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The much-hailed "Kerala model" of combating Covid-19 is under severe strain, and the state's health minister K.K. Shailaja has warned that a failure to flatten the curve by the end of this month could make the southern Indian state "the most vulnerable Covid-19 hotspot in India".
Kerala now has the highest number of active Covid-19 cases per million people in India with 2,421. Maharashtra has 2,297, Karnataka 1,845 and Delhi 1,503.
The state also had the maximum new cases per million people per week from Sept 26 to Oct 3 at 1,599, ahead of 1,198 cases in Delhi, 1,055 in Karnataka and 976 in Maharashtra.
Its test positivity rate (TPR) during the period was also high at 13.8 per cent, much above the national average of 7.3 per cent. Only Maharashtra has a higher TPR - 16.7 per cent.
After Maharashtra and Karnataka, Kerala has the highest active cases - 92,161 as of Wednesday. The state's total confirmed cases doubled last month and crossed 200,000 last week. On Wednesday, it was 242,779.
Health experts expect Kerala's Covid-19 cases to peak in the next two weeks and the key question is whether the state's health infrastructure is ready to handle more patients. The answer is not encouraging.
Ms Shailaja, who had won many laurels for controlling the Covid-19 crisis in the state relatively well till May, hopes that tough mitigation measures may succeed in flattening the curve by the end of this month. But she concedes it will be a tough fight.
"We are still safe. Our mortality rate is 0.4 per cent, one of the lowest not only in India but in the world itself," she told Mint. "Our positivity rate is 1.2 per cent, less than that of several other states, but more than the ideal rate of 1 per cent.
"Only 60 per cent of beds in more than 400 first-line treatment centres are occupied, 40 per cent of ICU beds in government hospitals and about 10 per cent in private hospitals are filled.
"But the next few weeks will be crucial for the state. If the virus spreads rapidly, we will be facing a dual crisis because of our demography.
"We have a high population density; within a square kilometre, our population density is 760, whereas the national average is 460.
"Next, our senior citizen population is up to 14 per cent of the total population. Another challenge is the high rate of non-communicable, lifestyle diseases in Kerala."
The state government has imposed prohibitory orders (CrPC Section 144) and a ban on assembly of more than five persons is in place till the end of this month. Additional government officers have been appointed as executive magistrates to help contain the pandemic. But there are no restrictions on people's mobility and functioning of trade centres and offices. At loggerheads with experts Amid the mounting tension, Kerala's Chief Minister Pinarayi Vijayan and medical experts on Tuesday locked horns over the control measures. While Mr Vijayan maintained that the state's control measures have paid dividends, experts want the government to engage more professionals in the fight against the pandemic.
They warned the state needs more curbs and more tests to confront the expected peak this month.
"At present 80 per cent of the ICUs are filled. And the government hospitals are shooing away non-Covid-19 patients. Bureaucracy is framing policies overlooking public health experts and others," said Indian Medical Association Kerala chapter (IMA) president Dr Abraham Varghese.
But the chief minister brushed aside the criticism by saying the IMA is only a doctors' trade outfit and not an expert body and the state has got the lowest mortality rate.
Some 155,000 Covid-19 patients have recovered in Kerala, while the death toll is 906. Across the state, 267,834 people are under observation, including 29,503 in hospitals. There are 720 hotspots.
What went wrong The state had the situation pretty much under control till June, after it reported India's first Covid-19 cases on Jan 3 - people who had returned from Wuhan, the city in China where the coronavirus originated.
Kerala's initial success in containing Covid-19 was attributed to quick action by the government, which used the test, trace and isolate strategy well.
There were days in May when there were zero new cases.
Then things started going wrong. By the middle of July, Kerala was reporting an average of 800 cases a day. On Wednesday, the state reported 10,606 new cases.
The numbers started rising when millions of Kerala expats started returning from the Middle East after businesses there shut down.
Checking each of those migrants became a near-impossible task for the overstretched Kerala administration.
Some observers also blame laxity in maintaining social distancing during festivals like Onam.
"Things went south with the perception that the disease had disappeared when it had only retreated," said Ms Shailaja. "There was a huge laxity from the public during Onam which resulted in a surge of cases in September. Then there were these large-scale protests by political parties. It led to a tendency among the public that it is okay to come out."
A governmental expert panel has said the caseload will come down by the end of this month. But the health minister believes it will not happen unless people strictly adhere to the advisories from the health department.
Indo-Asian News Service
"Things went south with the perception that the disease had disappeared when it had only retreated." - Ms Shailaja
