Responding to COVID-19: lessons from Kerala on what worked under resource constraint settings and a glimpse into the surgical management of patients

Abstract

Background: The outbreak of COVID-19 into a pandemic took many countries by surprise and were found wanting for their response and containment measures that they undertook and resulted in unacceptably high mortality in number terms made them search for alternative approaches and models of containment to combat the scourge. In the state of Kerala in India, the response of the government and public response was different compared with rest of the country. Its success with containment to prevent the spillover of the virus into the general public for a long period of time made other states and countries sit up and take notice. Materials and methods: Participatory observation in situ by the authors’ personal first hand experience in the public health and surgical practice fields enabled them to use the framework of components measures for outbreak containment following the Nipah outbreak in the state as a lens to capture the factors and measures undertaken for success in COVID-19 containment in Kerala. Results: Kerala ensured that a very low proportion of population got infected and a low case fatality rate of 0.94%. What worked was anticipatory preparedness of the political and health systems, systematic contact tracing and quarantine of contacts, transparency in reporting of data and dynamic data-based policy decisions. These measures when combined with social security measures for vulnerable groups, instilled a sense of solidarity with the state government’s harsh “lockdown” measures taken and thereby ensured community wide people’s participation that proved critical for the success in containment. Conclusion: By using the consolidated framework of components measures for outbreak containment following the Nipah outbreak in the state as a lens along with participatory observation by the authors, it was possible to capture the factors and measures undertaken for success in COVID-19 containment in Kerala.