Is the govt in denial?

KOCHI: On Friday evening, chief minister Pinarayi Vijayan once again reiterated that there is no community spread in Kerala and no reason to sweat over the recent rise in the number of positive cases. He argued his case succinctly and with enviable lucidity – the CM basically pointed out that of the 417 new cases over the last 7 days (May 23 to 29), only 27 were through contacts and of the total 577 active cases right now, only 45.

In other words, the overall percentage of cases who got infected through contacts is less than 10%. He also cited the state’s admirable Test Positive Rate and Case Fatality Rate – the former stood at 1 positive case among 65 tested whereas the all-India average is 1 positive case for every 20 tested. The CFT for Kerala stood at 0.78% while that for India as a whole was 2.87%.


Impressive as the CM’s arguments are, it is possible that he and the health authorities are making what in scientific parlance is called a category error. That is, you are making surmises by leaving out what should intrinsically belong to the calculation – in this case, failing to test people who might be virus carriers but don’t fall under any of the categories currently being tested. For instance, take the much-touted ‘fever clinics’ – anyone with a slight temperature, cough and cold who goes there is first asked about travel history and contact history. If they don’t fall under either, they are considered to be victims of the common flu or (pre) monsoon damp and discharged with general prescription medicines.

The ideal thing to do instead would be to test them for Covid and thus leave nothing to chance. That is not happening, and unless testing numbers are ramped up (currently in Kerala it is 177 per lakh whereas the prescribed number is 100 per lakh) and the criteria of who all are tested is drastically revised (that is, tests should happen within the community, among random people with no outward reasons to be suspected) there is no fool-proof way to rule out community spread. Community testing to determine community spread involves random checking of common persons who don't fall in testing category set by ICMR or state health department. In Chennai, for example, the government has started door-to-door screening of people, while in Karnataka they have set up smart kiosks for random screening of the public. This is something that has not yet happened in Kerala. In fact, even Influenza Like Illness (ILI) patients are not being tested though there is talk about it.

In fact, along with the rise in the number of Covid-19 cases in Kerala and the number of infected locals whose source of infection is unknown has also risen. Incidentally, real source of infection is unknown only in four of the 4,400 persons who tested positive in the ‘sentinel surveillance’ programme meant to check the spread of infection in the community. The health department established the epidemiological links of all these four confirmed cases and tested them for Covid, but none tested positive, again raising the question on how the four got infected. Those who tested positive are a community volunteer from Chathanoor panchayat in Kollam district, an acute respiratory infection patient from Munnar, a person with high social exposure at Vandenmedu panchayat in Idukki and a community volunteer from Kalluvathukkal in Kollam. Added to this, of the nine persons who have died so far of Covid in the state, the source of infection in four persons is not yet known.

Due to this increasing trend of locals getting infected without a known source of infection, the expert health committee headed by Dr B Eqbal, that advises the government on how to scientifically deal with the outbreak, has said that the government should now focus on the local community and take steps to control the infection in the community.

“The current rise in numbers was anticipated and now it is the state responsibility to contain the local spread. In natural course of time, the infection will slowly spread in the community just like in H1N1 and then our focus will be on treating patients with severe symptoms and not all Covid patients. Inevitably few people may die of Covid as co-morbidity is also very high in the state,” said Dr A Sukumaran, former state epidemiologist, who is come out of retirement to work at Covid Control Room in Wayanad.

“Community spread is inevitable as people are getting together. Lots of people are asymptomatic and we will never know if they have the infection unless tested but testing is also low in the state,” said health economist and epidemiologist Dr Raman Kutty. One reason why Kerala refuses to confirm community spread early on could be the compulsion to expand testing. The government has continuously maintained that due to limited availability of RT-PCR kits and due to unavailability of antibody testing kits they don’t want to exhaust their stocks. But that is not true. At present, we have about 23 testing facilities in the state, of which 15 are in government sector and eight in private. While government’s daily testing capacity is approximately 5,000 to 6,000 samples, the private hospitals have a testing capacity of around 3,000. But the number of tests done in state is 1,200 to 1,500 per day.

“Compared to other states, returnees here are spread equally around all districts in the state and therefore the number of tests should increase urgently. Though tests should be 100 per lakh per week, at the moment it is 177 per lakh in last four months, since the first case was tested positive in state on January 30,” said Indian Medical Association’s (IMA) Hospital Board of India chairman Dr Jayakrishnan A V.

There are other flaws too. “Though it is still the lockdown period… people are violating quarantine, social distancing norms, wearing masks improperly and worse, 50 % are not telling the truth about their travel history or health condition,” said Amrita Institute of Medical Sciences interventional pulmonologist Dr Tinku Joseph.

Despite the state government’s insistence that its USP is effective home quarantine, many in the health sector believe that with numbers increasing things are getting out of hand. “As the numbers increase, it is not really possible to monitor everyone in home quarantine and their family members. Regular awareness campaigns are essential to ensure that people don’t take the situation for granted as they adapt to the new normal,” said Dr Suresh Kumar, member, Kerala government's medical advisory panel on Covid management.

No one knows how the situation will evolve. But Kerala still has the time and capacity to prevent a nightmare.