As the Spread of Coronavirus Gets 'Decentralised', Kerala Needs to Reboot

After initially succeeding in flattening the curve, confirmed cases of COVID-19 in the state have spiked, with the chief minister acknowledging community spread in some areas.

Kochi: On May 9, 2020, 100 days after the first reported case of COVID-19 in Kerala (and the country), the state government could proudly declare to the world that the state had flattened the infection curve. It had only 16 active cases which were being treated in the designated hospitals.

At that stage, Kerala was lauded across the world for its unique intervention, with the media showering praises on the ‘communist government’ and its health minister K.K. Shailaja. Now, a little over two months, Kerala is in no position to rejoice or relax. As of July 29, the state has 9,619 active cases and 63 deaths due to the disease. The total number of infections identified are 19,664. The foreign media, which lauded the state a couple of months ago, started mithering, citing the sudden surge of cases.

Community spread in a few areas

According to the state’s health officials, Kerala is weathering through the second half of the virus’s community spread. Large community clusters have been identified in Thiruvananthapuram, Ernakulam, Palakkad and Kozhikode districts, which have become a huge cause of concern.

These circumstances led chief minister Pinarayi Vijayan to go on record that some areas in Thiruvananthapuram district have already seen community transmission last week even though not a single other state – even the ones where the number of cases has been much higher – has acknowledged this phase of spread. Even the central government has denied community spread. Unlike in other states where the cases are skyrocketing, Kerala’s spread of the virus seems not to be confined to urban clusters.

Poonthura and Pulluvila, two coastal hamlets in the Thiruvananthapuram district, were the worst hit and multiple clusters have been identified. The patient zero was identified as a fish vendor who had a frequent travel history to Tamil Nadu. As the transmission was rampant in the area with close to 50% positivity rate for testing, the government announced a lockdown in the capital city from July 6.

Kingsley Thomas, a grassroots health volunteer, said, “Initially, it was tough to convince the villagers about community transmission. After the active intervention of the government machinery, awareness programmes have been on track.”

A policewoman wearing a face shield waits for COVID-19 testing in Thiruvananthapuram, Kerala. Photo: PTI

According to Dr Mohammed Asheel, director of the social security mission, more than 100 doctors and other medical staffers have been deployed around Pulluvila and Poonthura. People who are vulnerable to the virus – senior citizens, pregnant women and those with comorbidities – are being identified.

But others have a different picture to paint. The number of tests being conducted is alarmingly low, say activists of the Coastal Students Cultural Forum. “The test positivity rate among the coastal belt is more than 50%, whereas this figure is just 2.6 % in the state, something that the government boasts about. The case fatality rate is 1.5 here, as against 0.33 across the state. This is nothing but discrimination towards the fisher folks,” says Kumar Sahayaraju, a researcher who is from the coastal village.

Criticism of Left government

This is the core area where the government is facing severe criticism. The number of tests being conducted has reduced when it matters the most, after declaring that community transmission is on in two villages.

“There were 100-150 tests per day initially, after the announcement of community transmission. But unfortunately, it later dropped to 40-50 and most of those are rapid antigen tests (which have a higher probability of showing false negatives). It is learned that the FLTCs (First Level Treatment Centres) are getting overcrowded and that might be a reason for this,” says Sindhu Mariya Nepolean, a native journalist.

The Congress-led opposition was never a fan of the state government’s COVID containment strategy. The ruling coalition and the opposition had conflicting views on the approach towards the pandemic from the time the first case was identified. Now, with the number of cases shooting up, they are on the offensive, holding the government responsible for the relapse.

“The state did not test enough so that it won’t dent the image built up by public relations agencies,” accused opposition leader Ramesh Chennithala. He said the government is also manipulating the data, flagging it as another concern.

Also Read: Transparency Has Been Kerala’s Biggest Weapon Against the Coronavirus

Still among the best: CM Pinarayi

However, CM Pinarayi Vijayan says the statistics still show Kerala’s COVID-19 management strategy is among the best in terms of many parameters. “As far as the testing is concerned, Kerala ranks third in tests per million by case per million ratio. The test positivity in the state is only 2.6%, which is well under control as per the WHO guidelines,” he says. The case fatality rate (deaths per 100 cases) of Kerala is still under 0.4, as against the national average of 2.67.

Kerala Chief Minister Pinarayi Vijayan. Photo: PTI

Some government officials say that the spike in the number of cases and even deaths was not unexpected. “With the return of non-resident Keralites and the relaxation in the nationwide lockdown, this was very much on the cards. Now the proportion of contact transmission has also gone up. In the coming days, the real challenge will be the management of non-COVID-19 cases, especially infectious diseases like dengue fever and chikungunya, which are expected to rise during the monsoon,” opined Dr B. Iqbal, chairman of the state government’s expert committee, during a webinar conducted by the Bharat Gyan Vigyan Samiti.

Thomas Issac, the state’s finance minister, also said on Twitter that the rise in cases was expected.

In the minister’s tweet lies a crucial detail: during a national lockdown, it was easy for Kerala to manage the situation. Now, the virus has been ‘decentralised’ and grassroots level planning has become the need of the hour.

Dr Iqbal says that COVID-19 is a highly infectious disease which can spread rapidly in Kerala. “Nearly 15% of the state’s population is above 60 years of age. A minimum of 500 people die of infectious diseases, every year. We could keep the virus at bay in the initial stages because of the aggressive strategy of combining many factors: testing and treatment, contact tracing, home and institutional quarantine, reverse quarantine of risk groups, ‘Break the Chain’ campaign, community surveillance and [designating] COVID-19 hospitals. Early preparedness, efficient, in the field health activity, effective communication, engaging the community and evidence-based management were our strengths,” he says.

Also Read: Kerala: Contraband Gold Emerges Biggest Threat to Pinarayi Govt’s Popularity

It is a fact that Kerala did fare well initially and is still topping the table. It is also true that the path ahead looks tough. The next phase would require decentralised planning and execution if the government is to contain the virus without a catastrophe. With Pinarayi Vijayan on the back foot due to the controversy around the gold smuggling case, the coming months will prove to be a test of fire for the Left front government.