Kerala, the first state to get the novel coronavirus, took four-and-a-half months to record its first 10,000 infections. This Wednesday, it reported more than 10,000 infections in a single day.
There was a time Kerala was feted globally for effectively containing the spread of the virus. Over the past few weeks, it has seen more cases every day than any other state barring Maharashtra and Karnataka.
Since September, Kerala has added more than 1.93 lakh cases – over 70 per cent of its current caseload of 2.68 lakh. And because most of its cases are recent, Kerala’s active caseload of more than 90,000 is, again, next only to Maharashtra and Karnataka.
The worst, it seems, is yet to come.
“Daily numbers could peak around 20,000. Our effort is to keep it below 15,000 a day. We hope that by November, these numbers would begin to decline,” state Health Minister K K Shailaja told The Indian Express.
Shailaja cited several reasons for the rise in numbers.
“Between June and September, about nine lakh people came back to the state. As it is, Kerala is very densely populated. Then we had Onam, and people did not follow the rules properly during the festival. So, there was a rise in cases in August. After that, there have been Opposition protests against the state government, and huge gatherings have been organised. It not only increased the cases but also gave the feeling that the government was unnecessarily putting restrictions,” she said.
“Our biggest challenge right now is to make people behave responsibly,” the Minister said. “We have to make people follow the social distancing protocols, and we cannot afford to lower our guard. I hope people will behave responsibly.”
Dr Mohammad Asheel, executive director of Kerala Social Security Mission under the government’s Social Justice Department, said the spike was not surprising. Kerala had “delayed the peak”, he said, but there was no escaping the pandemic “running its course”.
“There was a perception in May, June, and July, that Kerala had conquered the pandemic. But Kerala had not conquered the pandemic. Kerala is not an island that you can isolate everyone who got infected, and then you conquer the pandemic,” Dr Asheel told The Indian Express.
“Movements (of people) are happening. Neighbouring Karnataka and Tamil Nadu have a high number of cases. Expatriates are coming back. So, the virus has been circulating in the community,” he said.
“What the Kerala government was able to do was to delay the peak more effectively than other states. The national lockdown also had the same purpose. Kerala was able to delay it much further by combining lockdown with other public health measures like effective quarantine. But you cannot delay this permanently. The pandemic will have to run its course. At some point, the numbers will rise.”
According to Dr Asheel, “The important thing is not whether daily numbers have gone past 5,000 or 10,000; it is whether our public healthcare systems have the capacity to deal with 5,000 or 10,000 cases every day. Here, I think Kerala has done well in all these months to strengthen its capacities, so it is now in a much better position to deal with the rise in numbers.”
Dr B Ekbal, chairman of the expert committee to advise the government on Covid-19 management, also said there was nothing unusual about Kerala’s surge.
“I think the state is traversing through the peak. All states and countries will have to go through a stage like this at different points of time,” he said.
But it is also true that testing in Kerala was quite low in the initial months. Until June, Kerala was testing no more than 5,000-6,000 samples daily, while Maharashtra, Tamil Nadu, and Andhra Pradesh, the states with the highest caseloads, had ramped up to more than 20,000-30,000 samples every day. Over the past three weeks, daily testing numbers in Kerala have consistently been over 40,000, and have even touched 60,000 on a few days.
Dr Amar Fettle, who is the Health Department’s nodal officer for all international emergencies, said testing numbers would be increased further.
“We are adding more numbers every day. But there are unpredictable developments such as non-availability of teams for sample collection, or other local issues. Our teams have been working continuously for the last six months,” he said.
The spike in cases has forced the state government on to the defensive. Statewide prohibitory orders were issued earlier this week, banning assemblies of more than five people. Shailaja has been warning that if people violate physical distancing rules, the government would be forced to impose another lockdown. Chief Minister Pinarayi Vijayan has said the situation is grave, and put part of the blame on opposition protests and rallies.
Dr Asheel pointed to the relatively low death count in the state. “The primary objective in Kerala has been to keep deaths to the minimum. And I think it has done reasonably well on that front,” he said.
“Once the pandemic is over, the only metric that would matter is how many people we lost to the disease. This is very important. Even as infection numbers have risen sharply in the last few days, the case fatality ratio is lower than what it was in May and June, lower than what it was in August. It is constantly declining,” Dr Asheel said.