minister to allow trains. [The migrant workers] were getting restless. They are penniless and they have no work to do. Remember they are very young. So out of 5 lakh, even if 5000 comes out, [it will be a problem].
So, we requested and very reluctantly, trains were made available by the Railway Ministry. They gave only 1 train on an experimental basis. They were apprehensive that the train will be destroyed, [the workers] will block it, there will be massive chaos.... So they said we would not issue tickets, we’d give it to governments, you do whatever you want. But only 1200 people and they have to pay for the ticket fare. So we took on this challenge. I talked to the collector, SP. I cordon off the railway station and pick up 1200 guys without creating restlessness. I had already [assured] them that more trains will come. [They were told] not to create chaos and give us a chance. If the first train goes fine, tomorrow you'll have 5 more trains, but no chaos and you will not come out on the streets -- we told them. Already I think close to 200 trains with more than 2.5 lakh people have already left. Any chaos?.... Surprisingly, when the first train to Odisha was going from Kochi, my counterpart -- the Chief Secretary in Odisha -- was reluctant to take them. He was wondering [what to do] with these [many people], how to quarantine them and how to send them to respective districts. They were asking [us] details like the [district-wise list]... So I said we'll try.
Sruthin: The other day, I was speaking to a health Inspector — one of the grassroots level functionaries— in a Primary Healthcare Centre in Kerala’s Wayanadu, a predominantly tribal district. He told me that in his Panchayat, there are around a dozen health officials functioning. This in addition to one ASHA volunteer for each ward the Panchayat was having. These people were collecting COVID-19 related data, mainly about people who returned from high-risk areas, and people showing symptoms, and those who came in contact with them and so on. Whoever was in charge of a Ward then login to the State government’s COVID Jagratha application, and update daily. Listen to Mr Mehta about how such micro-level data helped the state.
We started depending on the Kerala State Disaster Management Authority control room where all data started flowing in regarding which Panchayat, which Municipality etc. Now when you start talking about hot spots and containment, if one case comes from a municipality, let’s say Trivandrum Municipality, the whole Municipality goes under [quarantine]. Whereas it could be from a very small unit, you know. Now, closing down offices and business establishments when you are opening up just because one case was reported from a small cluster, doesn't make sense. So we quickly developed a formula by which we started looking not just at the positive cases but also at how many primary and secondary people are affected. Then we gave weightage to them and started looking at [classifying these areas as] red zone, yellow zone, orange zone etc, [at ward and Panchayat level]... so [that] the entire municipality [need] not shut down.
Somebody had to coordinate the four control rooms that were simultaneously going on. As the Home Secretary, I was doing this job. Now all this is of no meaning unless there is a good general at the top. When you fight a war, everybody is part of it -- right from foot soldiers to the top general. Our Chief Minister here is not only a remarkable leader but also a great administrator. Every day at 3 o'clock 4 o'clock, he'd call a meeting. He'd have already collected feedback from various sources. Then he'd ask each one of us to speak on supplies, equipment, cases, trends, quarantine, police, health, labour camps, trains, border check posts etc. After all of us had spoken, he'd give instructions on what we're supposed to implement. After that, at 6 o’clock he calls the press conference. In the press conference, he announces his decisions. This goes to the public. People stop watching serials because [there was] no need for gossip, no fake news, speculation by TV channels. The CM comes with facts and figures and says what are the decisions taken. And he appeals how to make sure that [the disease] doesn't spread. Now you tell me if the CM is doing it again the next day, the first question he is going to ask is about what happened about the decisions [he] took yesterday. Have the orders been issued or not. The decision has already reached the ground. People have already come to know, and newspapers have reported about it. You tell me how do I not issue orders. Within 24 hours I am under pressure to issue orders.
Sruthin: Now there is no more a lockdown. And the non-resident Keralites are returning from gulf countries in large numbers. How are you going to manage the situation?
Dr Mehta: You cannot have indefinite lockdown in this country. When you know that the enemy is invisible, you don't know how long it will last. How long we can not normalise things. Life has to go on. You cannot have people starving, you cannot have businesses closed down. So, people have tremendous suffering... It leads to psychological problems. So, we have to open up sooner or later. People who are abroad want to come back. We have 2.2 million in Gulf countries alone. Many of them were suffering and they desperately wanted to come back because they felt Kerala is safer, as cases started rising in other places, cases are low here. So, we cannot stop them. What we said was please come with a test [report]. Have it tested so that it won't spread to others. And also prioritise -- those who have no visa and stranded there, students. Pregnant women, small children. We need to prioritise, and the 22 lakh cannot come together. So we communicated this to the government of India. Unfortunately, that was not possible, as many of these countries do not have testing facilities, and often it is available to only symptomatic people. So, we had no choice. The government of India said that we are starting Air India flights under Vande Bharat scheme. The only option we had was to ensure that they all are registered.... Initially we were quarantining them and not letting them go home, ensuring that their numbers are monitored. What happened is that… we found that a whole lot of them have houses, with 2-3 bedrooms and they can afford to be isolated, and we were sending them to hotels. There was no logic in it. So, we [told] the government of India that home quarantine itself is institutional quarantine. Gradually things settled down.
As the cases are unfolding, we are watching every day that 85% of them are imported cases. And the number of contacts is only 11%. So, that basically means, if a person goes to his house, he is not infecting others, and he is not spreading it to others. So, institutional quarantine or home quarantine has been a success. The surveillance system, the contact tracing has been successful.
So how do we sustain it when the numbers go up? Remember about COVID-19, it is the number which is scary. The disease is not scary. Fifty thousand 50,000 could easily become 100,000. One lakh will become 5 lakh, in no time. And out of this 5 lakh, even 1% are symptomatic and line up in hospitals, then you will run out of beds… This is what we observed in foreign countries -- that the hospital facilities get overwhelmed. They collapse. So, simultaneously we started working on making sure that people do not line up in hospitals, even if they are symptomatic, even if there are suspicious cases. We take them first to the first line COVID-centres, not to COVID-hospitals. There they are kept under observation and tested. If they are symptomatic, take them to COVID hospital.
Simultaneously the disaster management [teams] have started mapping how many schools we have, how many colleges we have, how many hospitals we have, how many ventilators etc...That level of grassroots microlevel planning was done at the district level. We ensured that the collectors, DMOs, police know about it. You can handle a crisis better if you have a well-prepared system. So, this is what we are planning.
Sruthin: What are your plans to revive the economy that is currently in a very bad state?
Dr Mehta: First, the Prime Minister had said “Jaan hai to jahaan hai”. Then he said Jaan aur Jahaan, donom -- later, in the second phase of lockdown. Because first, you have to save lives, that is our priority. You tell me about the economy, is it Kerala only that is affected? All the states are. All countries are affected. If international travel is gone, hotels and other industries are gone, people are not travelling and trying to work from inside their homes, obviously, the economy will [be affected]. So, you can’t help it. But you have to, sooner or later come back on your feet. But first, we have to ensure that the damn thing stops. Till vaccine comes, we have to live with it.
And the most important thing I wanted to tell you is about people who have comorbidities. People with [poor] immune systems. Or people who are 60 and above -- Kerala has a very large number, 42 lakh people are above 60 here. 5.4 lakh people above 70-74 years of age. And many of them are alone. Husband lost or wife lost, and children not with them. All of these people have comorbidities -- hypertension, diabetes, cancer, respiratory problems. If they get infected mortality will be very high. This is what is happening all over the world. This is what is happening in Delhi, Maharashtra. So, you have to ensure that they are protected. You have to ensure that they don't come out or nobody goes near them.
Sruthin: ...Will you be thinking about reverse quarantine?
Dr Mehta: Of course, we are already doing it. We have set up helplines to monitor and provide medical supplies and any help, including [that of] doctors. We are ensuring that they don't come out and that we are reaching them. If it is not possible in Kerala, it is not possible anywhere else.