COVID-19: Has Policy Short-Sightedness Brought Community Spread To Kerala?
Kerala’s fight against COVID-19 has finally come a full circle. Every gain earned by the state in the first three months of its battle against the pandemic has come to naught.
The state may not want to admit it in the open, but every health expert that The Lede spoke with is of the firm opinion that community transmission had indeed set in at various pockets across the state.
The writing was certainly on the wall, and a government, that had prematurely been chest thumping its way over what it thought was a success story, is now slowly waking up to a very painful reality.
Kerala might soon join the rest of India with its spiking COVID-19 positive figures and the lines that separated it from the rest as being an ideal state in fighting the pandemic, seem to be blurring fast with very passing day. Premature celebrations have been laid to rest and the champagne is back on ice.
On Saturday when this report was being filed the COVID positive cases in state had shot up to an all-time high of 488 out of which 234 cases are local transmissions, spread across the length and breadth of the state. This is apart from the health and other frontline workers who have turned positive.
With this, the myth that the state, in spite of having high positive cases will continue to have low local transmission, has been busted paving way for the onset of community transmission.
COVID-19 Changes Gear In Kerala
Take the case of Thiruvananthapuram, the capital city.
From Tuesday July 07 to Thursday July 09, the number of cases stood at 411 out of which 369 were local transmissions.
The coastal areas of the district have been worst hit.
Poonthura, a fishing hamlet has borne the brunt with 174 cases in the last four days.
On July 06, at a hurriedly convened high-level meeting at Cliff House, the official residence of the Chief Minister, the state government decided to place Thiruvananthapuram, the state capital under triple lockdown.
A visibly flustered Chief Minister Pinarayi Vijayan speaking at his routine media briefing on Thursday for the first time ever came close to calling the situation as community transmission but still, like his counterparts in other parts of India, kept away from doing so and called the present situation the result of a ‘super spread’, something that health officials say is not the reality.
“The situation is precarious across the state. We have always feared that community transmission is a possibility. We already have a super spread happening in Poonthura in Thiruvananthapuram. But now we are also awfully close to the onset of community transmission in the state,” Vijayan told media persons.
The situation is grave not just at Thiruvananthapuram. If the capital city was leading the COVID positive figures in the first week of July, Alappuzha topped the list on Saturday with 87 cases out of which 51 happened to be local transmissions. While the capital city came second with 69 and 57 local transmissions, around 11 cases remained with sources untraceable.
What is alarming is that such untraceable cases have spread across the state by Saturday. Ponnani in Malappuram district, which is another hot spot now has 25 cases with untraceable sources. Ernakulam has five out of more than 40 cases. The data for many others are still awaited.
COVID-19 has surely shifted to the next gear and is accelerating across the length and breadth of the urban areas with a ferocity unseen in the state before.
Irrefutable Signs Of Community Transmission
In May, The Lede had reported that the state was staring at an impending storm if it did not look at revising the current policies in fighting the pandemic.
Now the storm is truly knocking at Kerala’s doors. If sources in the state health department are to be believed its is not just Thiruvananthapuram that is under extreme duress.
Kochi, the biggest city, and the commercial hub of the state is also en route to a complete lockdown in the next few days. Major markets have all been shut in Kochi and stringent controls have been put in place at many places across the city. The ever busy Aluva market has been converted into a cluster the likes of which resemble the Koyambedu market in Chennai.
Doctor Sulphi Noohu is the vice president of the Indian Medical Association’s (IMA) Kerala chapter.
Sulphi clearly says that community transmission has undoubtedly set in in the state, something which the IMA had officially informed the Chief Minister. But the government continues to be in denial mode.
“We have a number of parameters prescribed by the WHO and others which show us whether a community spread has really started or not. It seems most of these parameters are pointing towards this reality in Kerala. Governments not just in Kerala but elsewhere in India have their own reasons for denying it. But the reality is something else and the IMA has very clearly let the Kerala government as well as the central government know about it,” Dr N Sulphi Noohu, Vice President IMA – Kerala Chapter told The Lede.
The doctor goes on to elaborate the current scenario in Kerala and why it has all the signs of a dangerous community transmission that could go out of hand in the days to come.
The first and perhaps most evident sign is the ever-increasing number of patients without traceable contact sources.
Till the end of May if the number of patients without traceable source of contact was around 50 that figure is more than thrice the number by the time this report was being filed.
More alarmingly, this number is spread across the state, not evenly, but with varying degrees at various pockets which health officials says is a huge source of worry as well as a clear indication that community transfer could already have set in.
On Saturday when the figures last came in, Ponnani, a municipality in Malappuram in north Kerala had 25 positive cases whose sources were untraceable. Ernakulam in central Kerala had five, Thiruvananthapuram, the southern tip had 11 amidst many other urban areas reporting such cases.
Another concern is the number of health workers in Kerala who are being detected with the virus. The figure as of date stands at 70 which perhaps may not strike one as overwhelming, when compared with the national figure of 950.
But what makes it significant is that many of these health workers, especially doctors and nurses, are not the ones who have treated a COVID positive patient thus far. Many of them may have attended to patients at OP centres without any symptoms of the disease, bringing forth the fear that asymptomatic patients may also be on the rise in the state.
Kerala seems to now have a huge number of asymptomatic patients who, as health officials, say are ticking time bombs if they come in contact with people from vulnerable groups.
“The government has its own agenda and definitions for community transmission. But it doesn’t mean much. I am fully sure that community transmission has hit Kerala because there are a number of cases without obvious contact sources. I don’t believe in numbers. Not only health workers, you even have policemen and other frontline workers who are turning positive. What more signs do you need?’’ asks Dr Shareek PS, an infectious diseases expert based in Thiruvananthapuram who is at the frontline in the fight against the pandemic.
Even when this report was being filed, news was trickling in that five more health workers including a doctor and two nurses had turned COVID positive, this time at the Cherthala Taluk Hospital close to Kochi on Saturday, forcing authorities to shut down the hospital.
Another indicator is that since last month a number of asymptomatic patients who have traveled from Kerala to other states have then been tested positive at their new destinations.
“All these indicators clearly point towards community spread. The only saving grace for us now is that it is in a milder form. Also, we should understand we have nearly 80% of asymptomatic patients which is why we do not see a sharp spike in cases. It also means the usual parameters that one uses for viral pandemics may not even hold true here. But this is certainly the time to contain it. Not a minute can be lost now. If we lose time now, things could really get really ugly and go beyond our control. This is what IMA has been saying all this while,’’ reiterated Dr Sulphi.
The Numbers Tell The Tale
Now look at these figures. In the month of June Kerala’s COVID positive figures fluctuated anywhere between 50 and 100 for the first eighteen days and then between 100 and 150 for the last 12 days, going up and down on a daily basis. There certainly was no clear pattern evident then.
But from the beginning of July for the first ten days, it has been a steady climb.
From 150, the numbers doubled to 301 by the July 08. While it took eight days to double initially, which is more or less in line with the national average, by July 10, the number was 416 compared to 193 on July 06, which means the doubling time came down to just four days, a clear indication that community spread had set in at many places in the state.
Poonthura, a suburb in Thiruvananthapuram, Ponnani Taluk in Malappuram, Aluva market in Ernakulam district, Noornad and Thamarakulam in Alapuzha and the Pathanamthitta Municipality are the worst hit hot spots in the state as this report was being filed.
The spread is in pockets now but is far and wide. It is only a matter of time it spills over to the rural parts.
Has Home Quarantine Failed?
When The Lede reported this story in the month of May, Kerala had taken a policy decision to send everyone who comes from outside the state to 14 days of home quarantine.
The Union Government had however asked the states to give compulsory institutional quarantine for everyone for at least seven days, followed with home quarantine. But it left the final call to the discretion of the states.
Kerala thought otherwise and hoped it could bank upon the highly literate society and its high sense of sanitation and health care awareness, as it has always done and triumphed in the past. But this time the outcome changed dramatically.
So, at every instance both the Chief Minister and Health Minister of the state reiterated that home quarantine was the best method before Kerala. But then this was a gamble, however calculated it might have been, which failed miserably. The growing number of positive cases in the state are nothing but a testimony to this failed policy.
This week the Chief Minister’s words summed it up all. “We had put in a number of measures to ensure that the virus does not spread in a big way. Home quarantine was certainly the best way forward. But some people behave as if all this does not affect them in anyways. It is these people who have caused such a precarious situation in the state,” conceded Vijayan.
The Chief Minister may be right in saying that a number of people had been brash in jumping quarantine and going by the 1058 odd cases filed by the state police over the last three months against people who did so, he certainly has a point in fixing the blame.
But then blaming the common man could be only serve as a way to shift the goal post rather than provide a fruitful explanation, since health professionals and other policy experts had been repeatedly saying that institutional quarantine works better that home quarantine.
The number of home quarantine violations shows the extent to which the virus could have potentially spread in the state.
No Proper Checks On The Ground
The Lede had contacted half a dozen people who were in home quarantine to find out if their movements were being verified by district administration or health officials. Three of them came back saying that they have not heard from any official ever. One person said he received phone calls warning them not to leave their homes for 14 days. Two of them said they had been paid a visit at least once.
“I came home from Bangalore last week with my family. While applying for the e-pass to enter Kerala we had filled all our details. After coming here not a single person from any department in the state turned up to check on us or see whether we are in quarantine. Me and my family did not step out of our house for 14 days because we felt as responsible citizens, we should stay indoors. I wonder how many people will do it on their own,” Sreekumar Venugopal who hails from Thiruvananthapuram told The Lede.
“I came two weeks ago from abroad. But apart from just one phone call, no one visited me,” says an NRI based in Kollam.
This dismal response data comes in the backdrop of the Chief Minister himself announcing a policy by which motorcycle brigades of policemen had been created to keep a close watch on those in home quarantine.
“We should have insisted on institutional quarantine without doubt, with various variables like some free, some slightly chargeable depending on where a person wants to go. You can always turn back and blame the people saying they were not careful, but the fact is that if you had institutional quarantine you would not have so many cases coming up because you are practically stopping people at the border, taking them to a centre for 14 days and then leaving them. After that you should have asked for 14 days home quarantine. That would have made sense. But here the government bungled it up with a confusing message. Many people were even confused about how many days’ quarantine it was,” former Planning Board Member G Vijayaraghavan told The Lede.
Where PR Won & Health Lost
For the last two months the Opposition parties led by the Congress had been continuously accusing the state government of chest thumping and shamelessly going overboard with its public relations work surrounding the fight against COVID-19.
Two months down the lane, the claims look authentic as the chest thumping has given way to sheer panic on the ground.
The first signs lie in the Chief Minister’s daily press briefing. While the month of May and most of June went into lauding and even boasting about the state’s efforts, press briefings in July were stark in comparison. It is now one of caution and getting the state ready for the eventuality with a lot of blame thrown in.
“The issue here is there is no consistency in policy for most things. Just look at how the administration dealt with bringing NRIs from abroad. First you said you will bring everyone here and two lakh beds are ready for institutional quarantine. Then you said only home quarantine. To justify that, you said all of them need to be tested. When the centre rejected your offer to have TruNat tests done abroad, you decided on travellers wearing PPE kits before boarding flights and that too you set different standards for those coming from different countries. So finally, apart from the chest thumping and grand PR efforts the only thing you achieved is create utter confusion. How do you fight a pandemic with such a strategy?” asks noted policy commentator Joseph C Mathew.
Not just that, the glaring breakdown of coordination between the state health department and others, especially the Chief Minister’s office is no secret.
“Very clearly neither the DHS (Directorate of Health Services) nor the health minister is able to take crucial decisions. This is a pandemic, a health issue which needs to be fought by health professionals. But here, decisions on health are taken by people who have no idea about it and we are often asked to implement it,” a senior doctor told The Lede in anonymity.
Tough Days Ahead
Kerala’s pandemic success story is for the history books now. The hard reality is that the state is now reeling under a community transmission that could blow out of hand at any time.
The urban pockets of the state are bearing the brunt at the moment. But that could very well change when it spreads to rural areas and health workers warn that such a scenario is not far away, since a complete lockdown, the likes of which we saw in March and April will kill Kerala’s already crippling economy.
But there are others who express hope in the midst of this, especially if the state could hold on for a few more days.
“Antigen tests will be in soon and the best part is the cost of it is as low as Rs 400. So we can go for mass testing then, not just in government but private hospitals. The tests do accurate results for positive patients. Hence doing that on a mass scale and isolating the positive ones from others for treatment is the only way out,” added Dr Shareek.
What shape the COVID-19 battle in Kerala will take in coming days will now depend on how fast and to what extent the state can stop the spread from the urban areas to the rural ones.
Not just that, with many more NRKs (Non Resident Keralites) all set to return over the next few weeks, the state will have to change its policy and shift from home to institutional quarantine.
Taking a leaf out of its neighbour Tamil Nadu’s book will stand in good stead for Kerala under current circumstances.