A blow to Kerala’s exceptionalism

An emergency medical technician helps an ambulance driver take out a COVID-19 patient from an ambulance at Government Medical College, Manjeri.   | Photo Credit: SAKEER HUSSAIN

The COVID-19 death reconciliation exercise in Kerala, taking place since October 22, has been a revelation of sorts. The exercise has added 10,678 more deaths to the State’s official list of COVID-19 fatalities, accounting for 26.7% of the total 39,955 COVID-19 deaths declared so far in the State (as of November 29). This makes Kerala the State with the second-highest COVID-19 toll in India. These are mind-boggling figures, given that the State Death Authorisation Committee has till date received over 26,000 appeals for inclusion of names in the fatality list, of which less than 7,000 have been included after scrutiny.


The entire exercise has punched holes in the State’s pandemic narrative of having one of the best containment strategies, as evidenced by a steady and low case fatality rate. Such tales of exceptionalism are always looked at with scepticism by epidemiologists and public health experts. And while the State will be appreciated for undertaking the death reconciliation exercise seriously, the loss of credibility is something that it will find hard to live down. The question being asked is whether the State administration ever saw the true picture of the impact of the pandemic. This is because even when many vigilant public health experts and clinicians pointed out discrepancies in the reporting of deaths, the wide disparities in the case fatality rate between districts, and the need to pay attention to the fact that many patients were dying at home, the State continued to be in denial.

A blow to Kerala’s exceptionalism

Some public health experts point out that for a State which prided itself on the robustness of its health system, its infrastructure, and the efficiency and expertise of its human resources, this attempt to project itself as an exceptional story for short-term political gains was immoral. In perpetuating this myth, the State got sidetracked from the only goal that it should have focused on, which was mortality reduction.

There were many things that the State did right during the pandemic – it increased the testing and surveillance facilities, invested in improving hospital infrastructure and ensured that there was no shortfall in oxygen supply. At the peak of the second wave, the State managed to keep transmission levels low so that hospitals were not overwhelmed.

But the huge data gaps because of improper death reporting and the government’s refusal to accept that people who were dying in homes or were brought dead to hospitals after apparent ‘recovery’ from COVID-19 were all COVID-19 deaths not just hid the true impact of the pandemic from the public, but also robbed the State of an opportunity to re-examine how COVID-19 care pathways could be improved.


As an epidemiologist pointed out, the State has all sorts of data at its disposal. But beyond secondary data analysis, which is excellent, little has been done on the field to rectify the problems identified. The State had identified that over 30% of COVID-19 patients in home isolation were dying at home or in transit due to cumulative delays in hospital admission. Was this knowledge put to good use to reduce mortality? Despite the high vaccination coverage and declining levels of hospitalisation and ICU occupancy, why does the State continue to record an average of 20-30 COVID-19 deaths daily? Are there issues in the quality of care that are not being addressed? Are some of these avoidable deaths? A senior clinician says, “The mortality of severe COVID-19 cases, which are managed by invasive mechanical ventilation in our public hospitals, is nearly 100%, which is unacceptable.” There are only two nurses per shift in ICUs for 20-25 patients, he says, adding that if “more attention was paid to training and developing dedicated critical care teams for ICUs, more lives could have been saved.”

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Printable version | Jan 26, 2022 4:21:27 PM |

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