Since last week Kerala has been in the limelight for a gradual increase in COVID infections. If one goes by the numbers, the state is registering more than 20,000 new cases every day – nearly 50 per cent of the daily increase in COVID cases nationwide. This has set alarm bells ringing in Delhi and the rest of the country. The health ministry has rushed a team to Thiruvananthapuram to study the situation and central authorities have issued a warning that the state should not allow the situation to get out of control by ignoring “super spreader” events.
A week ago the Supreme Court rapped on the knuckles of the Kerala state administration, warning them that they should not have relaxed lockdown restrictions on the eve of Eid. The court, which had frowned upon the Kawarian march in Uttar Pradesh, made it clear that public health should take precedence over religious events. The Kerala unit of the Indian Medical Association too issued a warning to the state government, calling its lockdown relaxation policy faulty. IMA said instead of preventing pandemic, it was in fact encouraging people to gather in large numbers.
How did this happen? Is Kerala, from being a model state that had handled the first two phases of COVID very well, slipping now? Has the state lost the plot and in fact posing a threat to other states? Is the Left Front government headed by Pinarayi Vijayan losing its touch? Where is Kerala’s famed health system? Why are the infection levels going up?
Epidemiologists and virologists, in fact, point out that far from being a culprit, Kerala is actually managing its COVID situation very well. According to them, the Kerala model is relevant and other states should emulate it. They insist that the Kerala case study and its data need to be studied closely to understand the real situation. So how does one explain the Kerala paradox?
Consider the following numbers. A recent ICMR study says that while the overall seroprevalence in the country is 68 per cent, that of Kerala is 44 per cent. This shows that while in other parts of the country 68 per cent of the population is infected, in Kerala only 44 per cent are affected. This, epidemiologists say, is a sign of good management.
Kerala has fully vaccinated 20 per cent of its total adult population, as opposed to the national average of 7.5 per cent. Similarly, the state has provided at least one jab to 38 per cent of its adult population as opposed to 25 per cent of the national average. Kerala was conducting on an average 1,40,000 tests a day, which was much higher as compared to other states. For instance, West Bengal, whose population is three times that of Kerala, was testing only 50,000 patients per day, one-third of Kerala’s average. More tests means more detection. Other northern states such as Bihar and Uttar Pradesh were doing fewer tests as compared to their population.
Kerala’s test per million is more than double as compared to the rest of the country. Therefore, the state is able to detect at least one infection in two tests as opposed to one in 26 or more tests conducted by other states. Instead of random testing, the state has employed measured and targeted tests, yielding better results.
Poor testing is obviously used as a pretext by states to hide their underperformance. While honest states declare their testing strategy and their testing numbers, those who are keen to game the system do get away with it. A comparable example is that of crime rate. National Crime Bureau statistics have repeatedly shown that states that report and register FIRs (First Information Reports) diligently seem to record more crime numbers as opposed to those that don’t.
Kerala has other impressive numbers. Though the infection figures are high there is no pressure on hospital infrastructure. For instance 50 per cent of hospital and ICU beds and more than 50 per cent of ventilator beds are vacant. Also the case fatality rate of Kerala has been only 0.5 per cent as opposed to national average of 1.3. This means fewer people have lost their lives. Various independent studies also show that Kerala has been relatively honest in admitting its deaths. While the state’s excess mortality rate is 1.6 times, it is less as compared to other states, some of which have shown 30 to 36 times more deaths than the reported cases. Kerala therefore, one can say, has been more honest in reporting its deaths.
Kerala has two distinct demographic disadvantages: It has higher proportion of older age people as compared to other states and, though it has a population of only 3.5 crore, its land mass is limited and therefore the settlements are dense. This exerts pressure on infection management. The state has also done its genome sequencing early as compared to other states and therefore it is in a better position to identify mutations. According to some virologists Kerala is facing higher infection now because the Delta variant has arrived late in the state.
All this does not mean everything is rosy in Kerala. The state has to keep its guard up because the R0 number or the figure that represents the spread of the infection is high at 1.2. This means one infected person can infect more people. The state has to maintain strict lockdown in some of its containment zones as more than half of its districts have infection rates crossing double digits. Overall the state is confident that with its strong health infrastructure it should be able to overcome the situation. The Centre should support the state in its efforts. It should avoid any temptation to politicise the situation or issue administrative fiats that may jeopardise the fight against the virus. For instance, the threat of invoking Disaster Management Act to specific containment zones is likely to end up as a controversy. Instead the Centre should support the state with more vaccines. The state, meanwhile, should release more relevant data about its testing methods so that there is more evolved policy making.