Here's what eminent virologist Dr Gagandeep Kang has to say about Kerala's handling of the COVID-19 pandemic.
When it comes to dealing with the virus – Nipah earlier or Covid now, most had come to believe that Kerala cannot go wrong. Yet the plantation economy-based south Indian state, known for a record of excellence in public health, is in the spotlight as the state that is now coping with nearly half of all the new covid cases reported each day nationally. It’s much-celebrated Kerala model to combat the virus increasingly under question.
What has gone wrong in a state that has a healthcare budget spending per capita almost double that of Uttar Pradesh? What is the lesson from this and for the rest of the country for combating the virus and its various waves?
Mortality & serosurvey data
Financial Express Online reached out to Dr Gagandeep Kang, one of India’s most respected virologists and a professor at the Christian Medical College, Vellore. She began by dispelling the notion that there was something wrong with the Kerala model. “Kerala has witnessed a sharp rise in cases but that is not to say its model has failed. On the contrary, its COVID mortality figures, the still available headroom within its health system to cope with the rising numbers and the latest serosurvey data all only go to show that it has done a good job so far.”
What stands about in the developments in Kerala is the fact that the mortality rate on account of COVID is at 0.5 per cent as against a national number of 1.34 per cent, the healthcare system has never been overwhelmed and there has been no situation where there is a problem of oxygen shortage or lack of ICU beds and ventilators as was seen in other parts of the country.
The focus, Dr Kang and also other experts, feel is to look at what the rising caseload (about 50 per cent of national number of new cases per day) coupled with the 44 per cent seropositivity or seroprevalence of antibodies tell about what needs to be done in the days and months ahead?
“The fact is that at least 38 per cent of the adult population has received at least one dose of vaccine. This means that while vaccine coverage has been higher than the national average, a large proportion of Kerala’s population is either uninfected or unvaccinated,” says Dr Kang.
And what to make of the seropositivity? “If you had a region with say 70 per cent seropositivity and you have a population that has 44 per cent seropositivity (like in Kerala), if you relax the interventions in the region with 70 per cent seropositivity then the number of cases that you will get will be much less than the number of cases when you get when you lift curbs with 43 per cent.”
What also emerges is that Kerala has managed to keep a large percentage of its population unexposed until vaccines arrived. “But vaccines have not rolled out fast enough for Kerala’s population to bridge the gap between protection obtained from infection in other states and protection obtained through a combination of infection and vaccination in Kerala. Because of this, Kerala’s population continues to be in danger and therefore you need to ramp up vaccination and reinforce the measures of contract tracing, tracking and not become lax.”
The dangers now
The recent increase, says Dr Kang, “is an indication that Kerala made a decision that it should not have about Eid (relaxation of norms). In addition, the population has been compliant so far but perhaps there is tiredness setting in with restrictions.” “What we are seeing is a trade-off between having protected your population and yielding to pressures to ease up on restrictions and permitting gatherings be it for elections or for religious purposes,” says Dr Kang. And therefore, her concern at the moment is around the way this will pan out now: “The worry for me is what is going to happen the future? If vaccines don’t come in and people are tired and the government does not maintain control then there is bound to be an upsurge in Kerala. The numbers are still manageable but then it cannot remain this way for long.”
Delta in May
Kerala got the highly transmissible delta variant in April-May while parts of North India started to see it in March -April. So, Kerala was a little bit behind. It also had better interventions. “So, what you are seeing is a combination of delta variant and relaxations of restrictions and allowing for large gatherings which is allowing for this cases to emerge.”
A clear lesson
What lessons do the developments in Kerala throw up? To Rama V Baru, Professor, Centre of Social Medicine and Community Health at the Jawaharlal Nehru University, there are clear messages: The big lesson from the developments in Kerala and the North-East is that the virus, its waves, its variants and their sub-lineages will keep impacting and have done so even in a state that traditionally stayed invested in building its health systems. But then, what needs to be taken note of now and imbibed by other states is the clear message that the investments in the healthcare and in a functioning public health system do matter and make a difference.
“Kerala,” she says, “is able to witness low mortality rate because of this. The other states must therefore learn and similarly focus on building the healthcare infrastructure, human resources, capacity building and even governance. All of it to better equip them to handle future waves.”
Also, since public health systems cannot be built overnight, the immediate need at the moment, she feels is to harness and optimise the available resources available across public, private, local self-government structures and civil society, aggressively forge alliances and coordinate roles to achieve better health outcomes in the shortest possible time.