Why ‘model state’ Kerala is accounting for more than half of India’s daily Covid cases

Centre has rushed a team to Kerala, the second one this month, to take stock of the situation and work with the state health department.

A Covid-19 testing centre in Kerala. | Photo: Praveen Jain/ThePrint
A Covid-19 testing centre in Kerala. | Photo: Praveen Jain/ThePrint

New Delhi: For two straight days now, Kerala, once a globally celebrated Covid-19 “model”, has recorded more than 22,000 new cases, and over 50 per cent of India’s daily tally.

The gravity of the situation has pushed the Centre to send a team to the state — the second one this month — to take stock of the situation and work with the state’s health department. 

While Kerala’s case fatality rate (CFR) remains low, there are fears over the state’s high numbers leaving a lot of patients with possible post-Covid complications in its wake.

On Tuesday, the state reported 22,129 cases against the all-India tally of 43,654 new cases. On Wednesday, the figure dropped marginally to 22,056 cases against the national tally of 43,509.

Graphic: Ramandeep Kaur/ThePrint
Graphic: Ramandeep Kaur/ThePrint

“We did prevention well, so we are susceptible to infection and that’s what the sero survey numbers show. It is important to see how cases are managed… we prevent well, we vaccinate. We are ensuring that the deaths are kept at a minimum,” a senior Kerala government official told ThePrint.

“This is what is called flattening the curve. If the area is going to be the same under the line as when there is a curve, there will be more cases over a longer period. That’s how you ensure the system doesn’t get overwhelmed,” the official added.

Seven of the 22 Indian districts that have reported an increasing trend in cases in the last four weeks, are in Kerala — Alappuzha, Kottayam, Malappuram, Thrissur, Wayanad, Ernakulam and Pathanamthitta. 

In a statement Wednesday, the Press Information Bureau said: “Kerala with an active case load of 1.54 lakh is contributing 37.1% of the total active cases in the country, with a growth rate of 1.41 in the last 7 days. Average daily cases being reported in the state are above 17,443.”

The Centre also wrote to the state blaming the surge on superspreader events.

It added: “The state has also reported a high case positivity of 12.93% cumulatively and 11.97% weekly. 6 districts are reporting more than 10% weekly positivity.”

The Kerala government maintains that it is because of the resilience of its health systems that cases in the deep interiors of the state are being detected and the fact that it did containment measures well early on, means there are many people who have been left untouched by the virus who are now vulnerable.

The fourth sero survey conducted by the Indian Council of Medical Research earlier this month found that seropositivity in Kerala is among the lowest in the country — 44 per cent. This means about half of the population of the state is still vulnerable.

However, this figure also means Kerala detected 33 lakh cases of about 1.6 crore infections (the state has a population of 3.4 crore people) — one case out of every five infections against a national average of one case for every 30 infections.

Also read: How Delta’s spread is testing even aggressive ‘Covid zero’ defences

Low seropositivity and CFR, but worries remain

According to virologist Shahid Jameel, the state’s seropositivity is the lowest in India, “so the state did quite well in protecting its people in the first and the second waves”.

“I was looking at some numbers and between 20 June when they had a low of 11,500 cases (daily average over the week) the numbers have gone up by 45-46 per cent but their testing has also gone up by about 30 per cent,” said Jameel.

“Their vaccinations are high but what worries me is that, I hope, they are not taking the UK route of letting the population be exposed while preventing deaths. Because 10-30% of people will have long Covid and we do not understand long Covid very well. New things get added all the time,” he said. 

But, Jameel conceded, he does not have an answer to why Kerala numbers have stayed consistently high.

The state’s vaccination numbers incidentally are better than the national average — 16.3 per cent against 7.4 per cent. One-dose coverage stands at 37.8 per cent against a national average of 26.4 per cent.

While the state’s CFR, which is the fraction of people dying for every 100 reported cases, remains a low 0.5 per cent against a national average of 1.34 per cent, the sheer numbers are causing worry. 

“Kerala has plateaued and they seem to have given up contact tracing altogether. Though their case fatality is low and that is probably because the health system is more primed to monitor people in home isolation etc, the high numbers are worrying. They are also using a lot of Ayurveda on people in home isolation,” a senior health ministry official told ThePrint on condition of anonymity.

Jameel said through the first wave peak of 97,000-plus in September 2020 and the second wave peak in May this year of over 4,14,000 new cases, Kerala’s share in daily cases has been less than 10 per cent. 

But now it has touched 50 per cent so there are also worries about “hidden” cases in other parts of the country. Kerala’s test positivity rate has remained in the 11-12 per cent range, he said.

“They need to bring the cases down. If partial lockdowns are needed in the high case burden districts, it should be done,” Jameel added.

Also read: India’s Covid cases have plateaued for 37 days. Here’s why this isn’t all good news