Kerala has been successful in containing COVID-19 and in achieving a low rate of spread, high recovery, and low fatality. The importance of the public health system, social capital and the active involvement of the people through local governments that played a significant role in Kerala’s success is highlighted. A brief historical review of the evolution of public health system and local governments in Kerala is also attempted.

Since the incidence of acquired immunodeficiency syndrome (AIDS), the first pandemic in the post-globalisation era, public health experts in Kerala have been conscious of the vulnerability of the state to epidemics in any part of the world. The high level of integration with the global economy, large non-resident population living in many parts of the world, and the reliance of the state economy on international tourism contribute to the relatively high vulnerability. The outbreak of Nipah virus infection in 2018 heightened the threat perception. Since then, Kerala has instituted a surveillance mechanism to actively look for emerging pathogens, including disease X (WHOs term for a hitherto unknown pathogen) that may strike the state.1 So when reports emerged from China about an unknown novel coronavirus, Kerala went into an alert mode. On 24 January 2020, Kerala issued guidelines on managing what was then called the 2019 novel coronavirus (2019-nCoV) and later came to be called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Since the epicentre of the disease was known, Kerala focused on persons who returned from China (or other hotspots as they emerged). Since data on persons whose port of origin fell in China (or in other hotspots) was available with the immigration department, it was possible to identify them and track their contacts and quarantine them. The first three positive cases reported were from the students who had returned from Wuhan. Since all arrivals from Wuhan had been quarantined, further spread was successfully prevented. All the three recovered by 20 February 2020 and the state remained free of active cases till 9 March 2020.