When India’s second coronavirus wave slammed the country last month, leaving many cities without enough doctors, nurses, hospital beds or lifesaving oxygen to cope, Sajeev V.B. got the help he needed.
Local health workers quarantined Mr. Sajeev, a 52-year-old mechanic, at home and connected him with a doctor over the phone. When he grew sicker, they mustered an ambulance that took him to a public hospital with an available bed. Oxygen was plentiful. He left 12 days later and was not billed for his treatment.
“I have no clue how the system works,” Mr. Sajeev said. “All that I did was to inform my local health worker when I tested positive. They took over everything from that point.”
has failed, in many ways, to provide relief for victims of the world’s worst coronavirus outbreak.
online networks, charities and volunteers has emerged in India to fill the gaps left by the stumbling response of the central government and many states. Patients around India have died for lack of oxygen in hospitals where beds filled up quickly.
Deaths are rising. Workers face long hours and tough conditions. The situation could still worsen as the outbreak spreads.
On paper, Kerala’s death rate, at less than 0.4 percent, is one of India’s lowest. But even local officials acknowledge that the government’s data is lacking. Dr. Arun N.M., a physician who monitors the numbers, estimates that Kerala is catching only one in five deaths.
A relatively prosperous state of 35 million, Kerala presents particular challenges. Over 6 percent of its population works abroad, mostly in the Middle East. Extensive travel forces local officials to carefully track people’s whereabouts when a disease breaks out.
tackling a 2018 outbreak of the Nipah virus, a rare and dangerous disease.
As borders closed last year and migrant workers came home, the state’s disaster management team swung into action. Returning passengers were sent into home quarantine. If a person tested positive, local officials traced their contacts. Kerala’s testing rate has been consistently above India’s average, according to health data.
Experts say much of the credit for the system lies with K.K. Shailaja, a 64-year-old former schoolteacher who until this week was Kerala’s health minister. Her role in fighting the Nipah virus inspired a character in a 2019 movie.
drove India into recession. This year, Mr. Modi has resisted a nationwide lockdown, leaving local governments to take their own steps.
India’s states are also competing against each other for oxygen, medicine and vaccines.
“There has been a tendency to centralize decisions when things seemed under control and to deflect responsibility towards the states when things were not,” said Gilles Verniers, a professor of political science at Ashoka University.
has worsened the country’s outbreak, though they have been hindered by a lack of data. Kerala has used gene sequencing since November to track variants, helping to drive policy decisions, said Dr. Vinod Scaria, a scientist at the CSIR Institute of Genomics and Integrative Biology in New Delhi.
“It’s the only state that has not given up at any point in time,” Dr. Scaria said, adding that “they’re eager to use evidence to drive policies.”
A political shuffle has led some experts to wonder whether Kerala can keep its gains. This past week the Communist Party of India, which controls the state government, excluded Ms. Shailaja from its cabinet. The party said it wanted to give young leaders a chance, but observers wondered whether Ms. Shailaja had grown too popular. She didn’t respond to requests for comment.
“Even the best-performing governments,” Professor Verniers of Ashoka University said, “are not immune from shooting themselves in the foot due to misguided political calculations.”