Kerala: Preparing for a crisis

Kerala enters another phase in its COVID-19 containment efforts as experts warn that cases of infection may peak in the coming months.

Police personnel enforcing COVID protocol in Kochi on August 4, a day after they were given a bigger role in deciding and maintaining containment zones.

Strange as it may seem, COVID-19 and news updates on it are gradually being relegated to the inside pages of newspapers in Kerala just when experts are warning that infections in the State will peak in the next two months.

On August 16, as the State crossed 200 days since the first positive case in the country was reported there, Chief Minister Pinarayi Vijayan said in a message on Twitter: “We are into the 200th day of the COVID19 crisis. Looking back, we can say with pride that this has not been just a period of despair & loss. It has also been a time of courage, compassion, resilience and survival. People of Kerala responded to the crisis with an unflinching spirit.”

The Chief Minister and several of his Cabinet colleagues are in self-isolation since August 14 following a scare about possible infection after their visit to the Kozhikode air crash site. The Chief Minister’s daily COVID press conference, a key element in the government’s strategy to keep the pandemic at bay and build public awareness about the infection, has been suspended since he went into self-quarantine. The Congress-led opposition, obsessed as it is with the government’s good record in handling the COVID-19 crisis until now and the effect it would have in the coming local body elections, has been raising a series of allegations with regard to the gold smuggling case   in order to divert attention, instead of offering constructive support to the government at a time of crisis. In mid-August, Health Minister K.K. Shailaja, quoting experts, warned that from September the State might see an increase of 10,000 to 20,000 cases every day. The death rate, too, was likely to go up if the spread of the virus went beyond the carrying capacity of health care facilities, she said.

A sharp increase in positive cases was noticed by the end of June, and from then on local transmission became the dominant cause of infection, unlike in the first five months when the infection was caused mostly by those who had arrived in Kerala from COVID-affected countries or other States.

On July 31, the State had a total of 23,613 confirmed cases, of which 19,171 were reported that month. But in the first 19 days of August, there were 26,618 new cases. From August 1 to 18, more than 1,100 cases were reported every day. On August 19, the State witnessed the highest single-day spike of 2,333 cases, taking the total number of confirmed cases to 50,231 (17,382 of them being active cases).

The Health Minister said efforts were on to mobilise resources to manage the possible increase in the number of cases. She said health care personnel were appointed, more than 800 first-line treatment centres had been set up, and basic facilities upgraded in COVID hospitals. A COVID Brigade has been formed, with doctors, nurses, paramedical staff and volunteers to run the first-line treatment centres (FLTCs).

While announcing the launch of the COVID Brigade, the Chief Minister said: “We need more people to volunteer, in view of the rising number of cases.”

Kerala is entering another phase in its COVID containment efforts. These include ramping up testing, identifying asymptomatic patients early on and providing treatment, using the police and their resources to trace contacts and manage containment zones, and revising treatment and containment protocols regularly.

The State has followed a centralised and uniform treatment pattern in all dedicated COVID hospitals, which has been an important element of its management strategy. As private sector involvement is expected soon in a big way, the Health Department said it would amend treatment guidelines in order to “streamline the treatment of SARS-CoV 2 infection based on the available evidence from across the world and also based on data from Kerala”. The guidelines would be updated from time to time on the basis of “evolving evidence”.

Meanwhile, in a controversial move in early August, even as it eased lockdown restrictions and limited containment zones to the immediate surroundings of a hotspot as a measure to liberate the economy, the government entrusted the police with the primary responsibility of enforcing quarantine measures and contact tracing.

Many organisations, including the Indian Medical Association, raised concerns about assigning the job of health care workers to the police. Leader of the opposition Ramesh Chennithala approached the High Court to appeal against the move to allow the police to gather call data records of COVID-19 patients, saying it was an infringement on the right to privacy of an individual as laid down in the Supreme Court’s judgment in the K.S. Puttaswamy case.

The opposition said the move was meant to convert Kerala into a “police state”.

The Chief Minister, however, justified the decision as the most effective way to trace contacts, given the increasing number of cases, and said that the State had been using this method for a few months now. He said “the information collected thus will not be passed on to anyone else or used for any other purpose.”

The police, in an explanatory note on August 15, said they were only using technology for effective contact tracing “in a legal manner”. They collected details of tower locations and did not gather contents of calls, they said.

The High Court had not given its verdict on the opposition’s appeal at the time of filing this report.

With the number of cases continuing to rise, the government announced that it would make testing more widespread, as demanded by health experts, “for early detection and management of the disease and for keeping mortality down”. The State spent Rs.1.7 crore every day to conduct tests alone. There were nearly 200 private hospitals or laboratories in the State with facilities for COVID-19 testing using various diagnostic methods. The government has relaxed the norms allowing people to undergo tests in private facilities as well.

Apart from the spread of clusters in coastal areas of the State, urban clusters in slum colonies and an increasing number of institutional clusters, for example, in prisons, are posing a challenge for the managers of the crisis. There is growing concern about non-COVID care in government tertiary care hospitals getting affected, with more health care workers contracting the infection.

The State has recorded a total of 182 deaths. Some people have argued that the figure is higher and that the procedure followed for the classification (coding) of deaths relating to COVID-19 is wrong. A discussion paper published by the Health Department recently denied this claim. It said the cause of death was ascertained on the basis of “international guidelines for certification and classification (coding) of COVID-19 as cause of death”. It said that of the 62 deaths in July, for which audit had been completed, seven were classified as “death not due to COVID infection” because the underlying cause was not COVID infection. The Health Minister is on record as saying: “Only those fatalities in which COVID-19 is the root cause of death can be determined as COVID-19 deaths as per the international guidelines.”