INTERVIEW: Kerala is trying to report every Covid case, says state’s Health Minister Veena George

LIZ MATHEW: The first Covid case in the country was reported in Kerala in January 2020. What have the challenges been since then?
We developed a protocol much before the World Health Organisation came up with one, and our strategy has been to delay the peak (of the Covid curve). The ultimate aim was to keep the total number of patients below the maximum threshold capacity. We went through the first wave and the pandemic is like an endemic now; the number of infections are reducing each day. On May 12, we had 42,000 new cases and since then, the numbers have plateaued and are now reducing. We eased the lockdown restrictions and now almost all sectors have opened up, including schools and colleges. Kerala’s Covid fatality rate is one of the lowest in the country — 0.6 per cent…. We are scientifically analysing the number of breakthrough infections and re-infections. The population density of Kerala, from Trivandrum to Kasargod, is 860 persons/sq km, which is double the national average of 430 persons/sq km. There a huge ageing population and a high number of people with lifestyle diseases in Kerala… If you analyse the data, there wasn’t a single person who died due to the lack of oxygen, hospital bed or ICU support. This was possible due to our strategy of keeping the number of patients lower than the medical capacity. Even now, when we are reporting 6,000-7,000 cases per day, the hospital and ICU occupancy is very low. The pandemic never hit Kerala like a tsunami.

Liz Mathew: You are the third woman health minister in a row for the CPI(M) —before you, there was K K Shailaja and P K Sreemathi. What is the significance of that record for a state that has earned kudos for its achievements in the health sector? Also, you took over at a time when the state was being criticised after being congratulated for the steps it initially took to contain the pandemic.
About the portfolio, I don’t have to say anything; it is the party’s decision… In the CPI(M), I’ve never seen any discrimination on the basis of gender. It just so happened that women were appointed health ministers. About the criticism on our handling of the pandemic, let’s look at some data. One, the fatality rate and the second, the undercounting factor. According to the ICMR’s (Indian Council of Medical Research) data, the undercounting factor of Kerala is the lowest in the country. The ICMR data states that out of six cases, one case is being reported in Kerala, whereas we have other states where one in 100 or 120 cases is being reported. If you look at the state’s population density, houses are very close to each other. Therefore, there were high chances of the virus spreading easily. This would have led to a sharp rise and fall, leading to more deaths. However, we could control the death rate. We try to report every single case and our data is maybe not perfect but is the best in the country, which the ICMR study reveals.

LIZ MATHEW: Your predecessor K K Shailaja was much senior to you in the party and government and under her, Kerala won a lot of praise for its handling of the pandemic. Did that put you under pressure when you took over?
I took charge during the peak of the pandemic… I was not under any pressure but I had to work hard because Shailaja Teacher had set a very good example and I had to work hard to rise to the expectations of my party and the people.CM PinarayiVijayan has been holding review meetings every week but earlier, when the cases were high, he would hold these meetings on a daily basis.

Thanks to our vaccination drives — among bed-ridden patients, people above the age of 60, tribals living in the coastal region and even a special drive for pregnant women —we were able vaccinate 95% of the population above the age of 18 with the first dose and 56% with both the doses.

Liz Mathew: Since October, a large number of previously unaccounted deaths have been added to the total death toll. Does that take the sheen off the ‘Kerala model’ in some way?
The fatality rate was 0.45-0.5… From June 14, 2020, we started reporting the deaths online. So a doctor working in a hospital that witnessed a Covid death can upload the death bulletin and the District Medical Officer (DMO) would declare the number of deaths at the district level. We analysed the unreported deaths. To count a death as Covid death, you need an RT-PCR or similar test. When the doctors started uploading the death bulletin in June, they may not have had the proper documents at that time. Now, we have collected the appeals, examined each case and decided to add them to the death toll. The government was particular that everything should be transparent.

Liz Mathew: You mentioned that Kerala saw no deaths due to the lack of oxygen, hospital beds or ICU support. What else would you highlight as your success?
In Kerala, even if a person dies at home, we ensure that they are tested for Covid. If found positive, we mark it as a Covid death. Kerala is a state that follows all protocols. The media here is very vigilant. Today, all the cases and deaths are being reported and still our fatality rate is the lowest in the country.

Kaunain Sheriff M: In the first wave, Kerala was lauded for its home isolation and contact tracing protocol but during the second wave, the chief of National Centre for Disease Control (NCDC) pointed out that home isolation was not being carried out well. How would you explain that?
We have Rapid Response Teams at the ward-level, comprising ASHA workers, a ward member, police personnel, social workers, etc. They have been taking care of those who are in quarantine. We have call centres at the panchayat and district levels where people who are in quarantine or have tested positive can call… Our home isolation was pretty good; it is quite evident from the ICMR data. ICMR’s seroprevalence survey revealed that the seropositivity rate of the state was 42% in June. From there, to reach 82% was possible only due to vaccination. All these things showed that we did pretty good. We also tried to execute the recommendations given by the Central teams that visited the state.

Kaunain Sheriff M: One of the Central teams that visited the state after the second Covid wave pointed to a data submitted by the district magistrate of Pathanamthitta that spoke of breakthrough infections. Has the state able to understand the magnitude of breakthrough infections?
Yes, definitely. When a person tests positive, our district surveillance team contacts them and prepares the data in such a way that it mentions if the person was vaccinated, the number of doses he or she got, days since the vaccination, etc. Breakthrough infections are those that occur two weeks after the second dose. When the district collector of Pathanamthitta shared the data with the Central team, my Principal Secretary and I asked if this kind of data is available in other states. We were informed that no other state had it. We looked at the data on breakthrough infection from other countries such as the UK and saw that it was the same as Kerala’s. So there’s nothing to worry. More than 94% of our adult population has been vaccinated so there are chances of natural infection but the severity of the disease will be very less. Hence, the hospital and ICU occupancy at this point is very less.

Kaunain Sheriff M: Has the state discussed vaccinations for children?
Our schools have opened as biobubbles —one teacher for a maximum of 20 students. We have divided each class into two or three groups. We are closely monitoring the situation. We keep a ‘symptom registry’ in every class and one doctor is always made available in the school… Regarding vaccination of children, I myself have written to Honourable Union Health Minister Mansukh Mandaviyaji to take a quick decision on vaccinating our children. And also about reducing the period between the first and second dose (of Covishield).. Now it is 84 days. But we have asked the Central government to reduce the period because, as you know, Kerala is a state where we have many NRIs. Many of our people work abroad and if they come here and take the first dose of vaccine, it will be difficult for them to stay for 84 days to take the second dose. So we have asked for the gap to be reduced. I have received a letter from the Union Health Minister that the Central government will consider it.

Kaunain SheriFf M: Another conversation that has been unfolding outside India is of booster doses. The Central teams that visited Kerala have red flagged that 30% of the population is co-morbid and the infection rate increases with diseases like diabetes. Have you take up the issue of the booster dose, especially for this co-morbid population?
I have already written a letter to the Union (health) minister, seeking a quick decision on the booster dose also. I think the Central government will be considering it. My principal secretary has taken up the issue with the Secretary, Union Health Ministry. And I have written to the minister. We are awaiting their decision.

Kaunain Sheriff M: What does your own data say about the need for a booster dose? Have you looked at susceptibility to the disease post the second dose among the state’s co-morbid population?
We have more number of people with lifestyle diseases — diabetes, hypertension, etc. We have analysed Covid-19 deaths and it was more in people with these comorbidities. It is good that they get a booster dose. This is why we have decided to request the Central government to take a decision on giving booster doses. Again, it is not our decision, the experts have to decide on that. And the Centre will have to take an opinion from experts and I hope a good decision will be taken soon.

Anuradha Mascarenhas: Kerala is the diabetes capital of the country. Is Covid triggering new or early onset of diabetes? What have your findings been? Also, at least in Maharashtra, post-Covid, there were a lot of cases of the fungal infection mucormycosis. What was Kerala’s experience?
If a diabetic patient gets infected with Covid, we have observed that their diabetes levels shoot up fast and that may result in mucormycosis. So far, Kerala had around 114 cases, of which 70% patients were cured, which, I think, is a good figure. And the cost of medicines is quite high but as you may know, the Kerala government gives free treatment for Covid in all government hospitals. We also have empanelled private hospitals and they kept aside some beds for free treatment.

Anuradha Mascarenhas: There is a lot of talk of a One-Health approach. Considering the rising threat of zoonotic diseases like nipah, zika and considering that the epidemic curve always starts in the southern states, how do you look at One-Health? What will your surveillance strategy be?
On One-Health, the state is holding discussions among the Health, Animal Husbandry, Agriculture departments etc. Also, we have started an Anti-Microbial Resistance (AMR) campaign. By 2023, we aim to be a completely AMR-literate state. We have given special orders to medical shops not to give antibiotics without medical prescription. With the cooperation of other departments, we are aiming to do more programmes on One-Health.

Anuradha Mascarenhas: On diabetes control, what are the interventions you are looking at?
For early intervention, we are starting a people’s campaign. In every panchayat, we have authorised ASHA workers to visit each and every house and collect data to analyse risk factors for all people above 30. We have a good network of laboratories in the state, especially after we implemented the Aardram Mission. We will test all those above 30 and keep a health card for each of them. As part of our campaign, we will take the message of good health to people, ask them to consider changing their food habits. We are also going to implement public gymnasiums in every panchayat to encourage exercise etc. We have a good plan, a good non-communicable diseases team and we are working on that.

Liz Mathew: Did the floods affect the pandemic situation in any way?
We had a plan in place before the monsoon. We had special (flood relief) camps for those in quarantine, those with symptoms and those positive were taken to CFLTCs (Covid First-Line Treatment Centres), CSLTCs (Covid First-Line Treatment Centres) or DCCs (Domiciliary Care Centres). So we did the separation at the initial level itself, when those affected by the floods were moved from their houses to the camps. We gave special attention to children and senior citizens. Also, antigen tests were done and people were allowed to enter the camps only after they were tested. So the relief camps didn’t affect our Covid cases.

Manoj CG: On the Anupama case, the CPI(M) machinery’s delay in resolving her issue forced her to sit on a dharna outside the secretariat. Now she is back on strike. How do you see the party’s handling of the case? (Anupama S Chandran, an SFI leader, and her partner Ajith had filed a complaint alleging that their baby was illegally put up for adoption by her family, allegedly in collusion with CPI(M) leaders).

As a minister of the Woman and Child Development department, I haven’t received any complaint. I came to know of the case from a TV report. I asked my director and principal secretary what the issue was and that’s when I got to know. I was not in Trivandrum then, I was in Pathanamthitta…. I asked my principal secretary to order an inquiry without any formal complaint. That was October 20. The government order (on an inquiry) was issued on October 21 or 22. I got to know that family court was handling the adoption case and I discussed with Chief Minister. After that, I took legal advice and got to know that court has put aside the case for final orders. So we had very little time to act. That day, we authorised an advocate to file a statement before the family court. That was crucial because the court postponed the order and the matter is under the consideration of the court.

Shubhajit Roy: According to you, which states managed the Covid situation well and which ones didn’t manage as well as Kerala? Also, were there lessons you learnt from other states?
Kerala’s demography and geography are quite different from other states. So we always try to have our own strategy. As I said in the beginning, we issued Covid guidelines back in 2020, even before WHO issued those guidelines. We followed our strategy and that helped us to keep the fatality on the lower side. This helped us to ensure treatment for those who required it.

Uma Vishnu: The decision-making apparatus in the CPI(M), like in most other parties, is still largely male dominated. Is there a push from within the party’s women members to change that in some way, to be heard more?
As a member of the party, I have space to raise my voice, my opinion is also heard. The party’s stand on women reservation and empowerment is very clear. As you all know, we have three women ministers now. So the party will be giving more importance to women leaders and we are organising more progragrammes on the same.

Liz Mathew: Once you have tackled Covid, what would your priority be for the health sector and for WCD, the other department that you are handling?
We opened post-Covid clinics everywhere, including in medical colleges, after the Delta variant caused the second wave of Covid in Kerala. Also, we now have to expect a viral era… new viruses, new variants. There are now reports in the UK and Israel of new variants of the coronavirus. The Kerala government will focus more on non-communicable diseases because it’s very important.