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When the second wave of coronavirus in India swept the country last month, leaving many cities without enough doctors, nurses, hospital beds or life-saving oxygen to deal with it, Sajeev VB got the help he needed.
Local health workers put Mr. Sajiv, a 52-year-old mechanic, in home quarantine and tied him to a doctor over the phone. When he became sick, they assembled an ambulance that took him to a general hospital with an available bed. Oxygen was abundant. He left after 12 days and was not paid for his treatment.
“I have no idea how the system works,” said Mr. Sajiev. “All I did was notify the local health worker when I tested positive for the virus. They have taken everything from that moment on.”
Mr. Sajiev’s experience had a lot to do with where he lives: a suburb of Kochi, a city in the southern Indian state of Kerala. Officials intervened in Kerala state where the central government of India is headed by Prime Minister Narendra Modi FailureIn many ways, to provide relief to the victims of the world’s worst coronavirus outbreak.
Although supplies are scarce, Kerala’s hospitals have access to oxygen, as officials have expanded production for months. Coordination centers, called war rooms, direct patients and resources. The doctors there talk to people at home about their illness. Kerala leaders work closely with healthcare workers on the ground to monitor local cases and deliver medicines.
“Kerala stands out as an exceptional case study when it comes to a preemptive response to the epidemic,” said Dr. Giridhar Babu, an epidemiologist at Public Health Foundation India, based in the northern city of Gurugram. “Their approach is very humane,” he added.
On paper, Kerala’s death rate, at just under 0.4 percent, is among the lowest in India. But even local officials admit it Government data are lacking. Dr Aaron NM, a doctor who keeps an eye on the numbers, estimates that Kerala is afflicting only one in five deaths.
The relatively prosperous Kerala state of 35 million people presents special challenges. More than 6 percent of its residents work abroad, most of them in the Middle East. Heavy travel is forcing local officials to carefully track people’s whereabouts when an outbreak occurs.
Kerala’s policies can be traced back to the early days of the outbreak, when a student returning there from Wuhan, China, in January 2020, became India’s first case of coronavirus. Officials successfully learned the lessons Responding to the 2018 outbreak Nipah virus, which is a rare and dangerous disease.
With the border closed last year and migrant workers returning home, the state’s disaster management team got to work. The returning passengers have been sent to home quarantine. If someone tests positive, local officials track their communications. The test rate in Kerala has been consistently higher than India’s average, according to health data.
Experts say much of the credit for the system rests with KK Shailaja, a 64-year-old former teacher who was until this week Kerala’s health minister. Its role in fighting the Nipah virus Probably Character In the 2019 movie.
“I led the fight from the front,” said Rego M. Jun, a health economist from Rajagiri College of Social Sciences in Kochi. “Test, trace and contact tracing was very strict from the start.”
Local officials like Ms. Shilaja came under severe pressure. Last year, Mr. Modi imposed one of the toughest lockdowns in the world on the entire country, a move that slowed the virus but Drive India into a recession. This year, Mr Modi has resisted the nationwide lockdown, leaving local governments to take their own steps.
Indian states are also competing against each other for oxygen, medicine and vaccines.
“There was a tendency to centralize decisions when things seemed to be under control and to shift responsibility toward states when things were not so,” said Gilles Vernier, professor of political science at Ashoka University.
To coordinate resources, Kerala officials have compiled war rooms, one for each of the state’s 14 counties. In Ernakulam County, where Sajeev VB lives, a team of 60 employees monitors oxygen supplies, hospital beds and ambulances. Thirty doctors monitor more than 52,000 Covid patients in the region.
Dr Anish VJ, the district medical official, said the war rooms were collecting data on hospital beds, ventilators, and other factors. When the doctors decide, over the phone, that a patient needs to be hospitalized, they notify the war room. Case numbers appear on a giant screen. Workers decide what care each person needs and then assign a hospital and an ambulance.
A separate group monitors the oxygen supply, calculating the burn rate for each hospital. “We know who needs the supply urgently and where it can be packed,” said Eldo Soni, the war room coordinator, pointing to a screen.
Dr Atul Joseph Manuel, one of the doctors who designed the war room, said the triage was crucial. “In many cities around the world, the lack of medical resources was not the primary problem,” he said. “It was the uneven distribution of cases that overcrowded many hospitals.”
Other places have set up similar centers, with varying effectiveness. Health experts say Kerala has succeeded because the state has a history of investing in education and healthcare. It has more than 250 hospital beds per 100,000 people, nearly five times India’s average, according to government and WHO data. It also has more doctors per person than most states.
Officials also worked closely with government health clinics and with local members of a nationwide network of certified social health activists, known in India as ASHA. Workers make sure that patients quarantine their homes and have access to food and medicine. They also preach the wearing of masks, social distancing, and the virtues of vaccination. (Kerala’s share of fully vaccinated people is roughly twice the national average of 3 percent.)
The work is low-paying and difficult. Geetha Ann, a 47-year-old social health activist and first point of contact for 420 families, begins her tours at 9 am. She delivers medicine door to door and asks if any family needs food. She said her phone rings non-stop while patients call for advice or help finding a bed.
Workers like her are supposed to be volunteers, so Ms. Geetha’s wages are low and infrequent. She earns about $ 80 a month but has to purchase her protective gear. “In the early days, we got masks, sterilizers and gloves,” she said. “Now, we have to buy it ourselves.”
Despite shortages elsewhere, Kerala now has enough medical oxygen, although supplies are scarce. Kerala-based local and national officials, worried last year about declining stocks and outside reports of patients dying in hospitals, ordered oxygen producers to increase their production, which had risen to 197 metric tons per day from 149 a year earlier. This prepared the country to triple demand when it hit the second wave.
Kerala has also won praise for how it tracked virus variants. Scientists are studying whether a variant was first found in India It exacerbated the outbreak in the country, Although they were hindered by a lack of data. Dr Vinod Sakarya, a scientist at the CSIR Institute of Genomics and Integrative Biology in New Delhi, said Kerala has been using genetic sequencing since November to track variants, which aids political decision-making.
“It is the only country that has never given up,” said Dr. Sakarya, adding, “They are keen to use evidence to advance policies.”
Political dribbling has prompted some experts to question whether Kerala will be able to hold on to its gains. Earlier this week, the Communist Party of India, which controls the state government, excluded Ms Shilaja from his government. The party said it wanted to give young leaders a chance, but observers questioned whether Mrs. Shilaja had grown too much. She did not respond to requests for comment.
Professor Vernier of Ashoka University said, “Even the best performing governments are not immune to firing in their feet due to misguided political calculations.”
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