Kerala Covid graph still a success with lowest mortality rate: Muliyil.
On July 28, Kerala recorded 22,056 new Covid-19 cases and 131 deaths, prompting another round of debate about the exponential increase in cases in the state, while the rest of the country is seeing a setback from the second.
With Kerala contributing to 50 percent of the country’s total cases, a political blame game has erupted on social media over the state’s containment strategies, which were touted as a model even by global agencies during the first wave of the pandemic.
Does the upward trajectory of the virus in Kerala indicate that the state needs to review its strategy? Epidemiologists say the state is on track to achieve a low death rate and the increase in cases should not be a cause for concern, as it has a robust medical system to handle the demands. The state has seen an increase of 91,617 new cases between July 10 and July 19, with a test positivity rate hovering around 11 percent.
Lead epidemiologist Jayaprakash Muliyil says Kerala remains a success story, having managed to keep the death rate well below the national average of 1.32 percent. “The main objective of any epidemic control is the reduction of mortality and Kerala has been successful in that. Kerala took a conservative approach and tried to round the curve as much as possible. As a consequence, two things have happened. The epidemic is prolonged and mortality is very low, ”says Muliyil, president of the Scientific Advisory Committee of the National Institute of Epidemiology.
With a strong public health system in place, the state is equipped to address a large number of cases, he says. “Kerala is doing everything in a logical and scientific way. They have enough hospital beds and oxygen. The system must not be tampered with. The hype about the numbers is just someone’s fantasy to count viruses, ”he says.
He also notes that one of the main reasons behind the increase in numbers could be the large population that is not yet exposed to the virus. Vaccination of the peak population is the way to go, he adds.
The latest seroprevalence survey released by the Indian Council for Medical Research (ICMR) explains the rise well, says Dr. TS Anish, a member of the state Covid-19 expert committee. The fourth round of the national serosurvey, which was released on Wednesday, found that seropositivity or the presence of antibodies was the lowest in Kerala at 44.4 percent.
“The Sero survey tells us that Kerala still has a large population that is not exposed to the virus. While Kerala has more than 50 percent of its population still susceptible to the new coronavirus, it is around 30 percent in the rest of the country. That explains the increase in Covid-19 cases in the state, ”says Dr. Anish.
Experts also note that Kerala has been an outlier during the first wave and second wave of the pandemic with a lagged peak compared to other states. Kerala’s peak in the second wave occurred in mid-May, a month later than other states.
The reason for the slow spread of the virus is that the state has adopted the strategy of delaying the infection through strict containment measures, says the expert. He points out that, compared to the national average, Kerala has managed to prevent at least 20 percent of infections during the peak of the second wave.
“This has helped us increase medical facilities and prepare with more ventilators, oxygen beds, and other infrastructure,” says Dr. Anish. He adds that by slowing the curve, the state was able to vaccinate more people during the second wave.
“From May to July we have vaccinated a large number of people, which helped us reduce the mortality rate,” he says. Unlike Delhi or other states, Kerala did not report a single death due to oxygen shortages or lack of medical facilities due to efficient surveillance strategies, he says.
The issue also took on a political tone after many BJP leaders took to social media to criticize the Kerala government’s recent Covid relaxations during the Bakrid festival. The government eased Covid restrictions for three days before the festival, prompting strong criticism from the Supreme Court.
However, Dr. A Althaf, coordinator of the Kerala IMA epidemic control cell, says that the increase in cases has no direct relationship with the relaxation of Covid regulations. He says the upward trend was the result of the increase in the number of tests after Bakrid. “After Bakrid, three lakhs were tested continuously for two days to check for spread,” he says, adding that Kerala tests 1.5 lakhs daily.
Experts also attribute the highest numbers to efficient case detection. Even though the highly transmissible Delta variant dominates infections in the state, it is well equipped to detect cases, including new variants, says Dr. Anish.
“We have detected more than three million cases, which represents about 10 percent of the total population. If you look at national data, so far only 2.5 percent of the total population has been reported. That will create the impression that Kerala has more Covid cases in India, ”he says.
Kerala is also leading in testing, experts say. It has performed more than twice as many tests per million as the national average, according to the data.
“Case detection in Kerala is higher in terms of per million inhabitants. Most other states have a large number of undetected cases. In some areas, the unknown cases are 40 times more than the known cases, ”says Muliyil. Target testing is the most cost-effective use of testing infrastructure, a strategy currently adopted by the Kerala government, it adds.