Exactly a year after SARS-CoV-2 reached the shores of Kerala, when the virus was first detected in a student from Wuhan, Kerala has come full circle. It now finds itself in the spotlight again: this time it has the highest case pool of active COVID-19 cases in the country. Kerala’s graph is steadily climbing, while it is going down in the rest of the country.
Kerala’s brush with Nipah was what initially shaped its response to the coronavirus. Though the nature of both was entirely different, the public was well-oriented towards masking, isolation, contact tracing and quarantine when these suddenly became the imperatives against COVID. In fact, much of Kerala’s successes in COVID containment were led by an aware and vigilant public, local bodies and the police, rather than the Health Department.
Achievement
Kerala’s biggest achievement was the manner in which it meticulously did strategic testing of symptomatic persons, contact tracing, isolation and treatment so that the peak was delayed. At no point was the public health system overwhelmed by patient overflow and mortality rate was kept under check. Delaying the peak also meant that the disease transmission would be slow and prolonged in the community.
“This trajectory of the pandemic was expected and we were prepared for a long plateau. What we did not reckon was the level of fatigue that had set in amongst field health workers and a weary public,” says Rajeev Sadanandan, Chief Minister’s adviser on COVID.
As the plateau got extended, the State eased up on restrictions in public places. The public was lulled into believing that the pandemic was on its way out. By this time, contact tracing and follow-up in the field had become non-existent; the police had officially withdrawn from their task of maintaining COVID protocols and the political attention had moved on from COVID.
Herd immunity
A committee of the Department of Science and Technology which analysed India’s COVID cases in December reported that till November Kerala had missed about 25 infections for every medically diagnosed case while this was about 70-120 cases for most other States and 300 or more for Uttar Pradesh and Bihar. This meant that while most States would have attained high herd immunity levels, Kerala’s population largely remained susceptible.
“The current course of COVID in the State is but the natural course of the pandemic and it will not go away till at least 60% of the population is affected. If we are pointing to how other States have brought down their case graph, then an explanation is in order on what these States did differently than Kerala,” says T. S. Anish, public health expert.
That said, right from the beginning, surveillance and data management are areas where Kerala seriously messed up. The State never opened up the primary database from districts for data analysts to generate more granular or disaggregated data. Such micro-level data could have given valuable pointers on identifying case clusters, where surveillance and testing needed to be stepped up.
Political exigencies also led the government to deliberately delay conducting a serosurveillance study till local body poll results were out. A study at the right time could have given a clear indication of the actual prevalence of the disease in the community.
To what extent did the government uphold transparency and balance political compulsions against science will forever remain the most compelling questions on Kerala’s COVID management.
