Dr B. Ekbal wears many hats. He is a neurosurgeon, an academic, a public health activist and an established tabla player. He is also the chairperson of the expert committee that advises the chief minister of Kerala on all matters related to Covid-19. “I have learnt a lot more in the last three months than I did in my entire life,’’ says Ekbal in an exclusive interview with THE WEEK, referring to his experience of leading a team of experts drawn from all fields to fight the pandemic. But he warns that the battle is not over yet. Excerpts from the interview:
Q/ Kerala is gradually phasing out the lockdown, although the number of infections and deaths are going up.
A/ Kerala's Covid story is at a turning point as we are entering the third phase of the fight against the pandemic. We could manage well till now because of our well-planned contact tracing, stringent quarantine measures and effective implementation of quarantine. But as the lockdown is going to be lifted, we are entering a new phase, which is going to be very challenging. At the same time, it is only realistic that the lockdown be phased out. There is an extent to which any government can hold on to lockdown as a protective measure. Kerala must expect a huge inflow of non-resident Keralites (NRKs) from red zones across the world and this is bound to increase the number of positive cases dramatically. It is unavoidable and we are prepared to deal with it. Our focus at this juncture is to contain the spread of the disease from NRKs to others, which could lead to community spread.
Q/ How much more worse can it get?
A/ I don't want to give numbers, but it can be really bad. We are entering a phase where all restrictions are being lifted and it is bound to increase the risks. There are many variables that determine whether one succeeds or not in the fight against Covid and system efficiency is one crucial factor. It can improve or deteriorate as challenges increase. We all must be conscious that the system is not fatigued as the fight against Covid is not going to end soon.
Q/ How long will it last?
A/ We have only reached the intermission. The second half of our Covid story need not be similar to the first half. It can be totally different. If one goes by the history of other pandemics, I would say that it can take up to one year to 18 months for the virus to mutate and to become an epidemic and then an endemic. But it need not mean that the virus will be this virulent for such a long time and that is a relief. I am also hopeful that a vaccine will be found in between.
Q/ What are the key factors that helped Kerala in its successful fight against Covid-19?
A/ Kerala's success story is also the success of its unique social capital—its decentralised and robust public health care system, its vibrant local governance and its educated and informed community involvement. In fact, Covid has come at a time when our primary health centres and district hospitals have been witnessing dramatic improvements in infrastructure and funding. This vibrant and robust health care system in turn boosted the morale of our health care staff to fight the pandemic. Equally crucial is the role played by Chief Minister Pinarayi Vijayan and Health Minister Shailaja Teacher. The chief minister anchored the whole thing and led from the front. This gave the entire system the much-needed confidence. So it is this combination of a good system and a good leadership that helped Kerala in its fight.
Q/ What are the key strategies that Kerala adopted in fighting Covid-19?
A/ Kerala, with its high density of population, high percentage of the 60-plus population and a large number of people with comorbidities is among the riskiest states in India when it comes to Covid-19. So our fight had to be extra aggressive. We can divide Kerala's fight into three phases. The initial phase was when the state reported the country's first set of cases. We had our war room ready under the chief minister, quarantine cells in all district hospitals and rapid response teams in all districts as early as January, while for other states, Covid-19 was something that was happening in far away China. This phase of early preparation was a game changer. By the second phase—the lockdown phase—the system was very much in place and we ran it effectively. Now we are entering the third phase—the post lockdown phase—which is going to be very very tough. But with our past experiences and with a proper system in place, we will be able to overcome this, too, I believe.
Q/ Was the lockdown effective, considering the human cost involved?
A/ From a medical point of view, I am certain that the lockdown has definitely helped in reducing the number of infections and deaths. But I personally feel that had it been delayed by one week, the distress it caused to the population, especially the migrants, could have been avoided. But I feel there is no point in judging something in hindsight.
Q/ What impact do you think the monsoons will have on Kerala’s fight against the pandemic?
A/ Kerala is yet to recover fully from the shock caused by two consecutive floods. The monsoons will naturally bring back all the scary memories. Along with it, a gamut of communicable diseases like dengue and leptospirosis will also come. The management of non-Covid cases, which have been ignored till now, is equally important. The fact that only Covid deaths made it to the front pages does not mean that non-Covid deaths have disappeared. All those illnesses are still around. As the lockdown is coming to an end, the reporting of comorbidity cases is bound to escalate. All these are going to be huge challenges.
Q/ What is your opinion of `herd immunity', which many have advocated as the most natural way of handling a pandemic?
A/ Herd immunity arises when 60 per cent of a given population gets infected and acquires immunity. If only the healthy young population in a country gets infected and they acquire immunity, then that is a good option. But that is unrealistic as there is no way to assure that only that category of population will be affected. It is not possible to create herd immunity through social engineering and if the vulnerable segment of the population gets infected, the death toll will be unimaginable. So I don't think herd immunity is a good idea. Britain had toyed with this idea but changed tack as the number rose. Sweden did try and the result in not very promising, if one goes by the death toll.
Q/ How do you assess the performance of India as a whole in the Covid fight?
A/ I am actually surprised that disease dissemination is low in India when compared with many other countries. The picture may change in the coming days but till date India has been doing well on the Covid front, given its population and other social indicators. Similarly, many states are surprisingly doing well, if one goes by the available figures. For example, Chhattisgarh, Tripura, Assam and Odisha are doing exceptionally well. It is a happy thing to know that it is not just just Kerala that is doing a good job.
Q/ As a medical professional, who is also a social scientist, how do you imagine a post-Covid world? As many say, has Covid rung the death bell for globalisation?
A/ It is too early to discuss a post-Covid era. But one thing I feel is that Covid has proved that everyone in this world is connected. Globalisation may not exist the way it did but localisation is not the answer either. Humankind will be able to overcome Covid only through mutual support, knowledge sharing and cooperation. Because no country in this world will be completely safe even if there is one single Covid case anywhere in the world. 'One world, one health' is the only way forward.