Thiruvananthapuram Kerala’s COVID-19 case graph hit the first peak in the last week of October when the State had 97,000-odd patients in its active case pool. One-and-a-half months later, the graph continues to be on an extended plateau, reporting between 5,000 and 6,000 cases daily.
The State now has the second highest active case pool in the country with 58,884 cases, behind Maharashtra, and accounts for nearly 20% of the nation’s active COVID caseload. The graph has seemingly dipped in all southern States, all of which are now registering between 500 and 1,200 cases daily, while in Kerala, disease transmission continues at a slow and steady level (test positivity range between 8% and 10%), widely distributed across the State.
However, public health experts and epidemiologists see nothing unusual.
“The disease epidemiology is no different in Kerala than the rest of the country. The crucial difference is that because of the strong containment measures and almost 100% public participation in control measures like universal masking, Kerala’s epidemic peak was much delayed. The case graph is now on a plateau, but we predicted a surge post local body elections,” says Rajeev Sadanandan, former Additional Chief Secretary, Health, and Chief Minister’s adviser on COVID-19.
“Based on what we know of the nature of the epidemic, it does not seem likely that the epidemic curve has actually declined in the rest of the country as is being projected. Better case detection is the only factor distinguishing Kerala now from the rest of India,” he adds.
If Kerala is reporting more COVID cases now, it is because of improved case detection due to focussed testing, officials say. Though Kerala has always drawn flak over the relatively lower number of tests it has been doing in the population, the State maintains that its strategy is to optimise testing amongst the symptomatic population to pick up the maximum number of cases.
“Rather than mass testing, we opted for efficient testing, focussing on the population at high risk of infection. The high health-seeking behaviour in the State and a network of highly aware and active health workers in the field meant higher yield of positive cases from the field,” says T.S. Anish, Associate Professor, Community Medicine, Government Medical College here.
The State has also been criticised for its reliance on rapid antigen tests over RT-PCR tests. “During the epidemic, we found that rapid antigen testing as a public health strategy had overall more efficiency than PCR because it was less time consuming and more accessible to people,’’ Dr. Anish adds.
The sudden apparent increase in mortality, as seen in daily reports, now that the case graph has plateaued, has been another curious phenomenon
“We started out death auditing with the premise that all deaths are non-COVID unless proved otherwise. Now that the State’s “undercounting” of deaths has become a serious public debate, there seems to be some easing up as far as COVID death reporting is concerned,” a senior official says.
However, it is reasoned that while most people recover from COVID within 10 days, those who succumb to COVID do so after a prolonged hospital stay of at least 25 days. Thus, it is natural for deaths to go up three-four weeks past the point when cases peaked.
It is also pointed out that there is an increase in unexpected COVID mortality, with a lot many people being brought in dead to hospitals due to COVID or because of issues in the COVID continuum.
The situation in Kerala around the epidemic is still evolving, for the State is just beginning to open up its public transport and schools. Experts opine that 10 months into the pandemic, inter-State comparisons are meaningless because other than the virus, it is the unique characteristics in each State (literacy, health-seeking behaviour, population density & structure) that define the disease epidemiology in each region
“Current data indicate that the case graph is on a plateau, which could be prolonged. We have to watch out for next week’s hospital admissions because we expected the case graph to spike after the elections. If that rise does not happen, we may be well and truly past the peak. But even if the case graph spikes, our health system is competent and robust enough to manage it,” says Mr. Sadanandan.
