Dealing with a pandemic: the Kerala Model of containment strategy for COVID-19

Densely populated Kerala, a state in the south of India, was the first state to be affected by the coronavirus disease (COVID-19) on 2 February 2020. The number of cases here rose much faster than in the rest of India. Following the nationwide lockdown from the midnight of 24^th March, restricting the entry of people from outside the state, the COVID-19 curve flattened by the third week of April 2020. New cases dropped to near zero by the first week of May, with no evidence of community spread. The measures adopted by Kerala during this phase of the disease, i.e. the so-called ‘Kerala Model’, deserves judicious scrutiny to understand if there are any lessons to be learnt for their implementation in other countries [1,2].

Kerala’s preparedness to deal with COVID-19 was evident from the guidelines issued by the state on 5 January 2020, i.e. much earlier than the first case detection in India. The main reasons for the containment of the disease were efficient contact tracing, aggressive testing, and effective quarantine of the infected. COVID-19 testing laboratories and specialized corona care centers were multiplied. The use of traditional medicines for immune-boosting was encouraged, as Kerala is the land of Ayurveda[3]. Scientific laboratories in Kerala made available low-cost COVID-19 testing kits and personal protection equipment, which have been manufactured on a large scale by private companies locally.

As the lockdown was slowly lifted by the first week of May 2020, and the state borders were opened, a large number of Keralites, who were stranded outside Kerala, returned home by road, flights, trains, and ships. All returnees had to register themselves in the Kerala government portal so that the state had their full details. Those who showed signs of the disease, at the entry point, were sent to corona care hospital facilities. Those with no signs of the disease were asked to remain in room quarantine in their own homes for 14 days. Those who did not have separate bedrooms for themselves with attached bathrooms in their homes were sent to government quarantine facilities for the same period. At the end of 14 days, those with symptoms were tested for COVID-19. Even if the tests were negative, they were instructed to remain isolated in their homes for two more weeks.

COVID-19 cases in the state are now going up steeply. Even after three weeks of relaxation of lockdown measures, almost all the new cases are those who have come from outside the state. Because of the state’s measures, the number of those who are getting the disease through contact within the state is minimal, largely due to all those entering the state being placed in home or institutional quarantine.

Lessons learnt from the ‘Kerala Model’ may not be useful to countries which have seen ongoing community spread of the disease, but there are some countries in Asia, Africa, Latin America and Europe where COVID-19 is just beginning to spread. The Kerala experience would be certainly useful to them. Institutional quarantine is certainly expensive, and may not be permissible in some countries. The Kerala experience showed that home quarantine is as effective as institutional quarantine. Even countries with a resource-poor setting can adopt this method. It was also found that it is not essential to conduct tests on every individual coming from outside the state, as many of those who tested negative initially, turned positive later. Hence, restricting tests to suspected cases helped in rationing resources.

Author contributions

All authors contributed equally.

Disclosure statement

No conflicts of interest have been reported by the authors.