COVID-19 UPDATE

Kerala: Bracing for the worst

Print edition : September 25, 2020

Parid, who is 103 years old, leaves the Ernakulam Medical College Hospital on August 18 after fully recovering from COVID-19, 20 days after testing positive for the disease.

A Kerala government poster during Onam “Soap, mask and gap” to keep COVID-19 at bay, the slogan reads. Photo: by special arrangement

In Kerala, hundreds of people are getting infected daily through local transmission, infection from unknown sources has increased manifold, and the government is warning against complacency.

ONAM was a low-key affair in Kerala with the government asking people to celebrate the festival with care, adhering to the “soap, mask and gap” guidelines for COVID-19 prevention. Experts warned that the State was about to see the worst of the pandemic, with cases perhaps increasing by 10,000 to 20,000 every day in the coming weeks. The trend of an increase in the number of cases, which was visible from the last week of June, has continued. The State, which had 23,613 confirmed cases on July 31, reported 76,525 cases by September 1, with 22,512 (29.42 per cent of the total) of them being active. The highest single-day figure of 2,476 cases was recorded on August 26.

Even as the number of cases was increasing, the number of those recovering from the illness was also on the rise. Over 70 per cent of the positive cases (55,778 persons) had recovered by September 2. According to official figures, 305 people (0.39 per cent of the cases) died until September 2.

Unlike the situation in the first five months of the viral infection in the State, as containment measures failed at many places and the number of positive cases started going up, concern and criticism about the measures adopted by the State began to increase.

Chief Minister Pinarayi Vijayan said at a pre-Onam press conference that the evolution of the pandemic had been on predicted lines: “We are passing through the most critical stage of COVID-19. However, we cannot say that the current status of the pandemic is unexpected. Kerala was among the places in the world where COVID was reported quite early. But compared to other regions, we were able to contain the disease for a long time, without allowing it to climb to a peak. India now has the largest number of COVID cases in the world. The spread of the disease is becoming severe in south India. In Karnataka, the number of cases has crossed three lakh and 5,107 people have died [by late August]. Tamil Nadu has nearly four lakh cases and has had around 7,000 deaths. Karnataka recorded 82 deaths per 10 lakh population; Tamil Nadu 93 deaths per 10 lakh population; and Kerala, eight per 10 lakh population. If the situation had been the same as in the neighbouring States, Kerala, with a very high population density and a comparatively high proportion of aged people and high incidence of diabetes and heart disease, should have been in a bad situation. But even with such drawbacks, the spread of the disease and the death rate could be contained to a large extent. This was because of the support of the people and the exemplary functioning of the government systems,” he said.

Meanwhile, the second volume of the State Health Department’s Death Audit Report, released recently, has kept alive the controversy over whether the procedure followed for the classification of COVID deaths is right.

The government maintains that it ascertains COVID as the cause of death on the basis of World Health Organisation (WHO) guidelines for certification and classification of COVID-related deaths. It defines a COVID death (for the purpose of surveillance) “as a death resulting from a clinically compatible illness in a probable or confirmed COVID case unless there is a clear alternative cause of death that cannot be related to COVID disease (e.g. trauma). There should be no period of complete recovery between illness and death.”

But some experts say such a classification tends to leave out many COVID related deaths as those caused by unrelated reasons. However, they agree that Kerala’s case fatality rate of 0.37 would remain the best in the country even if such suspect/probable cases are taken into account as COVID deaths.

The government considers that it has gained a big advantage by controlling the rate of spread of COVID effectively until now. The first five months had seen the State Health infrastructure strengthened in a big way, with the appointment of more health workers and volunteers and the establishment of COVID First-Line Treatment Centres (CFLTCs), COVID care hospitals, and more laboratory and testing facilities in all districts. As part of the Aardram Mission, 386 Primary Health Centres in the State have been converted into Family Health Centres (FHCs), with more doctors and facilities. More than 150 FHCs are to be inaugurated soon.

As announced by the Chief Minister, the State now has 1,076 CFLTCs and 96,785 beds. Nearly 1,843 health workers have been appointed in the CFLCTs alone. Since the COVID outbreak, 9,768 health workers have been appointed through the National Health Mission. Nearly 1,200 house surgeons and 1,152 temporary employees have been deployed for COVID containment activities.“As the disease is reaching a peak, we could make ready the facilities to limit its impact. We already have enough facilities to accommodate even eight times the number of patients that we have now,” the Chief Minister said.

On January 30, when the first COVID case was reported in Kerala, the National Virology Institute at Alappuzha alone had the facility to conduct COVID tests. Now, 19 government labs and 10 private labs are equipped to conduct RT-PCR tests. Besides, there are 234 private labs conducting antigen tests. The number of COVID tests being conducted every day would soon be raised to 50,000 (from around 40,000 now, on most days).

Soon after the first case came to light, the government had announced that COVID treatment would be free in Kerala. COVID tests, food for patients, medicines, mattresses, ventilators and plasma therapy are being provided free of cost in government hospitals. The government has permitted private laboratories recognised by it to conduct COVID tests and has mandated uniform rates throughout Kerala for these tests.

The Chief Minister said: “We have permitted government-recognised private labs to conduct COVID tests for anybody who comes forward for it voluntarily. We have also directed that labs in private hospitals can only charge government mandated, uniform rates for these tests. These rates are lower than in most other States. For example, ICU charges a day in private hospitals in Kerala are Rs.6,500. The rate is Rs.46,365 in Andhra Pradesh; Rs.11,000 in Tamil Nadu; Rs.15,000 in Haryana and Delhi; and Rs.8,500 in Karnataka.”

There is no doubt that the rate of spread of the infection in Kerala is disturbing. Total lockdown was announced when the number of cases was just a handful in the State. While the initial worry was over the transmission of the virus from infected travellers returning from abroad or from other States, now hundreds of people are getting infected by the day through local transmission. Infection from unknown sources has also increased manifold. The official map of containment zones in the State now marks almost the entire State in red, with hundreds of such zones spreading into rural areas from urban centres in each of the 14 districts. The risk of infection is high. And even as it announces easing of lockdown restrictions, the government is reiterating that everyone must create a protective cover around themselves and help strengthen its “Break the Chain” campaign.

At a press conference a few days before Onam holidays began in the State, the Chief Minister drew attention to what he described as “a dangerous campaign” going on in the State that COVID was a harmless disease and that the death rate was only 1 per cent. “If such an impression spreads among the people, it will cause peril in the State. We need to remember that 1 per cent of 3.5 crore population in the State would come to 3.5 lakh people. Even if only half that number of people are infected, we can imagine what that would mean. Moreover, even if the death rate remains small, we must know that as and when the number of patients increases, the number of deaths will also increase proportionately,” he said

The Chief Minister said Kerala was trying its best to avoid deaths. “Every life is valuable. We must all pledge that we will continue to retain Kerala as a region with the lowest COVID death rate. We have remained committed to the idea that when we wear a mask or wash our hands frequently or maintain physical distancing, we are not merely keeping ourselves safe but saving the lives of others, too. We must not let go of that commitment. We must be vigilant in the days ahead too,” he said.

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