Opinion and Editorial

Exclusive: Kerala's Covid-19 model in trouble as India cases fall

R Krishnakumar
Filed on October 17, 2020
Cověd-19, kerala, india, healthcare, pandemic

As the state reports over 11% of India's daily cases, it's entering what CM Vijayan called an "extremely critical" phase in its battle against the virus.

The peak, the flat-line and the downward curve have been used as standard indicators in reports that detail the spreading of Covid-19 across the world. For the Indian state of Kerala, they could also describe the progressive levels of enthusiasm seen in discussions around its healthcare models and intent shown by its administrators in tackling the pandemic.

Two weeks into October, as India sees a drop in active cases, Kerala is fighting a surge in the numbers. Experts, however, argue that the alarm over daily numbers should not distract the state from the key goal of maintaining its low case fatality rate.

The initial elation over controlling the outbreak has passed; a sense of guarded optimism has followed. Now, as the state reports over 11 per cent of India's daily cases, it's entering what Chief Minister Pinarayi Vijayan called an "extremely critical" phase in its battle against the virus.

The Chief Minister told reporters on Thursday that the state had managed to prepare better for the rise in cases because it had kept the numbers in check during the initial phase of the outbreak. He, however, maintained that the more recent stats are worrying. "Kerala has reported 8,911 positive cases per million people while the national figure is 6,974. We have continued to increase the number of tests," Vijayan said.

In October, Kerala has already crossed the 10,000-cases daily mark twice, hitting the peak of 11,755 on October 10. On Friday, it had 7,283 cases. The state has reported more than 20 deaths each day of the month.

As of October 16, Kerala has reported a total of 325,212 confirmed Covid-19 cases, 95,008 of them active. The total number of deaths is 1,113. The state's case fatality ratio is 0.34 per cent, against the national rate of 1.52 per cent. Kerala has conducted 109,003 tests per million people - the national figure is 69,214 per million - and the state's test positivity rate, on Friday, is 14.05 per cent. The state's active case ratio in 29.21 per cent and recovery rate, 70.41 per cent - the national figures are 10.92 per cent and 87.56 per cent, respectively.

On Saturday, the Union Ministry of Health said the number of active cases in the country had dropped below the 800,000-mark, "for the first time in 1.5 months".  

Officials who work with the state government on strategy and implementation said Kerala's mitigation model was designed "to balance life and livelihoods", while increasing the capacity of its healthcare systems. Dr Mohammed Asheel, executive director of the Kerala Social Security Mission, said the spike was expected since it was impossible for the state to cut itself off from the rest of the world. He maintained that daily case numbers did not exclusively indicate the severity of prevalence.

"The best indicator is in the answer to the question - how many people have died? Kerala has managed to delay the peak while taking the case fatality rate as low as 0.34 per cent (it was 0.77 per cent in May)," Dr Asheel told Khaleej Times. The demographic challenges - Kerala has a population density of 859 per sq km, while neighbouring Tamil Nadu and Karnataka have 555 and 319, respectively - further validate the state's mitigation efforts, Dr Asheel said.

The first Covid-19 case in India was reported in Kerala - a medical student from Wuhan, China - in late January. The state's measures in controlling the outbreak, under Health Minister K K Shailaja, were lauded by experts and sections of international media.

The minister had downplayed the social media buzz around her efforts, stating that it was too early to celebrate and the daily case numbers could go as high as 20,000. On Friday, the Central Government deputed teams to Kerala and four other states - Karnataka, Rajasthan, Chhattisgarh and West Bengal - where a surge in cases has been reported over the past few weeks. Is there anything more to the rise in the Kerala numbers, than an alleged false start?

Experts called it an inevitable spike, primarily set off by the return of non-residents from other states and countries. Cases of community transmission, easing of lockdowns and poor adherence to social distancing stipulations, a series of political street protests against the Communist Party of India (Marxist)-led state government and relaxation in restrictions during the festival season of Onam, in late August, also contributed to the numbers.

Even as the state keeps its case fatality rate low and is being recognised for its capacity-building measures, its testing strategies have divided opinion. In the initial phases of the outbreak, some of the criticism was based on the argument that more tests could decidedly dispel the claims of low prevalence.

Late on Friday, an official statement from the Chief Minister's Office said 51,836 samples were tested over the past 24 hours. The calls for more tests have continued.

In the first week of October, the Chief Minister had hit out at the Indian Medical Association (IMA) after the association criticised the government over failures in its management of the pandemic. Vijayan accused IMA of "misleading" the public about the government's efforts in handling the outbreak. The government has also faced heat over an alleged failure in coordinating mitigation measures with subject experts and healthcare workers.

Dr Abraham Varghese, president of the IMA's Kerala chapter, said the low case fatality rate was the "only positive" and the state was battling serious concerns around the high case positivity rate and a lack of intent in implementing containment measures. "We did better than the other states in the initial phase but the recent numbers are disturbing. There's a need to ramp up testing, at least to 100,000 per day," Dr Varghese told Khaleej Times.

The easing of restrictions in business hours and public gatherings has meant that the idea of reverse quarantine - separation of the more vulnerable population from the rest - has failed to take off in Kerala, Dr Varghese said. "A lack of coordination among bureaucrats, experts and healthcare workers is another problem. The prevalence hasn't peaked yet; the worst hasn't hit us yet," he said.  

The Ayyappa Temple in Sabarimala, one of India's most popular spiritual destinations, has opened for monthly pujas on Friday. Entry to the hill shrine, located in Pathanamthitta district, is limited to 250 people per day; pilgrims have been directed to carry Covid-19 negative results of tests conducted within 48 hours prior to the visit.

The restricted pilgrimage season at Sabarimala could mark another turn in Kerala's road to the new normal. Experts feel that the low case fatality rate has reflected in lax public response to pandemic guidelines. The state, however, cannot afford to lower its guard after battling the virus for over eight months. The pandemic fatigue is setting in but Kerala's already stressed healthcare systems will, still, have to work toward delaying the peak. It was never a question of choices and this time, the celebrations will wait.

R.Krishnakumar is a senior journalist based in Thiruvananthapuram.

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