Why Kerala has been overwhelmed by COVID 2.0

From being the blue-eyed boy of India’s COVID battle in 2020 to becoming one of the worst-hit states in 2021, it has been a downward spiral for Kerala.

The Pinarayi Vijayan-led government, fresh from its triumph in the Assembly election, on Thursday, announced a statewide lockdown from May 8 to 16 in view of the alarming rise in COVID cases in the State. All offices and commercial establishments will be closed, except for essential services. However, healthcare experts said the decision has been too late coming.

Related news: Kerala CM announces complete lockdown in state from May 8 to 16

On Wednesday, Kerala reported 41,953 new cases with a test positivity rate of 25.69%. While the numbers are worrisome, what is more frightening is the increasing reports of scarcity of oxygen, ICU beds and ventilators in districts such as Thiruvananthapuram, Thrissur and Palakkad.

Government stance

The state government insists there is sufficient stock of oxygen as well as ICU/ventilator facilities.  On Wednesday, Vijayan said at a press conference: “There are 2,857 ICU beds in government hospitals across Kerala. About 38.7% of ICU beds in government hospitals are still available. In private hospitals, there are 7,085 ICU beds and currently, 1,037 beds are being used for COVID patients.

“The total number of ventilators currently available in government hospitals is 2,293. Of these, 441 ventilators are being used for the treatment of COVID patients and 185 for non-COVID patients, which means, a total of about 27.3% is currently in use. Of 1,523 ventilators in private hospitals, 377 are currently being used for COVID treatment.”

Though the data provided by the Chief Minister give an assurance of the crisis still being under control, the ground reports tell a different story.  The ICU/ventilator occupancy in worst hit districts such as Ernakulam, Thrissur and Thiruvananthapuram is almost 100%, say healthcare industry insiders.

While the deaths due to lack of oxygen is nowhere near as staggering as in Delhi and other places, Kerala has its share of these, too.  A 38-year-old patient from Pathanamthitta district  died yesterday reportedly due to the non-availability of ICU. A 66-year-old woman in Thrissur died due to similar reasons.

The crematorium scenario is just as gloomy. It is reported that people have to wait long for crematorium ‘slots’ in Thiruvananthapuram district amid rising mortalities. About 12 to 15 additional cremations are being done in ‘Santhikavadam’, the crematorium in the capital city, it is reported.

Where Kerala slipped

So where did Kerala – whose success last year made state Health Minister KK Shailaja a global celebrity – go wrong this time round?

The primary reason, experts say, is the intensity of the infection in the second wave. While the first wave of COVID did spread panic and death, the mutant strains that came up subsequently have made managing the pandemic even more difficult this time.

“Our system is getting exhausted,” said Mohammad Asheel, the State Security Mission Director, who comes on Facebook Live to request people to mask up, sanitise and maintain social distancing. “It will go beyond our control if people do not listen to our repeated requests to take extra care to keep the COVID protocols.”

Asheel further said queueing up unnecessarily for ICU beds may clog the system further. “In most of the cases we need only oxygen beds and not ICUs. When people panic, they look for only hospitals where there is ICU occupancy, which only helps to worsen the situation,” he said.

Aravindan, a member of the expert committee advising the government on COVID, said the availability of critical facilities is comfortable, but the distribution is uneven, leading to a crisis situation in various pockets of the state.

“Technically speaking, our ICU/ventilator occupancy and oxygen stock is not yet exhausted, but the problem is that these facilities are not evenly distributed. The government is in the process of acquiring more private hospitals in districts where there is dearth of ICU/ventilator and oxygen beds,” he said, adding this could alleviate the problem.

According to Amar Fettle, the state nodal officer for COVID, the Government is widening the network with private hospitals on a daily basis. “We are finding more and more private hospitals in each district and they are being empanelled under the government’s COVID management programme,” he told The Federal.  Many private hospitals are not yet willing to come under the scheme as it is not ‘profitable’ for them, he added.

Lockdown dynamics

The strict nationwide lockdown implemented from March-end last year might have had a big hand in helping Kerala contain the pandemic then, experts observed. This year, the Centre has desisted from such a move, asking the state governments instead to use their discretion.

While states such as Maharashtra, Delhi, Karnataka and Tamil Nadu brought in curbs even earlier, Kerala had been avoiding a complete lockdown. The fact that the government had an election to contest may have shaped the decision, said observers.

For at least two weeks now, organisations like the Indian Medical Association (IMA) and many experts have been urging the State government to go for a complete lockdown; but the decision came only today.

“The health department has been making this demand since a few weeks, but all other departments were against it and the Chief Minister gave in to the pressure,” noted a senior officer with the health department.

Related news: Kerala COVID spike linked to UK variant, shows data

“There was strong resentment against a lockdown. The opposition parties vetoed it at the all-party meeting held a few days back,” the officer with the expert panel told The Federal.

“Kerala might have done a better job compared to many other states, but we have not done enough to face this crisis, taking a cue from the lessons of the first wave. We should have enhanced our bed capacity, ICU and ventilator facilities to the optimum level,” said the officer on condition of anonymity.  “A new 100 bed hospital is constructed in Kasargod district, new blocks are built in some government hospitals, oxygen production is enhanced, but we did not have alternative plans to bridge the demand-supply gap and to enhance human resources,” he added.

Issues particular to Kerala

While administrative shortfalls have made pandemic management more difficult this time round, health experts said that the state’s demographics could have a hand, too. Its high population density (860 people per sq km) makes containing the contagion very difficult, especially where there is no complete lockdown in place. Until recently, public places such as bars and cinema theatres were kept open, and occupied, too, making contact tracing for source of infection next to impossible.

Also, Kerala was among the earliest states to bring the caseload down last year. Consequently, fewer people in the state presently have antibodies against the coronavirus, said experts.