THE number of COVID-19 cases in Kerala crossed the one lakh mark by September 11. It stood at 1,17,863 a week later. Of these, 32,709 were active cases. The official death toll was 480. The number of new cases was the highest on September 16 at 3,830. Experts predict that it will soon reach 5,000 a day. From September 7, at least 12 to 14 deaths were reported every day.
But from the beginning of the month the State witnessed mass demonstrations and clashes with the police as opposition parties questioned the State government on one or other facet of the gold smuggling case into which parallel inquiries by the Central Bureau of Investigation (CBI), the Customs Department and the Enforcement Directorate are yet to be concluded.
With local body elections likely to be conducted soon, every urban centre in the State has been witnessing dangerous mass mobilisations that continue late into the night, with the participants and their leaders paying scant attention to COVID safety norms. Chief Minister Pinarayi Vijayan described it as “a deliberate attempt to derail the State government’s COVID-19 prevention efforts” at a time when experts have warned of a sharp rise in infections.
He said: “The fact that people’s representatives are involved in it is not a small thing. The government cannot allow such senseless attempts to spread the disease throughout the State. The police force, which was active in COVID-19 containment efforts, is now forced to deal with these everyday attempts to destroy the law and order situation in the State. The protesters rush towards the police without following safety norms. This disregards the direction of the Kerala High Court against conducting demonstrations violating the COVID protocol.”
A few days earlier Health Minister K.K. Shailaja had said that coronavirus infections and related deaths were likely to increase when restrictions were further eased from September 21 under the Central government’s Unlock-4 guidelines.
“We have kept the number of deaths below 500 till now. Among the bigger States, Kerala and Assam have the lowest mortality rate. But as the restraints are eased from September 21, we anticipate a rise in number of deaths and need to be cautious. We cannot afford to have our robust health system collapse under the weight of new challenges, as the numbers are bound to rise. We need to be ready, physically and mentally for the days ahead,” she told health care workers at the online inauguration of a series of development projects at the Kalamasseri Medical College Hospital in Ernakulam.
One of the issues the Minister highlighted was the scarcity of ventilators Kerala could face because of a shortage worldwide and the additional numbers the Health Department had ordered were yet to be delivered. The lack of sufficient number of ICUs (intensive care units) could also become a problem soon, she said. The number of people requiring intensive care has been going up. According to one estimate, about 52 per cent of COVID patients in the First Time Treatment Centres (FLTCs) are asymptomatic and about 47 per cent show mild symptoms. Only about 1 per cent are admitted with severe symptoms.
The Minister said a high density of population and a large proportion of the elderly and people with lifestyle diseases were issues that Kerala should pay special attention to as the number of cases went up. Government estimates show that over 80 per cent of the infected are below the age of 60. In the first fortnight of September, there was a 34 per cent rise in active cases in the State. The biggest worry was an increase in the rate of infection among the vulnerable populations, especially the elderly and those with comorbidities, who have so far remained relatively safe because of reverse quarantine and other containment measures.
Two members of the Stte Cabinet, Finance Minister Thomas Isaac and Industries Minister E.P Jayarajan, tested positive and forced other Ministers, including the Chief Minister, to go into quarantine. On leaving the hospital after recovery in ten days, the Finance Minister wrote on his Facebook page about his experience and insights from hospitals. Among them were: 1. Health workers in COVID hospitals are relatively safe. Only rarely do they get infected. But workers in non-COVID hospitals are at greater risk. 2. The number of patients in ICUs is going up. This is a dangerous trend. The death rate in Kerala is 0.4. That situation may change. 3. The transmission rate is between one and two. One patient transmits the infection to more than one person. 4. This will increase the demand for ICU beds. There are two kinds of ICU patients at the Thiruvananthapuram Medical College Hospital (where he underwent treatment): the elderly and obese youngsters.
The Minister said the foremost lesson to be learned was the need for extreme vigilance. He said: “I went to Venjarammodu to receive the bodies of two martyrs [victims of a recent instance of political murder]. The emotional atmosphere there made it difficult for people in the crowd to keep a safe distance from one another. Everybody wore masks. Sanitisers were in plenty. But any crowd will increase the chance of infection manifold. That is the experience.”
Unique patterns of transmission
A report on a study of the genetic epidemiology and evolution of SARS-CoV-2 isolates from Kerala conducted by doctors and researchers of the Government Medical College, Kozhikode, CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB), New Delhi, and the Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, has revealed unique patterns of transmissions in the State.
The study reports that the main strains of the virus originated mainly in Odisha, Karnataka and Maharashtra and were introduced into the State by inter-State travellers. None of the strains could be traced to global genomes; the inference being that the prevalent strains in the State were not brought in by the huge expatriate population that returned to Kerala in the past months. The report, therefore, suggests that focussed testing, tracing and quarantining of expatriates and other international travellers in the early months of the pandemic had been an effective strategy, but it was not meticulously implemented in the case of inter-State travellers.
The study found four novel genetic variants and 89 variants which were identified only in Kerala. The samples of the study were from the northern district of the State. The government has decided to entrust the medical college hospitals in Thiruvananthapuram and Ernakulam with the task of conducting similar studies in the southern and central regions.
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