Why have COVID-19 cases surged in Kerala? How has the State fared? Have norms been flouted by the people?
How has the State fared? Have norms been flouted by the people?
The story so far: Plaudits won by Kerala for stamping out the COVID-19 pandemic appeared premature when in early July, a superspreader event in the densely-populated coastal villages of Poonthura, Manikyavilakam and Puthenpally (on the outskirts of Thiruvananthapuram city) led to a spike in infections through local transmission. Very soon, the cluster grew over a fairly large population and similar clusters mushroomed in Chellanam and Aluva in Ernakulam.
Daily cases of local transmission exceeded imported infections within a week. An alarming 81% of the cases reported on July 24 were through local spread of the virus. The total number of cases leapt from 6,166 on July 8 to 16,995 on July 24, with 9,371 active infections. There were 453 containment zones, triggering discussions about a potential Statewide shutdown, but the suggestion was put on hold almost unanimously at an all-party meeting chaired by Kerala Chief Minister Pinarayi Vijayan.
However, the State leveraged its epidemic management skills gleaned from two Nipah outbreaks, the ingenious technology-driven use of ‘contact-tracing’ using spatiotemporal data, social capital and decentralised governance to tether the daily figures to zero all over again in the first week of May. On May 4, just 16 patients (3.5% of the total cases) were under treatment in hospitals. Deft planning and execution and enthusiastic people’s participation ensured the success of the ‘break-the-chain’ of the coronavirus campaign, the community kitchen initiative to feed the needy, psycho-social counselling to alleviate stress and rationing of essentials. People lapped up the government’s socio-economic interventions during this period.Spirits were still high and the government began to open up sectors on priority in a phased manner from mid-May with the twin aim of reviving economic activity and to ease the burden on the labour class, farmers and the self-employed.
Was the third wave entirely unexpected?
When the Centre was contemplating repatriation missions from abroad, the pandemic had straddled the continents. Kerala, which has a large population of overseas Indians, wanted tests to be conducted at the port of origin so that travellers who were suspected to have contracted the infection could be segregated and ferried separately. When that did not happen, passenger handling policy at Kerala’s airports was revised with the aim of multi-layer screening to isolate people with symptoms and shift them to designated COVID-19 hospitals, which were already up and running.
The local bodies were tasked with readying institutional quarantine centres for the returnees, a policy which made way, in the wake of an influx of people starting from May 7, and with hiccups in the arrangement, to ‘paid quarantine’ for those who could afford it and home quarantine for all others except those with no home isolation facility. The State has so far received 6,03,199 people in the post-lockdown repatriation exercise. It became a vexing political question when the government insisted that everyone desirous of entering the State mandatorily register themselves on the COVID-19 Jagratha portal and get passes.
A prescient warning had been sounded by the experts’ panel advising the State on corona containment strategy; the planning wing had presented projections and the State braced itself for a surge in cases. In fact, extreme shortage of testing material — swab, medium and kit — in May-end and early June determined the way the State modulated its strategy. “We chose to test only those likely to have been infected and used the kits sparingly. Meanwhile, sentinel surveillance among the high-risk sections like health workers and the police was kick-started to detect social spread,” said a top official.
How serious is the situation?
Kerala’s vulnerability to the pandemic is compounded by its ageing but active population, a high degree of comorbidities in its people, and population density. Despite spiralling cases of community transmission, it has been able to maintain a cumulative test positivity rate of 2.6%. Says Rijo M. John, health economist, “But the cause for concern is the current positivity rate of 4.6%, which although much better than the national average of 11.7%, calls for doubling the rate of testing. It’s also ominous that cases are now doubling in 10 to 11 days whereas nationally it’s 18 to 20 days. That apart, case fatality at 0.32% is among the best.”
The State has been able to augment its testing by adding over 80 testing centres, with 25 RT-PCR stations. The rate of testing has steadily increased through July to cross 25,000 in a 24-hour cycle on July 24. The Kerala Medical Services Corporation has stockpiled adequate number of testing material for 30 days, and “the tests will be further ramped up in containment zones”, according to Dr. Mohammed Asheel, part of the State’s COVID-19 taskforce.
A doctor spearheading a major component of the battle against COVID-19 said the public health-care staff in Kerala are on the verge of exhaustion, having been on their toes since January. “There’s definitely a shortage of skilled human resources on the medical and non-medical fronts and this issue was flagged a few months ago, with the government making stand-in arrangements.” A COVID Brigade comprising trained medical professionals, skilled citizens and volunteers will be pressed into service at the COVID First-line Treatment Centres (CFLTCs) being set up by the local bodies.