Why is Kerala’s COVID curve still not flattening? Here are the reasons

The Indian Council of Medical Research’s fourth seroprevalence survey, which uses antibody tests to estimate the percentage of people in a population who have antibodies against SARS-CoV-2, says Kerala continues to have a large number of people who are not immune to COVID-19.

The state’s COVID trajectory continues to differ, with only 45 per cent of its population having been exposed to the virus, compared to 65 per cent nationally. In other words, 55 per cent of Kerala’s population is still open to infection.

According to experts, the data again confirms that Kerala’s COVID management strategy, though successful, needs to be tweaked. It is time to look beyond Test Positivity Rate to targeted and micro-level interventions. “We don’t have to be scared of TPR because we have been following a strategy of targeted testing. Now we have to start random testing too and provide both figures every day,” said Dr KP Aravindan, a member of the expert committee advising the Kerala government on COVID management strategy.

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“TPR is indeed an indicator, but it is not the only one. The high TPR in Kerala is also a sign that the state has been conducting targeted testing rigorously. That should not be a reason to punish people by making it the only standard for implementing or relaxing lockdown rules,” said Dr Padmanabha Shenoy. He told The Federal that the TPR value could be easily manipulated if that is the only criteria for imposing and relaxing lockdowns. “Local bodies may go for random testing and show a low rate of test positivity. We have to consider case per million too as a point of measuring the prevalence.”

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Dr Aneesh Thekkumkara, another member of the expert committee and associate professor at Government Medical College, Thiruvananthapuram, said the data is being misread. “Kerala’s seroprevalence was much less than the national average,” he said.

This could be an indicator of Kerala’s achievement in COVID management, he said. “The data shows the effectiveness of robust containment measures in Kerala, including quarantine, contact tracing, rapid detection of cases through improved access to tests.” Dr Thekkumkara also pointed to the surveillance and containment measures within clusters and ‘break the chain’ initiatives in the state.

With a huge population remaining susceptible, the Centre should consider Kerala a priority state for the vaccination programme, the experts said.

“Vaccinating maximum number of people as fast as possible is the only way out. Besides, we have to strictly maintain masking and social distance norms,” said Dr Thekkumkara, adding that more stringent lockdown rules will not help much. “If 75 per cent of the population gets vaccinated, COVID will become just like any other normal flu. We have to apply our focus on hospital admissions and ICUs, and thus bring down fatality,” he said.

Dr Padmanabha Shenoy had another explanation for the prolonged high plateau in number of cases. “The answer lies in the excess death data,” he said.

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“Take a few other states – Madhya Pradesh had 2.1 lakh excess deaths from April 2020 to  May 2021. If we assume infection-related mortality of around 0.4 per cent, we can see that 5.3 crore people in MP would have got infected by now. That is 74 per cent of the population,” he said.

Similarly, more than 50 per cent of people in Tamil Nadu and Karnataka are already infected, Dr Shenoy said. “With another 10 per cent fully vaccinated, 65 per cent of people there will be immune. Between April 2020 and May 2021, Kerala saw only 6,000 excess deaths. Even if we consider the allegations that the actual number of COVID deaths is being played down, the scenario does not change much.”

As of July 23, total number of COVID deaths in Kerala is 15,616. “Even if the actual number is more than double, it would mean that only 32 per cent of the total population is infected,” said Dr Shenoy.