What was right about Kerala’s response to the COVID-19 pandemic?

Despite having a low per capita income, the state has its social development indicators, such as human development index, infant mortality rate, sex ratio and female literacy rates, comparable to those of many developed countries. Table 1 Number of infections, deaths, case fatality rate (CFR) of various countries and Kerala Country Number of cases Deaths Recovered CFR (%) CFR (revised %) Italy 240 310 34 738 188 891 14.46 15.53 Spain 295 850 28 343 150 376 9.58 15.86 France 162 936 29 778 75 649 18.28 28.25 Canada 103 250 8522 66 191 8.25 11.41 USA 2 637 077 128 437 1 093 456 4.87 10.51 Brazil 1 345 254 57 658 733 848 4.29 7.28 China 83 512 4634 78 640 5.55 5.56 Russia 634 437 9073 399 087 1.43 2.22 Kerala 4189 22 2150 0.53 1.01 India 549 197 16 487 321 774 3.00 4.87 CFR calculations based on formula deaths/number of cases, revised CRF based on formula deaths/deaths+recovered as per methods presented in https://science.thewire.in/the-sciences/covid-19-pandemic-case-fatality-rate-calculation/. Despite having a low per capita income, its indicators of social development—such as the human development index (0.84),6 infant mortality rate (12/1000 live births),7 sex ratio (1084 females to 1000 males)8 and female literacy rates (92.07%)9 are comparable to those of many developed countries. Kerala, with a population of about 35 million,9 has a high population density of about 860 people per square kilometre.8 Kerala has 3.5 to 4 million inter-state migrant workers.10 Proportion of elderly (>60 years) is 12.6% of the total population.11 Among Indian states, the prevalence of cardiovascular diseases is reported to be highest in Kerala (>5000/100 000 population) including ischaemic heart disease (>2250/100 000) and stroke (>625/100 000).12 Prevalence of high blood pressure and diabetes is also very high with approximately one in three adults having hypertension13 and one in five adults having diabetes.14 It is estimated that there are more than 2.4 million Keralites living in various countries, a vast majority in Middle Eastern Countries, and their remittances to the state net domestic product was nearly 36.5 per cent.15 Primary healthcare services has been organised systematically with a network extending to the village level.