Did Kerala miss an opportunity to contain COVID-19 transmission earlier, when disease transmission was not so intense? Should the virus have been allowed to run riot across the State before deciding on a lockdown?
Many public health experts believe that Kerala indeed had a great opportunity to contain disease transmission and break its pace, a couple of weeks ago, when it had been very evident that the second wave of COVID-19 is totally different from the first and that the epidemic curve was going to rise steeply.
During the first wave, the State’s strategy had been to delay the peak so that there was more time for preparation and the health system infrastructure would not be overwhelmed when the patients numbers surged.
At the peak of the first wave, in October last, Kerala had 97,417 active cases of COVID-19, 23,455 patients in hospitals , with 843 in ICUs and 209 on ventilator support
On the eve of lock-down, the State has 3.75 lakh active cases, 28,740 patients in hospitals, with 2,033 patients in ICUs and 818 on ventilator support. And the peak of the epidemic curve is still at least two weeks away.
There were ample warnings from epidemiologists about letting down the guard early. From what one could gather from the rest of the country and the globe, it was evident that the second wave would be brutal, fast and that there would be more hospitalisations. In March itself there were reports from Chennai and Mumbai about the scramble for hospital beds.
Kerala’s epidemic curve had been on a declining trend in February-March and the graph began to rise again after March 27.
Mid-April, when the case graph began registering 11-12 k cases daily, it should have been clear that clamping down COVID protocols alone was not going to result in effective containment, epidemiologists feel
At the time, public health experts had expressed their fears that the disease transmission in the State could be driven by the new virus variants in circulation in the country.
The evidence confirming this came a week later when IGIB, New Delhi and the Rajiv Gandhi Centre for Biotechnology here reported that the virus variants B.1.617 and B.1.1.7, which were highly contagious, were in wide circulation in the State.
The expert committee on Covid in the State had immediately recommended to the Government that the situation was getting out of hand and that a two week cyclical lock-down at that point in time was essential to break disease transmission. Professional bodies of doctors like the IMA and KGMOA also endorsed this, but the Government was only willing to impose restrictions and rejected the idea of a shut down.
“It should be understood that whatever interventions we adopt now, its impact would be felt only two weeks later. Disease transmission is not going to come to a halt suddenly, just because lock-down has been imposed today.
We are going into lock-down when our daily new cases has crossed 40 k and probably, we might plateau at 45-50,000 cases. But if we had put the brakes earlier, when the graph was crossing the 11-12 k mark, we might have been able to plateau the curve at a lesser number and there would not have been so much pressure on the health system also,” a public health expert said on condition of anonymity.
“Given that a proportion of the patients would indeed die of COVID, arguably, we could have saved more lives too if we had clamped down on disease transmission early. Containment and reduction in case numbers will become more difficult as the curve gets closer to the peak. A lock-down is a drastic measure but to derive its full benefit, it has to be done at the right time,” he added
“More than the surge in case numbers per se, we could have prevented our health system from being overwhelmed, if we had imposed a short lock-down a week ago. In most districts, hospitals are running full and staff shortage is acute. Major hospitals have begun to create makeshift facilities for accommodating oxygen beds. The Government continues to say that the occupancy position is still manageable, but the situation on the ground is stark,” said Arun N.M, a consultant in Internal Medicine, Palakkad.
He felt that the State had crossed that critical point in time, when a total shutdown would have really benefited the State in containing disease transmission, at least a week ago.
The impact of the current lockdown would become evident only two weeks later, by which time, the State would have chalked up several thousand more cases, hospitalisations and many more deaths, perhaps breaching the State’s surge capacity