Kerala had built a bulwark against COVID-19 when it slowly started reporting some of the first few cases of the disease in India in early 2020. Even when the state opened its airport to international passengers in May through Vande Bharat Mission, India’s largest repatriation exercise, it managed to protect its people from the infection, until a series of events let the guard down since August — Onam, political protests over allegations against the ruling Pinarayi Vijayan government and the Kerala local body elections 2020, among others. Today, week after week, Kerala continues to report the highest number of active COVID-19 cases.
As on January 19, Tuesday, among the five states that account for 72% of the total active cases in India, Kerala tops the list, according to the Union Health Ministry. The state accounts for 34.22% of the total patients undergoing COVID-19 treatment in India currently, followed by Maharashtra (25.88%) and Uttar Pradesh (4.30%). Kerala continues to report the highest number of daily new cases. With 6,186 new cases on Tuesday, Kerala has 70,289 active COVID-19 cases.
Taking note of the rising cases, the Union government sent an expert team to analyse the situation, although the Kerala government maintains that everything is under control and all measures are being deployed to prevent a further spike. In several media interactions, Kerala Health Minister KK Shailaja attributed the rise to the state’s initial preparation to strengthen its health infrastructure while trying to delay the peak, which was expected to happen at some point of the pandemic.
There are a number of aspects that could probably explain why Kerala’s COVID-19 cases are not reducing. According to health experts, Kerala did well early on in the pandemic, where a large proportion of its population was not exposed to the coronavirus. However, fatigue eventually set in and its much-appreciated system to trace all primary and second contacts to prevent the transmission did not sustain, noted Dr Shahid Jameel, a virologist and the Director of the Trivedi School of Biosciences at Ashoka University in Haryana.
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“Kerala’s early success in containing the transmission can be attributed to contact tracing. But then, the influx of people from other states and countries coincided with the system where it actively engaged most of its resources in contact tracing. With these two events, the fatigue set in. Contract tracing could actively be sustained only for a short time,” he explained.
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In an interview with The Indian Express, KK Shailaja teacher said that the state’s immediate focus is on reducing the COVID-19 mortality rate through its health infrastructure. The Kerala government has managed to achieve, a mortality rate which is one of the lowest in the country — 0.41% (for every 100 confirmed cases, ~0 have died from the disease). However, the government has been criticised of not including several deaths under its COVID-19 tally.
Dr Jacob John, a noted virologist and former professor at Christian Medical College in Vellore, explained that the infection spread has three factors associated with it — the population density (the number of people per unit of area); the proportion of infected and uninfected people; and the responsibility of the public.
Kerala has a high population density. “Kerala is one large village or a large city, where it is continuously populated, unlike states like Tamil Nadu, where there is a distance of two to three kilometres between each village. Kerala is one of the thickly populated states in India,” Dr Jacob elucidated.
Because Kerala managed to drastically curtail its COVID-19 cases initially, the proportion of infected and uninfected is different compared to the rest of the country, where it saw more infected people and less uninfected people. “In Kerala, it is more uninfected people than infected people. This proportion guides the infection spread,” he said.
Kerala has been reporting 5,000 to 3,000 new COVID-19 cases per day for the past few weeks. But the state is experiencing the same peak that Maharashtra and New Delhi did at one point and the infection rate will come down soon, reasons Dr Jacob. “The reducing infection rate is an indication of the proportion of infected persons to the uninfected person. When the infected people are more than the uninfected people, the infection has to come down. By now, Kerala has reached the point where other states were, in the months of November or December,” he explained.
Dr Jacob also concurred that a sense of fatigue set in even among the general public due to the continuous flow of people with infections from other countries. “People have not been taking disciplined precautions, including wearing maks and maintaining physical distance,” he noted.
Although Kerala’s testing rate is significantly low compared to other states, the experts said that the state should focus on drastically testing people with symptoms.
Dr Shahid also pointed out that Kerala’s low mortality rate was a good indicator of its strong public health infrastructure.”It also goes on to show people’s trust in the system and the higher education level of its population. It is significant that the state is focussing on reducing the mortality than the transmission at this stage,” he said.