Kerala’s rising COVID-19 cases explained

Concerns that the surge, largely by the Delta variant, potentially leading to a third India-wide wave may be exaggerated

Updated - July 06, 2022 12:15 pm IST

Published - August 28, 2021 12:02 am IST

Commuters jostle for space to board a KSRTC bus in Kochi on August 26, 2021.

Commuters jostle for space to board a KSRTC bus in Kochi on August 26, 2021.

Once again, the COVID-19 situation in the State of Kerala is in the spotlight, albeit for all the wrong reasons. More than 60% of the newly reported cases in India in the past week came from Kerala alone, and that naturally raises many eyebrows. How can a State with only 2.5% of India’s population contribute to 60% of its caseload?

Antibodies prevalence

One thing that we need to acknowledge first is the fact that the most recent nationwide seroprevalence survey in May 2021 by the Indian Council of Medical Research (ICMR) had estimated that the prevalence of COVID-19 antibodies was the lowest in Kerala at 44% compared to the national average 68%. It meant Kerala had the highest proportion of the population still unexposed to the virus at that time. Given that the virus will keep spreading until a certain level of herd immunity is achieved in the population, either through vaccinations or through natural infections, it is a foregone conclusion that the cases will continue to be high whenever there is increased crowding.


Kerala has already vaccinated 75% of its adult population (55% of the total population) with at least a single dose. The daily new COVID-19 cases after peaking at around 40,000 daily during the first week of May have been on a decline ever since and reached a plateau of about 11,000 cases to 12,000 cases and a test positivity rate (TPR) of about 10% during the first week of July this year. Since then, however, the State has been seeing a steady but gradual rise in daily new cases assisted by increased daily testing which reached a peak of nearly two lakh in early August.

Decline in daily testing

However, the daily caseload saw a decline since August 1 largely owing to a decline in daily testing. The seven-day average daily testing had decreased from 1.7 lakh to 1 lakh leading up to Onam on August 21 even as the TPR went up from 12% to 17%. A series of irrational lockdown relaxation measures and the resulting intermittent spike in mobility on random days, along with reduced daily testing and increased festivities leading up to Onam, were all resulting in increased infections.

Yet, the decreasing reported daily new cases in the days leading up to Onam largely assisted by reduced testing gave an inadvertent feeling that the cases were under control. But, it is now understood that the decline was not organic as cases shot up above the 30,000 mark for the last couple of days owing to a slight increase in daily testing. If the State did even two lakh daily tests now, it would be reporting close to 40,000 daily cases. But the low level of testing is still keeping the reported daily case count well below that.


Important questions remain. There are genuine apprehensions on whether the current surge in cases in Kerala is due to a new variant of the virus, whether it will mark the beginning of a third wave in India, and if the present surge could result in the collapse of Kerala’s health-care system.

Delta variant spread

It is to be noted that the Delta variant — a variant that was the primary reason for the majority of cases during the second wave in the rest of India — was detected in nearly 90% of the samples tested from Kerala recently. It implies that this variant of the novel coronavirus is still catching up with the Kerala population while the rest of India has already witnessed one major wave of this variant that resulted in 68% seroprevalence in India. So, concerns about the present surge in Kerala, predominantly by the Delta variant, potentially leading to a third wave in the country may be exaggerated.


Kerala’s health-care infrastructure had reached near saturation during the peak of its second wave when daily new cases had passed 40,000 and TPR reached a high of 28%. Given the current surge in cases and increasing TPR, it is highly likely that the State will once again experience a similar situation in the days ahead and overwhelm its health-care infrastructure. Hence, the authorities must be extremely cautious of this situation and make sure that the rising numbers and increased hospitalisation do not exhaust the health-care system.

The State must immediately take stock of its existing health-care infrastructure and see how long it can hold given the current caseload and its inevitable rise in the days ahead. If it cannot handle the impending surge which may potentially see more than 40,000 daily new cases in the immediate term and the associated increased hospitalisations, it may be wise for the State to go in for a complete lockdown for a very short period of one to two weeks to arrest this surge and allow the cases to cool off in the immediate term. In the meantime, the State should make every effort to increase the pace of vaccination, significantly increase testing and tracing efforts so that not many cases go undetected. Once the cases are brought under control, it must evaluate options and envisage a more rationalised lockdown relaxation than the ones that are presently in effect.

Also read | Post Onam, new COVID-19 cases mark a big jump in Kerala

If managed effectively, the current surge will slow down in a week or two and, by then, the natural infection and vaccinations would have taken the population-level COVID-19 immunity in Kerala to at least 60% to 70%, bringing it closer to the rest of India, but with a lesser human toll compared to other larger Indian States.

Rijo M. John is a health economist and an adjunct professor at the Rajagiri College of Social Sciences, Kochi . He regularly analyses India’s COVID19 data at @RijoMJohn

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