Kerala’s two-pronged strategy to ‘crush the curve’

The Kerala government intensifies its containment and prevention strategies to bring down the test positivity rate during the second wave of infection, besides increasing the pace of vaccination despite delay in vaccine supply.

Published : Apr 23, 2021 06:00 IST

People waiting for COVID test  at Fort Hospital  in Thiruvananthapuram on April 16.

People waiting for COVID test at Fort Hospital in Thiruvananthapuram on April 16.

An alarming increase in the numberof COVID-19 cases across the State soon after the chaotic Assembly election season has made the Kerala government scramble to re-introduce emergency preventive and containment measures. The government made a fervent appeal to people to go back to the basics and follow the norms of social distancing, maintaining personal hygiene and wearing masks to prevent disease transmission, and intensified efforts to vaccinate people in the vulnerable groups and those above 45 years of age.

At the height of the first wave in Kerala, in October-November 2020, the test positivity rate (TPR) was over 18 per cent and the State recorded over 10,000 patients a day. A steady rise in numbers was visible right from the end of March, and especially after the first week of April when political parties threw caution to the winds while campaigning and the government machinery was busy with the conduct of the election and the vaccination drive.

A total of 8,778 new COVID-19 cases were reported in Kerala on April 14. Of this, 7,905 had contracted the infection through contacts, 205 of them had entered the State from elsewhere, and 627 people had no identified source of infection. The TPR recorded that day was 13.45 per cent, the highest until then in 2021, and all other data showed an increasing trend.

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Ernakulam and Kozhikode, at 1,226 and 1,098 respectively, had already been reporting more than 1,000 positive cases every day. The daily numbers were growing in several other districts. For instance, Malappuram and Kottayam recorded over 800 additional patients a day by mid-April. The TPR in Kozhikode district reached 18.58 per cent, which is a cause for concern because during the first wave, at several places, including Poonthura, a coastal region in Thiruvananthapuram where community spread was first reported, the TPR had crossed 20 per cent.

The rate of infection among health workers has been rising, and what is alarming is that many of them have already received two doses of vaccine. (In all, 4,92,142 health workers received at least one dose of vaccine and 3,26,310 received the second dose by April 13.) The number of deaths has also risen. It was 22 on April 14, from around 10 to 17 for a whole month from mid-March. The number of active cases rose from below 3,000 in the previous weeks to over 5,000 by mid-April.

The total confirmed cases in Kerala since the reporting of the first cases in January 2020 was 11,89,175 as on April 14, the second highest among the States, but official figures showed that 94.67 per cent of them (11,25,775 patients) had already recovered, and only 4.9 per cent of them (58,245) were active cases and 0.41 per cent (a total of 4,836) had succumbed to the disease.

Mini containment zones

But health officials were worried about the speed and scale of the new wave for which the State seemed to have been less prepared than it was during the first wave. The official machinery and the people in general have dropped their guard. But as daily infections increased steadily to reach the levels similar to those recorded in October-November last year, many local bodies initiated lockdown-like restrictions in ‘mini containment zones’. The number of mini containment zones, or hotspots, began increasing suddenly after several months. By mid-April there were 420 hotspots.

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As on April 13, the average number of cases was 5,615, or 64 per cent of the peak figure last year, and the average number of deaths was 17 or 57 per cent of the peak figure in 2020.

Doubts have been raised frequently in some quarters about the tests per capita being conducted in the State and it has been suggested that the true number of infections is likely to be higher than what the official figures indicate. But the death rates are still low, a factor that has stood Kerala in good stead so far.

On April 15, the State government announced restrictions on large gatherings, shopping festivals, number of diners at hotels and restaurants, and shorter working hours for other commercial establishments. Prior permission will be necessary to hold weddings, housewarming ceremonies and public functions. Only those with COVID-19 negative certificates and those who have taken two doses of vaccination will be allowed entry into malls. Strict restrictions are to be followed within containment zones. Tuition centres have been asked to exercise extreme caution.

More testing to be done

A high-level meeting called by Chief Minister Pinarayi Vijayan decided to intensify testing for COVID-19. As part of this drive it was decided to test 2.5 lakh people over two days on April 16 and 17. All those who participated in the election process were to be tested. It was decided that those in high-risk groups, such as COVID warriors, those staying in places showing widespread infection levels, and those who come in contact with a large number of people on a daily basis as part of their work were to be sought out and tested. The government also decided to introduce mobile RT-PCR testing units in markets and other such places where widespread transmission is known to occur.

“The government hopes to contain the spread through widespread testing, strictly implementing restrictions and through intense vaccination drives,” the Chief Minister said after the meeting. He said facilities for testing had been arranged in all districts, and district administrations had been asked to ensure that targets were met.

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Earlier, Health Minister K.K. Shailaja said that total lockdown was not an option in the State, “as the government had to protect lives as well as livelihoods”. But local lockdowns would be introduced in places where the intensity of the infection was found to be high. She told mediapersons that dwindling vaccine supply was threatening to affect Kerala’s mega vaccination drives and although Kerala had asked for an additional 50 lakh doses of vaccine, “the Centre has not supplied even half of that quantity”.

She also said that if the Centre permitted the States to buy vaccines from the private sector Kerala could increase the number of inoculations. “If vaccines are not made available on a large scale, it will jeopardise Kerala’s mega vaccination drive,” she said.

Nearly 13.39 per cent of Kerala’s population (estimated to be 3,65,69,000 in 2021 as per the report of the National Commission on Population) had been vaccinated by mid-April, according to official figures. Of this, 48,97,155 had received the first dose of vaccination and 5,93,285 also the second dose. A total of 54,90,440 vaccinations was completed by April 16. Shylaja, who convened a meeting of senior health officials, said the government was launching a two-pronged strategy “to crush the curve” by intensifying containment and preventive measures to reduce the pace of disease transmission, while making vaccinations more widely available and increasing the pace of vaccination. Earlier, the State Health Department had decided to increase the surge capacity in all its secondary and tertiary care hospitals, re-mobilise human resource, and augment ICU and ventilator facilities in medical college hospitals for the management of a possible increase in the number of people with serious COVID-19 ailments.

Aggressive vaccination drive

Kerala began an aggressive vaccination campaign, and although the public response was remarkable in the initial days when it was opened to those in the 60-plus age group, and the response in some districts such as Thiruvananthapuram was encouraging. However, there was also public scepticism and vaccine hesitancy in many districts, such as Idukki, Malappuram and Kasargod, especially by the time the drive was opened for people in the 45-plus category.

But after the first wave was curbed, the government’s COVID-19 containment efforts lost much of its initial verve, people shed caution and resumed normal life and the pain of the total lockdowns had restrained the government from imposing further restrictions. During the Assembly election campaign, even as political leaders urged people to be careful and maintain social distancing, they were addressing huge election rallies where COVID-19 precautions were ignored, thus sending conflicting signals. Prominent politicians admitted to hospitals with COVID-19 after the voting day included Pinarayi Vijayan, former Chief Minister Oommen Chandy, Assembly Speaker Sivaramakrishnan and Agriculture Minister V.S. Sunil Kumar.

Also read: Lessons from the first wave

State health officials believe that if the pace of the vaccination can be kept above the speed at which the new infections were spreading, then Kerala can overcome the crisis. But the depleting vaccine stocks and dwindling supply are a constant worry. By April 10, only 31.63 lakh of the 1.13 crore people aged 45 and above (or 28 per cent) were vaccinated in the State, with 2.1 lakh doses administered every day.

In a letter to Dr Harsh Vardhan, Union Minister for Health and Family Welfare, on April 12, with a request for the immediate allotment of 50 lakh doses of COVID vaccine, the Chief Minister said: “So far the State has received 56,84,360 doses of COVID vaccine including 54,40,740 doses of Covishield and 2,43,620 doses of Covaxin and we have administered 48,24,505 doses till April 11, 2021. The stock which is left with us is sufficient for conducting vaccination for the next three days only.”

Union Health Secretary Rajesh Bhushan said at a press conference in New Delhi on April 13 that “Kerala has zero wastage of vaccine doses” while some States had registered 8-9 per cent wastage.

As per a seroprevalence study, only 11 per cent of Kerala’s population has got COVID-19 infection so far, a factor that the government has been highlighting to underline the effectiveness of the COVID-19 control measures it has adopted. “But it also means that the remaining 89 per cent of Kerala’s people are still vulnerable and the vaccination drive has to be speeded up if we have to protect them,” Shailaja said.

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The government has asked all local bodies where the TPR has crossed 15 per cent to start their own first-line COVID-19 treatment centres. As on April 14, several districts, including Kozhikode, Idukki, Palakkad, Wayanad, Malappuram and Kottayam, had recorded TPRs above 10 per cent.

Meanwhile, the government and the respective Devaswom authorities announced that the Thrissur Pooram festival, which attracts tens of thousands of people, would be held this year but under “unprecedented restrictions”, including entry into the Pooram grounds only for those who produce vaccination or COVID-negative certificates. The district health authorities warned that the TPR, which had come down to 1.3 per cent in mid-March in the district, had now risen to over 9.49 per cent and might even reach up to 20 per cent by the end of April. They said that it would be a challenging task to regulate the crowds that throng the Pooram festival and ensure people’s safety when the number of COVID-19 cases was increasing.

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