Omicron phase: Kerala's initial success in Covid pandemic control faltering

High testing, rural-urban mobility, disbanded ground force reasons behind high daily caseload

Kerala’s much-acclaimed story of pandemic control seems to have turned weak on some counts in the Omicron phase of Covid-19.

Even as new Covid cases are going down across the country, Kerala continues to report more than 20,000 of them a day.

Experts say tactical errors by the local government, higher rates of testing, and high mobility among rural and urban areas are some of the factors that have contributed to a slow reduction in the case count during the third wave.

The state, with 258,954 active cases, accounts for 32.75 per cent of the country’s as on February 10. Maharashtra is a distant second - 10.98 per cent with 86,847 active cases now.

Kerala reported a peak positivity rate of 49.4 per cent during the third wave, much higher than the 29.7 per cent it clocked during the second wave. Compare this with densely populated zones like Delhi (30.6 per cent) and even Maharashtra (23.4 per cent), which have fared better in terms of controlling the infection spread.

The good news is, the positivity rate is on the decline now in Kerala - from 46.2 per cent on February 2, it has fallen to 32.3 per cent on February 9 (according to the Union health ministry data). From 51,887 fresh daily cases on February 1, they dropped to 23,253 cases on February 9.

What went wrong during the third wave?

Kerala was an example of how it controlled the spread of the pandemic during the first wave in 2020, tapping into its past experience of dealing with the deadly Zika and Nipah viruses.

Critics point out that lack of preparedness of the state machinery ahead of the third wave is to blame.

“Opening schools right ahead of the third wave and allowing parties at a time when Kerala was not yet out of the Delta wave were mistakes. Moreover, they disbanded the Covid-brigade a couple of months back without prior planning,” said S S Lal, a former official with the World Health Organization.

While some experts have said the higher population density is the reason behind higher transmission, Lal seems to disagree: “Kerala has a population density of 859 people per square (sq.) kilometre (km). Compare this to 27,411 per sq. km in Greater Mumbai, 25,000 per sq. km in Chennai, and over 11,000 per sq. km in Delhi and Ahmedabad.”

He said the Covid team of around 20,000 people played a vital role in pandemic management.

“These people were part of the health mechanism in the first and second waves. They are currently on strike for various demands including pending payments and jobs,” he added.

The spread of the virus in a population with a higher rural-urban mobility is relatively fast.

K Srinath Reddy, president, Public Health Foundation of India, said: “Kerala has a slightly different demographic - an elderly population and high mobility among rural and urban areas. What is to be seen is what percentage of people are falling severely sick or are getting hospitalised, and the age-adjusted death rate.”

Kerala seems to have done well there. The hospitalisation rate is 2-3 per cent. Between February 2 and February 8, only 3.3 per cent of those infected were hospitalised. Of them 0.4 per cent needed intensive care unit admission, and 0.8 per cent were on oxygen-supported beds. The state’s death rate, 0.25 per cent, is on a par with the national average (December-February period). 

Kerala is one of the states with the highest vaccination coverage - 100 per cent first-dose coverage, 86 per cent second-dose coverage, and 74 per cent teenager coverage. Less hospitalisation may be a factor in the higher rate of vaccine coverage.

A high rate of testing, bettering the national average, is also a factor contributing to Kerala reporting high daily cases. Kerala does 3,491 tests per million people daily, much higher than the 829 of West Bengal or the 2,174 of Maharashtra. 

Moreover, Kerala does a lot of antigen tests, which yield results within minutes. More than half the daily Covid tests done in the state are antigen tests. The state government has further slashed the test price to ~100 only for antigen tests, and ~300 for RT-PCR tests.

“If the threshold for testing is lower, more people would get tested, and the number of infections captured will be higher. If Kerala is testing more than the rest of India, it’s no surprise it is also reporting higher numbers,” said Reddy.