For the past 10 days, Kerala has been reporting 10,000 to 12,000 Covid cases every day and the Test Positivity Rate (TPR) is now around 10% as compared to 29% in May, when the state saw its peak with nearly 40, 000 cases.
Health experts within the state government say the strategy is to drag the wave so the cases do not go beyond the health system capacity threshold.
Doctors and experts have pointed out that according to the sero prevalence survey in the second wave only 11% population of Kerala was infected with Covid, while the majority 89% was still not exposed to the virus.
Dr Mohammed Asheel, public health specialist and a member of Covid 19 core team, said, “When we entered the second wave, what we were trying to do is keep the wave below our health system capacity threshold. So, we expected that we will end our wave only after all the other states have ended theirs.”
He also added that keeping a lot of people susceptible until we have the vaccine immunity is the way ahead.
Another, Dr TS Anish, associate professor, community medicine, Trivandrum Medical College and a member of state expert committee, said testing in a community has two purposes – one to identify the positive cases, isolating and treating them to stop further spread. The other is that the number of people tested positive can be used as an indicator of “epidemiology spread”.
He further said, “If we have to control infection using testing, we will have to identify high risk individuals and test (them). The advantage of targeted testing is that more and more people will be tested positive and we can contain the outbreak by quarantining them and preventing it from further spreading. But the other is that TPR will be high and people will think that the area is highly infected… In Kerala, we are doing targeted testing maybe more as compared to other states and that must also be the reason for the increase in TPR.”
Experts within the government have also said their strategy is to drag the wave so that cases don’t go beyond the health system’s capacity threshold. They expect Kerala to become the last state to end the wave.
On managing the pandemic, Dr Mohammed Asheel said, “We can have 10 lakh cases in one month, a week or in three months. It is better to have this in three months because if you have it in one month or week there will be gross undercounting, we will have people who’d be dying on the roads without oxygen, ventilators, ICU. Never in the entire wave in Kerala there was a situation where systems were overwhelming or people dying in the roads due to lack of oxygen.”
Some experts say a sudden increase and decrease of cases is a failure of the health system while others say preventing the peak at the cost of a raising TPR is a good sign.
Dr Anish said, “If we look at the epidemic curve of the countries where it was controlled like in Singapore, Sri Lanka or France, we will see an epidemic curve which is not very sharp, it is actually a flattened curve. In India, Kerala is the best example where the epidemic is growing slowly and the epidemic is coming down slowly.
But doctors also warned about plateauing of cases, and said if a third wave hits soon, it will have repercussions on the health infrastructure.
Dr N Sulphi, national coordinator, IMA social media wing said, “The plateau is there for almost 10 days. It is a concern we have to bring it down. The major concern is that if a third wave comes soon, there will be a major problem, the cases in Kerala will be more and hospitals will be overloaded.”
Kerala has a large number of vulnerable section including, elderly and those with co-morbidities such as diabetes, hypertension, and cardiovascular diseases.
The doctors also added that the vaccination drive should be expedited and the testing should also be increased. The strategy of the health department is to keep most people susceptible till they get the vaccine immunity. They expect the cases to fall further in the next couple of weeks.