As the national Covid-19 curve trends downward, Kerala continues to be the outlier.
Over the last two days, the state has reported a significant rise in new infections, which has led to an increase in active cases at the national level for the first time in two months.
Kerala has been discovering between 11,000 and 13,000 cases every day for almost a month now.
During this same period, the daily count in the country has halved — from more than 80,000 a day to about 40,000 a day. Nearly every major state other than Kerala has reported a significant decline in the daily case count.
Since June 15, Kerala has been the biggest contributor to the national caseload. For the last two days, the state has accounted for more than a third of all cases reported in the country.
Kerala’s contribution has increased steadily since the overall numbers began to decline two months ago. At the peak of the second wave, Kerala was contributing less than 10 per cent of all cases in the country. (See chart )
This trend is very similar to what was seen in January. At that time, Kerala was contributing almost half of all cases on some days.
At that time too, Kerala’s curve hit an extended plateau on its downward journey. In a way, the first wave never ended in Kerala. The state had continued to report 5,000-6,000 cases every day, when even Maharashtra saw its daily count fall to about 2,000. Almost the same thing is happening now.
Over 30 lakh people have been infected in Kerala so far, a number that is second only to Maharashtra’s. But Kerala’s relatively small population of about 3.5 crore means cases as a proportion of the population is much higher than in Maharashtra.
Kerala has recorded more than 90,000 cases per million population, almost four times India’s overall number of about 24,000. Only Goa has a higher ratio.
Relatively fewer Covid-19 deaths in Kerala has long been cited as evidence of the state’s better record on tackling the pandemic. But its relatively low case fatality ratio of 0.47, against the country average of 1.32, can partly be attributed to the large number of cases. In absolute terms, Kerala’s Covid-19 death toll of 14,157 is the country’s eighth highest.
As a proportion of population, other smaller states such as Sikkim, Puducherry, Manipur, Goa, and Himachal Pradesh have worse death figures than Kerala’a. But Kerala’s 424 deaths per million population is much higher than the all-India number of 311.
Part of the explanation for the high numbers in Kerala lies in the better reporting in the state. This has been corroborated by serosurveys as well. The last national serosurvey had shown that for every infection that is detected, about 25 go unreported. A similar survey in Kerala earlier this year found only about five unreported infections for every reported case.
But that does not explain the continuing high positivity rate in the state. Kerala has been finding almost 13 infections per 100 tests; in Uttar Pradesh, this figure is under 3.
Kerala’s new Health Minister Veena George attributed this to the strategy of targeted instead of random testing.
“When a person tests positive, we test all close contacts of that person, family members, etc. This kind of targeted testing is keeping the test positivity rate high.
“In local bodies, where test positivity ratio is high, we are ramping up testing ten-fold, which is helping us in detecting many positive cases. If Kerala had gone for random testing, the TPR would have come down drastically,” George told The Indian Express on Thursday.
Kerala has ramped up testing from about 50,000-60,000 per day in the middle of April to over a lakh now, and sometimes crosses 1.5 lakh samples a day. However, several other, albeit bigger, states are testing more: Uttar Pradesh has been testing over 2.5 lakh samples every day, and Maharashtra more than 2 lakh on average. Tamil Nadu, Karnataka, and Bihar too are testing around 1.5 lakh samples daily.
George said Kerala had also been trying to manage the pandemic in a way that the total caseload always remained within the capacity of its health infrastructure.
“We never had a situation in which our health facilities were under strain due to the active caseload. Kerala’s Covid-19 peak has been slow, and a similar trend would be seen on the downward slope as well. We have reached a plateau as far as active cases are concerned, and the fall would be slow. The recent unlocking has contributed to a spike in cases, but we hope that the curve will come down. We had anticipated the present situation,” she said.
Even the good work on vaccination has not succeeded in bringing infection numbers down in Kerala. Almost 45 per cent of the state’s population has received at least one dose; about 10 per cent is fully vaccinated. This is better than Maharashtra or Tamil Nadu.
As of now, Kerala is the only major state where active cases are rising. In the last one week, the active case count in the state has increased by over 7,000. As of Wednesday, there were 1.08 lakh active cases in the state, second only to Maharashtra’s 1.14 lakh. But unlike Kerala, Maharashtra is seeing a steady, though slow, decline in its active case numbers.
Some Northeastern states, notably Tripura and Arunachal Pradesh, too have been reporting a rise in active cases. But their numbers are very small compared to Kerala’s or Maharashtra’s.