Why Kerala is reporting nearly half of India’s Covid-19 cases
Up to 44% of Covid-19 cases in India have of late been reported from Kerala, which was once cited as the role model for management of the disease. Kerala health ministry statistics show that the state’s Covid-19 positivity rate is five times the national average.
Most states are reporting Covid cases as low as the May-June levels. But in Kerala, intensive care unit (ICU) beds in several hospitals are almost full. According to the ministry, there are 3,050 ICU beds -- 1,200 in government hospitals and 1,850 in the private sector --- and of them about 90% are occupied.
“As of now, the situation is under control but if the situation aggravates the health ministry will have to find other alternatives like makeshift hospitals for Covid patients,” said health expert Dr SS Lal.
Health experts blamed the over-confidence of the state government and its over-dependence on antigen tests, considered to be less accurate, than the reverse transcription-polymerase chain reaction (RT-PCR) tests believed to be the gold standard for Covid-19 diagnosis, for the rising number of cases and high positivity rate. Worse, they say, the state is still flaunting old records to paint a rosy picture.
“The state failed to go after the virus, but it went after records of the pandemic. The situation is serious. We have been warning the government about it for quite some time,” said Lal, a US-returned public health expert, adding the state was paying the price for ignoring early warnings.
Statistics show that the situation has turned serious in the last three months. Covid-19 cases started to rise after a brief lull in October (called the second wave). The average test positivity rate (TPR) rose to 13% and on October 13 it went up to 18.16%. In November, the TPR came down to 8% and in December it went up to 9%, shows the ministry data.
In the second half of January, the cases started rising again with the TPR increasing to 12.48% on January 25 from 10.88 in mid-January.
As the positivity rate rose, the number of active Covid cases also increased. Average active cases in the last three months were between 65,000 and 70,000, statistics show. On Wednesday, the active caseload was 71,607.
According to the Union health ministry, out of the 20 worst-affected Covid districts, 12 are in Kerala now.
Ernakulam and Kozhikode top the state in Covid-19 cases. The Indian Medical Association (IMA)’s Kerala chapter has asked the state government to take stringent measures in Ernakualm including a lockdown to check the spread. The state government appears to be reluctant because it could impact upcoming assembly polls, which are three months away and has rejected the demand.
“The state is treading dangerously and some districts like Ernakulam need strict measures including a lockdown,” said IMA Kerala president PT Zacarias. “Situation is really fluid. Some people behave as if with the arrival of vaccine, everything is normal now,” said S Mini, a nurse at Ernakulam district hospital.
The only silver lining is the low mortality rate. “We need a genetic study to find out whether in Kerala a less lethal strain has developed which is not causing many deaths but the infection is spreading faster,” said public health expert and epidemiologist Dr B Raman Kutty.
Experts, however, alleged fudging and under-reporting of cases and deaths. “Total deaths are 3,643 as on Tuesday. Since December first week I collected data from government and private hospitals and health volunteers and posted a difference every day on social media. According to my estimate, Covid-19 deaths will be at least thrice the official tally,” said Dr NM Arun, an internal medicine expert who has studied Covid-19 deaths extensively.
A government doctor at Thiruvananthapuram medical college, who did not want to be named, admitted that there was a huge disparity in official tally and the ground situation. Even the names of a legislator and a youth leader, who died of post-Covid-19 complications, did not figure on the official mortality list. Health ministry officials said they were Covid-19 negative during their last days.
“We have a standard protocol, and we enumerate deaths based on this. We agree some deaths failed to figure in the official list,” said a health official, debunking claims of data fudging.
Lal said dependence on unreliable and cheap antigen tests despite repeated directives from the Union health ministry was the reason for this rise in cases.
A close look at the Covid dashboard shows that out of 9,289,304 tests conducted till Monday, antigen tests accounted for 66%. In neighbouring Tamil Nadu, all 15.2 million crore tests were RT-PCR tests. In Karnataka, 70% of close to 18 million tests were RT-PCR tests.
Health experts say antigen tests are only 50% sensitive while RT-PCR 90%.
“It seems home quarantine of those who came from outside did not work and the virus started spreading in the community. The state surveillance machinery either failed to detect this or ignored it. There were tell-tale signs of community spread and the state should have taken those warning signs seriously,” said G Pramod Kumar, a former senior advisor to the United National Development Programme.
State health minister KK Shailaja said it was wrong to blame the government alone for the surge in cases. “We admit cases are on the rise. Our intervention delayed the peak and we kept strict tabs on the mortality rate,” she said, adding the year-end festive season and local body elections were responsible for the rise.
“We can’t remain in lockdown ever; life has to go on. We have streamlined our measures again. We have strengthened our surveillance and contact raising. We hope the surge will be contained by next month,” she said.
But experts said going by the present infection rate, it will take two-three more months to subside.
As cases pile up, a worried state government has launched a fresh programme, Back to Basics, to tide over the crisis. The Union health ministry has asked the state government to scale up tests before it gets out of control. Since almost all sectors have opened up, it will be difficult for the government to impose another lockdown now.
What worries health experts is that this particular wave of infections is showing no downward trend in the state with a high population density (859 people per sqkm) and a large number of elderly (at least 15% of the population are above 60 years of age). A study conducted by CADI (Coronary Artery Disease among Indian Asians) has shown that Kerala’s diabetes prevalence is 20% against the national average of 8%.
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