Hero health Minister K.K. Shailaja has been unanimously hailed as the reason a state of 35 million people have only had 4 deaths due to COVID-19 infection. While many countries across the globe went into panic and sent their economies towards collapse, Shailaja has efficiently and calmly handled the novel coronavirus situation – she has been praised for this. Here’s how she did it…
KK Shailaja had chanced upon a news piece about a virus in China that was spreading aggressively. Experience taught her to always be aware of situations around her and abroad. On January 20th 2020, she called one of her medically trained health secretary and asked, “Will it come to us?” The reply she received was, “Definitely, madam.” And so the health and social welfare minister of Kerala, India, began her preparations.
“Fighting an epidemic like corona requires scientific temper, humanism and a spirit for inquiry and reform. Superstition, credulity, emotionalism and irrationalism will derail the whole process by dispiriting and discouraging the experts and health activists who try hard to resolve the threat scientifically. In Kerala, we have initiated stringent police action against those who attempted to spread stupidity in the face of virus scare. That was among the main reasons why Kerala made some early advantages in checking the spreading of the virus.’’
KK Shailaja on HuffPost India Interview
In comparison to other countries
| Country/State | Population (rounded in millions) | Gross Domestic Product (GDP in US Dollars) | Positive Cases of COVID-19 | Deaths (COVID-19) |
| Kerala | 35 | $ 2900 | 666 | 4 |
| USA | 330 | $ 60,000 | 15,81,903 | 93,806 |
| UK | 66 | $ 42,588 | 2,48,818 | 40,496 |
| Spain | 47 | $ 30,524 | 2,79,524 | 27,888 |
| Italy | 61 | $ 34,318 | 2,27,364 | 32,330 |
Shailaja teacher
KK Shailaja has been affectionately called various names recently. She is known to most as Shailaja Teacher but some report her as the ‘hero health minister,’ ‘Coronavirus Slayer’ and ‘Rockstar Health Minister.’
She has been a former secondary school teacher of Chemistry and Physics. The first-time minister modestly says that she has “very little exposure to the field of medical science.” She credits her years of teaching sciences and her experience as an activist in keeping a scientific approach towards diseases and healthcare. “I strictly followed scientists and experts than those who eulogise on the imagined benefits of cow dung and cow urine,’’ she says.
She has drawn widespread admiration for demonstrating that effective measures for disease containment are possible within a democratic poverty stricken region.
How it began
After her phone call with her medically trained deputy, she held a meeting with her rapid response team. The next day, 24th January, a control room was set up which helped instruct medical officers in Kerala’s 14 districts to create the same in their region. The chain of command – which starts at the health department and moves down to the field workers on the front line – has been strong. The first novel coronavirus positive case arrived on 27th January in Kerala from Wuhan. By this time, the teams were well equipped; they used the strict protocol set out by the Indian Council of Medical Research and National Institute of Virology – similar to the World Health Organisation’s protocol of test, trace, isolate and support.
One passenger arriving from Wuhan, a student, was identified even before arrival. “Airport authorities were asked to inform us as soon as her plane lands. So, when she landed, we sent her directly to an isolation ward set up in a hospital in her hometown, Thrissur. Since she had interacted with her family at the airport, they were also sent to isolation,” Shailaja mentions in an interview with Livemint.
As passengers arrived onto the airport, they were all screened for their temperatures. The three that had fever were isolated into a hospital nearby. The remaining passengers were given COVID-19 pamphlets – which had been printed out in advance in the local language, Malayalam – and told to isolate within their homes. The hospitalized patients tested positive for COVID-19. Shailaja said, “The first part was a victory but the virus continued to spread beyond China and soon it was everywhere.”
Quick Proactive Response
A family arrived at the airport in late February from Venice. When the surveillance teams asked them their travel route they were evasive with their answers. This family did not adhere to the new protocols advised and went on to meet their contacts (in the hundreds). The contact tracing team found a case of COVID-19 that led back to this family. The team tracked all their contacts using advertisments and social media, and placed them into quarantine. Later, six individuals developed the infection.
As more and more clusters were proactively contained, additional people were arriving into Kerala from Gulf countries, some of them were carrying the virus. On 23rd March, all flights into Kerala airports were suspended. On 24th March, a nationwide lockdown was announced for India, starting the next day.
A total of 170,000 people were in quarantine in Kerala with strict measures to ensure compliance. While all other Indian states have a 14-day home quarantine, Kerala is the only state where the requirement is 28 days. Houses were visited by health workers and those people that lacked sanitary conditions in their houses were housed in improvised isolation wards at the expense of the state government. The people in isolation has gone down to 21,000.
Post-lockdown, India witnessed mass migration by daily wage workers who couldn’t stay in their houses, and didn’t have access to food or water due to lack of money. This was not the case in Kerala. Shailaja said, “We have also been accommodating and feeding 150,000 migrant workers from neighbouring states who were trapped here by the lockdown. We fed them properly – three meals a day for six weeks.”
The Kerala government has been alert of the situation faced by those coming from affected countries. They launched mass media drive with motivational messages, promoted psychological support and counselling, and unity. Additionally, the police have actively clamped down on those that have been trying to take advantage of the COVID-19 situation by spreading false rumours and superstitious messages. Shailaja was appreciative of the strong stance by police. She said, “Vested interests have clearly understood that we will not tolerate their gimmicks. That helped a lot.”
Related: Coronavirus COVID-19 disease 2019: A guide.
Isolation Ward Visits
Shailaja was fervently advised against isolation ward visits. “But I took it up as a responsibility. All precautions have been taken but the collective will and determination finally started reaping dividends. Patients, their families and the civil society have cooperated with us in the fight. The opposition parties also extended full support,’’ she said.
During interviews, the first patients who tested positive expressed that they were extremely grateful for all the facilities and care that was available to them. The first student who tested positive said that Shailaja’s visits were a “huge relief.”
Earlier Victory
Shailaja has been somewhat of a celebrity before the COVID-19 outbreak. She was portrayed in the movie, ‘Virus’ because of her efforts against a deadlier virus: the 2018 and 2019 Nipah Virus. She says her character portrayal in the film expressed too much worry; in reality, she says that she cannot afford to show fear. She was praised for her proactive response and for her visiting the village most affected by the outbreak.
The villagers did not understand how the virus was spreading, were frightened and were preparing to abandon their village. She says that she arrived there with doctors and “we organised a meeting in the panchayat [village council] office and I explained that there was no need to leave, because the virus could only spread through direct contact.” She advised them to keep at least a meter away from a person who is coughing and this way, it wouldn’t affect them. “When we explained that, they became calm – and stayed,” she says.
The Nipah virus outbreak was a learning opportunity for Shailaja that, she says, prepared her for COVID-19. It taught her that diseases like Nipah require a serious proactive approach especially since they do not have any treatment or cures (vaccine).
Fighting Spirit
Shailaja’s forebearers have been activists and freedom fighters. For instance, her grandmother campaigned against untouchability. Shailaja has witnessed the “Kerala Model” be constructed from its roots.
The key for the Kerala model has been land reform which was enacted through legislation. It helped by capping the amount of land a family could own and increased land ownership for tenant farmers. The model also enabled increased investment in public education along with a decentralised public health system – each village in Kerala has access to a nearby primary health centre, with hospitals in each region, as well as 10 medical colleges.
While a similar model is in effect in other states, stated by a public health expert in Pune, State of Maharashtra, MP Cariappa, people are not so invested in their primary health care system. A fact known throughout the country is that Kerala is the most literate state of India. Cariappa says, “With widespread access to education, there is a definite understanding of health being important to the wellbeing of people.” Additionally, Kerala has the highest life expectancy and the lowest infant mortality of all the states in India.
Shailaja says, “I heard about those struggles – the agricultural movement and the freedom fight – from my grandma. She was a very good storyteller.” She added that the Kerala model has been the key to such an active and efficient response to COVID-19, without which such feats would not have been possible.
Efficient use of available resources
Shailaja’s party came into power in 2016 and noticed that the primary health care centres started to show signs of aging. They took it upon themselves to modernise the centres. One of the many changes brought in were the creation of clinics and a registry for respiratory disease. She says, “That meant we could spot conversion to Covid-19 and look out for community transmission. It helped us very much.”
With the start of the COVID-19 outbreak, districts were told to assign two hospitals catering towards the infection and medical colleges were told to set aside 500 beds. While the western world witnessed a rise in infection, diagnostic tests were in short supply in Kerala. So they were used only for patients and their close contacts as well as random sampling of asymptomatic people. Highly exposed groups were also included in this list: medical staff, police and volunteers.
When time came for closing public gatherings such as places of worship in Kerala, there was no noticeable resistance towards closures. While in other states, there was widespread protests. This was achieved because, Pinarayi Vijayan, the Chief Minister of Kerala, consulted local faith leaders. Additionally, Kerala’s high literacy level seems to play a part: “People understand why they must stay at home. You can explain it to them,” says Shailaja.
Related: Coronavirus: Why There Are Reasons To Feel Heartened 2020.
Shailaja was surprised by the western and gulf countries responses and large number of fatalities. In Kerala the diagnostic test results are produced within 48 hours. She says, “In the Gulf, as in the US and UK – all technologically fit countries – they are having to wait seven days. What is happening there?”
She says, “I think testing is very important – also quarantining and hospital surveillance – and people in those countries are not getting that,” saying that she has been called by many Malayalis living abroad who say so.
Future preparations
Shailaja and her teams have created plans – plans A, B and C (the worst-case scenario) – for when the lockdown and travel restrictions are eased to allow influx of people from affected nations. For Plan C, hostels, hotels and conference centres are going to be used to provide 165,000 beds. In addition, more ventilators have been ordered. Shailaja says that they have a low number of skilled personnel to cope (such as for contact tracing) but, for this too, she is prepared: “We are training up schoolteachers.” The teachers will return back to their jobs once the situation has calmed down.
Her Advice
Shailaja understands that most Ministers will not be subject matter experts in their given profiles. “But you can make a difference by keeping your eyes and ears open. You can read a lot on coronavirus on the internet. The latest information can be accessed. I am using late-night hours to read such articles rather than going behind the superstitious claims of India’s Hindutva right. The only requirement for you is the ability to grasp,’’ she said.
She added, “Ensure that the whole administrative set-up is keeping reason and science above superstition. Facilitate better coordination among scientists, experts, doctors with proven capabilities and public health specialists. Don’t hide or suppress anything from the people. There must be extreme transparency and accountability in the interventions and any official attempt to manipulate the data would backfire.’’
Shailaja’s clear communication with her team, logical reasoning and broader vision has saved 35 million Kerala residents from panic and stress. The hero health minister says, “Empathy and transparency are my investments in this field.’’
