Nearly five months after it flattened the Covid-19 curve in the second phase of infection drawing praise from the international community, Kerala has galloped into the list of top ten states with maximum caseloads, generating extreme concern among the state’s health officials.
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On Wednesday, the state reported a new daily high of 8,830 cases, pushing the tally of the total number of infections beyond 1,96,000. The rise in cases is especially striking because just two weeks ago, the state was reporting between 3,500-4,000 cases daily. The current average growth rate of infections in the last seven days is 4.12%, among the highest in the country.
What especially raises concern among doctors and health officials is the proportion of active cases, i.e., the number of people currently under treatment, to the total number of infections. Kerala has over 67,000 active cases, which is nearly 35% of the total number of cases recorded so far. It is much higher than India’s active case ratio which is at 15.42%. This means that the state is under greater pressure than before to allocate beds and resources for symptomatic patients and arrange more ICU beds and ventilators for those in critical condition.
In fact, the state has the third-highest number of active cases in the country, behind Maharashtra and Karnataka. Even states like Andhra Pradesh, Tamil Nadu, Uttar Pradesh and West Bengal, and the Union Territory of Delhi, which all have higher caseloads than Kerala, have lower numbers of people under treatment.
Consequently, another parameter on which Kerala is falling behind the national average is the recovery rate. Kerala’s recovery rate is at 65.39% while India’s is at 83.01%. This may be due to the fact that hospitals and first-line treatment centres (FLTCs) treating Covid-19 patients are discharging them only after they test negative on the antigen tests, even though the ICMR and the health ministry said they can be discharged if they don’t have symptoms.
Kerala’s spike in cases is substantiated when one looks at the positive cases detected per million population. While India’s is at 4,671, Kerala’s is at 5,583 cases per million population, pointing to the depth of the spread of infection. In new cases per million population per week as of September 19-26, Kerala with 158 cases is only behind Delhi (212) and Maharashtra (169) in the country. The test positivity rate as of September 30 is a whopping 13.86% when the recommended level of WHO and ICMR is below 5%.
One of the few parameters on which Kerala fares better than most states in the top ten list and the national average is the mortality rate. The state, as of September 30, has recorded 742 deaths due to Covid-19 complications which translates to a mortality rate of 0.38%, among the lowest in the country. The national average is 1.57%. States like Gujarat, Rajasthan, Telangana and Madhya Pradesh, which have lower caseloads than Kerala, have reported more deaths.
The infection spread in Kerala is uniform across the state with 11 out of 14 districts having reported over 10,000 cases since January. The maximum brunt has been borne by Thiruvananthapuram district, which includes the state capital, with over 34000 cases, followed by Malappuram with 22,543 cases and Kozhikode with 18,819 cases. Thiruvananthapuram is also far ahead when it comes to the number of Covid-19 deaths. The district has reported 226 deaths as of September 30, followed by Malappuram (73) and Kozhikode (70).
Even though the state government has admitted that the situation is extremely critical, it said it does not favour a complete shutdown. Opposition parties like the Congress and the BJP have also supported the move as a shutdown could push the population, already facing the effects of joblessness and dip in demand, into further economic uncertainty.
However, the government has contended that restrictions on attendance at public events like marriages and funerals will have to continue. Also, there will be increased policing on following Covid-19 guidelines like wearing masks and maintaining a physical distance.
The Kerala chapter of the Indian Medical Association (IMA) wrote to chief minister Pinarayi Vijayan this week, asking him to declare a ‘health emergency’ in the state so that the public could be apprised of the seriousness of the situation. Among the requests it put forward was increasing daily number of tests to 1 lakh so that asymptomatic cases are also detected fast and isolated. The most number of tests Kerala has conducted recently was 63,000 on Wednesday.
The IMA also said attendance at government and private offices and establishments must be at 50% or less and pleaded for restrictions on the functioning of markets, hotels and malls in hotspots and containment zones. It cited the absence of scientific co-ordination between officers at the highest level and alleged that government decisions are implemented without taking into confidence medical experts and organisations.
“Today, there is a paucity of beds and staff at government hospitals designated for Covid-19. In Medical college hospitals, at least 20-30% of the staff are getting infected regularly and going into quarantine. In several hospitals, even if beds are present, there’s a dearth of staff. Many of them are reluctant to work in these conditions. So we’ve already reached the maximum level (in terms of resources) and if the situation deteriorates further, we are heading for a calamity,” said Dr RC Sreekumar, who heads the research cell at IMA.
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