COVID second wave: Surge warning in Kerala

Mutant variants are likely to cause a surge in the number of cases in the State in the coming weeks, but in nearly a year of well-planned initiatives the State has been preparing to deal with any crisis.

At a COVID care centre at Kaloor in Kochi on April 23.

Kerala’s most notable achievement during the first wave of COVID-19 that began in March 2020 was its prevention and containment measures in a way that the number of patients always remained below the surge capacity of its hospital system. The State successfully managed to delay the peak in infections and keep the death rate very low for the entire duration of the first wave, which ended only by November after nearly seven months.

The highest number of cases in a day (11,755) was recorded on October 10, and the test positivity rate (TPR) at that peak was 17.75. From then on, especially after November, the numbers began to go down. On March 15, 2021, the number of new cases in a 24-hour period was only 1,054, and the TPR was 2.7 per cent. On March 23, the number of active cases in the State was 23,833, the lowest in several months.

However, from the last week of March the number of daily cases and the total number of active cases in the State began to rise steadily, and by April 27 the number of daily cases was 32,819 new and the total number of active cases was 2,47,181. Within a month the TPR rose to around 25 per cent. Chief Minister Pinarayi Vijayan warned that the State “was sitting atop a volcano” and that the active caseload had gone up by 255 per cent in just two weeks.

While it took nearly seven months for the first wave to touch its peak, in the second wave those highs were crossed in just about two weeks. The Chief Minister said the State was doing everything possible to enhance the surge capacity of its health system, but if there was no let-up in the number of people getting infected and the rate of COVID-19 spread, the system might collapse under pressure—unless the people too cooperated by strictly adhering to COVID-19 protocol and followed rules and government-imposed restrictions.

Mutant variants

“There is wide and intense transmission of mutant variants of the COVID-19 virus in the State,” Pinarayi Vijayan told the media. “Rapidly spreading U.K. variant and the more dangerous South African variant have been found in many parts of Kerala. The U.K. variant has been found more in the northern districts. At least 40 per cent of the new patients have been found to be infected with mutant strains of the virus. Of these, nearly 30 per cent have been infected by the U.K. variant (B.1.1.7), 7 per cent with the double mutant strain (B.1.617 reported from India) and 2 per cent with the South African variant (B.1.351),” he said.

Sequencing of samples by the Institute of Genomics and Integrative Biology (IGIB), New Delhi, has shown that mutant variants are spreading in 13 of the 14 districts of Kerala, except Pathanamthitta. While in February the highly infective variants were found only in 3.8 per cent of the samples tested, in March that figure rose to 40 per cent. Health authorities believe that given the high infectivity potential of these variants, their proportion would have now risen to 70 per cent.

Said Pinarayi Vijayan: “We are passing through a phase of most intense transmission of the pandemic in Kerala. The likelihood of Kerala too experiencing a situation now found in many northern States is very high because of the presence of mutant strains as in Delhi and other States several weeks earlier. It was when the transmission of mutant virus strains became strong that the situation turned serious in many such States. There were instances of people once infected by the virus getting reinfected (by the new variants) in such places. As such we have to foresee the most intense transmission of the pandemic in Kerala too.”

The Central government had asked States to consider introduction of a lockdown in districts with a TPR of over 15 per cent. This would have meant putting 12 of the 14 districts of Kerala under lockdown. But after an all-party meeting convened by the State government, the Chief Minister announced that the consensus was against a total lockdown in the State but for the continuation of the series of very strict restrictions already announced. This included night (9 p.m. to 5 a.m.) and weekend curfews, during which only essential activities were to be allowed; closing down of cinemas, bars, shopping and sports complexes; imposing heavier restrictions for religious gatherings and weddings; and restricting social, political, cultural and religious events and avoiding all celebrations on May 2, the day of the counting of votes of the Assembly election. There was large-scale deployment of the police, with the help of the local bodies, for monitoring and surveillance activities.

Concern about rate of increase

The first few weeks of May are crucial for Kerala, and experts believe that if the current rate of transmission continues, the number of COVID-19 patients may even rise to 50,000 a day. Representatives of the Indian Medical Association (IMA) and other professional organisations have, however, said that the government needs to increase the number of tests being conducted every day, four or five times from the current level, if all such cases are to be identified. Some estimates claim that by mid-May the total number of patients under treatment could even go up to five lakh and that at least 5 per cent of them would require ICU facilities and about 1 per cent would require ventilator support. The concern is that the rate of increase in the number of people with the infection, and the proportional increase in the people who may require ICU beds and ventilator facilities, may go beyond the surge capacity of the health system.

There are only 2,665 ICU beds for COVID and non-COVID patients in government hospitals in the State, and nearly 7,000 in private hospitals (out of which only about 300 are being used for COVID-19 treatment). Private hospitals have now agreed to set apart 25 per cent of the beds for COVID patients.

“The most important thing is to intervene effectively and reduce the number of people requiring hospital admission and intensive care treatment. If we focus on that, we can also bring down the number of deaths. The number of deaths will increase in proportion to the increase in the number of those getting infected. So, we need to be vigilant inside homes, offices, shops, public roads and everywhere all the time,” the Chief Minister said.

As a measure to keep as many beds free, the State has also taken the decision to allow the discharge of COVID-19 patients without waiting for 10 days and a negative result from a rapid antigen test, as was the norm until now; appoint an expert committee to introduce clear norms for admission of patients in hospitals; and ensure that facilities are increased in all centres in advance in anticipation of a possible surge of patients into hospitals. But a shortage of doctors, nurses and other health staff remains a concern.

On April 28, when this report was being filed, Kerala recorded 35,013 new COVID-19 cases, the highest single day rise until then. It had 2,66,646 active cases under treatment that day, and the death toll had risen by 41 to a total of 5,211. In the previous 24 hours, 1,38,190 samples had been tested and the TPR stood at 25.34 per cent, the government announced. But the TPR in some districts and within them, several local bodies, showed a huge increase.

Vaccine for all

The Central government’s new vaccine policy has led to a situation in which Kerala will have to pay for vaccines for those in the 18-45 age group. The State has demanded that such an “inappropriate policy” needs to be revised and that vaccines should be distributed free of cost to all. Meanwhile, in tune with its policy announcement that vaccines would be free in Kerala, the State has decided to distribute it free to those in the 18-45 age group too. The State Cabinet decided on April 28 to pay for one crore doses of vaccines from the Serum Institute and Bharat Biotech companies in the months of May, June and July.

Said Pinarayi Vijayan after the Cabinet meeting on April 28: “The aim of the State government is to ensure free vaccines to all its people. This includes 70 lakh doses of Covishield from the Serum Institute at a cost of Rs.294 crore (at Rs.400 plus 5 per cent GST for each dose) and 30 lakh doses of Covaxin from Bharat Biotech (at Rs.600 including GST per dose). This would cost Rs.180 crore [the cost before the Serum Institute reduced the price of Covishield by Rs.100 per dose].”

Medical oxygen surplus

A big relief for Kerala during this second wave of the pandemic is that nearly a year of well-planned initiatives has ensured that the State has enough stock of liquid medical oxygen required for its needs, in contrast to many other States. Until a year ago, Kerala used to depend on neighbouring States for its requirement of liquid medical oxygen. But the initiatives of the Petroleum and Explosive Safety Organisation (PESO) and the State Health Department to augment capacity in the public and private sectors and plug leakages today finds the State with a capacity to produce over 200 tonnes of medical oxygen, as against its current requirement around 98 tonnes a day. The State has also been supplying a part of its production to neighbouring States.