By the last week of April, with only two dozen active Covid-19 cases and barely 500 new cases since January 30, Kerala had claimed to have flattened the curve when other states were struggling. Four months on, Kerala ranks 14 among states with a high caseload.
On September 1, Kerala had 76,525 confirmed cases, 31% of them active, compared to just 21.3% active cases at the national level. Of Maharashtra’s 7. 92 lakh cases, only 25% were active. Read in Tamil
What changed in Kerala?
Testing ramped up
The recent spike can be linked to increased testing. On August 26, when 40,352 samples were processed, Kerala reported a record 2,476 cases. On August 31, new cases were at 1,530 out of 18,027 samples. On September 1, when tests came down to 14,137, positive cases fell to 1140.
Until the first week of July, Kerala was testing less than 10,000 samples a day, and daily positive counts hovered between 200-300. In April-May, testing was only 500-1,000, mainly symptomatic people or their contacts. The Health Department then said it didn’t follow the “test, test slogan” and focused on quarantine, tracing and testing symptomatic cases. But the recent spurt has forced the government to increase daily testing.
Shift to local
In the initial months, Kerala’s cases had been mostly those with a travel history, and their primary contacts. Until early May, only 10% of the cases were of local transmission. Since then, locally transmitted cases have begun to dominate the state’s graph. As of September 1, cases with a travel history form only 19% of the state’s total. So far, the state has had 8,31,082 persons with a travel history (including 4, 22,920 from abroad), and only about 14,000 of them have tested positive so far, compared to about 61,000 infected locally. In daily caseloads in recent weeks, only around 10% have travel history.
Across Kerala, cases have emerged in 200-odd clusters in densely populated coastal areas, markets, government hospitals, and closed communities such as old-age homes, factories and malls. Certain rural and urban wards have also witnessed local transmission. Several persons had been infected in healthcare centres, where they had gone for non-Covid-19 treatment. In the state capital, 500-odd inmates of the central prison have tested positive, with the infection point assumed to be healthcare centres. Some of these clusters are still active, while most of the institutional clusters have been brought under control.
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Lowering of guard
During the lockdown, the battle was marked by community participation and effective government intervention at the grassroots. These control measures became less intense with time. On July 1, a report presented in a high-level review meeting pointed out flaws in quarantine management: “Vigil on those under quarantine has come down. On June 1 when 73949 persons had been under observation in Kerala, the local self-government department… had contacted only 50 per cent of those under home observation. Whereas, the police had contacted only 67 percent and the health department 73 per cent and revenue 2 per cent. On June 20 when the figure of those under quarantine in the state was 1.44 lakh, the monitoring of the government departments came down. On that day, the local self-government department could reach only 43 per cent of quarantined people, while the health department 60.4 per cent of those under quarantine. Non-compliance of quarantine has become a refrain, with police registering cases every day.”
Also read | Kerala growing faster than national average
Transmission via markets
At airports, seaports and inter-state borders, travellers were screened for quarantine. Trucks reaching various markets from other states, however, were not screened, and the cargo was not disinfected. From large markets, Covid-19 travelled to smaller ones in rural and coastal areas. Only on July 13 did the high-level committee recommend that “for going ahead with flawless Covid-19 preventive measures, truck drivers have to be included in the screening test”. By then, the virus had reached several markets, and spread from there. A market in Thrissur city was disinfecting trucks before allowing their crew to mingle with locals; on August 12, the state decided to emulate this in all markets.
From June, positive cases with no travel or contact history began emerging regularly. Victims of accidents, persons arrested in criminal cases began testing positive. From single digits, the number of cases in which the source of infection is unknown has been growing day by day. As many as 158 such cases were reported on September 1. Many persons who died without Covid-19 symptoms, too, were found positive in post-death tests.
From mid-April, the impression that the state had flattened the curve led to a sense of complacency. When the Centre issued guidelines about easing lockdown restrictions, Kerala relaxed these further. It allowed public transport, and graded several areas as green zones.
At every stage, Kerala was a step ahead of central relaxations by opening malls and places of worship, and allowing weddings. Several weddings and burial events, attended by scores, later emerged as Covid-19 clusters. On August 3, Kerala Chief Minister Pinarayi Vijayan blamed the complacency of people for the surge. For the last one month, police have been given the task of contact-tracing and managing containment zones, but the graph of cases is going up.
How Kerala was different
Before the first phase of unlock, Kerala’s cases were mostly those who had returned from virus hotspots abroad, and their primary contacts. As there was a complete lockdown in April, Kerala’s task was only to isolate, test and treat positive cases in these groups. Elsewhere in the country, Covid-19 was beginning to take hold. All this created an impression that the Covid-19 battle in Kerala was over.
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