- Kerala accounts for over 50 per cent of the fresh Covid cases in India
- Most of the Covid cases in Kerala are of Delta variant: Expert
- Over 2.5 crore doses of Covid vaccines have been administered in Kerala
New Delhi: The Southern state of Kerala reported over 21,000 (21,613) cases of COVID-19 on Wednesday (August 18), accounting for 61.43 per cent of the total new infections recorded in the country. The only other state contributing to a majority of the country’s caseload is Maharashtra, which reported over 4,400 (4,408) new cases in past 24 hours. NDTV spoke with Dr Anish TS, Member, Kerala Covid Panel, Dr Rijo M John, Health Economist and Dr Chandrakant Lahariya, Epidemiologist and Health System Specialist to know why Kerala, a state that was lauded internationally for controlling the spread of the coronavirus infections during the first wave of Covid, is now continuously reporting a rising number of cases since the last week of June. This comes at a time when the number of cases in other states has been falling after peaking in the first week of May during the second wave of the pandemic.
Late Second Wave
According to Dr John, one of the major reasons for the rise in cases in Kerala over the past few weeks is that the second wave started more than one and a half months later than the rest of the country because of the preventive measures and containment strategies. He said,
In fact, when about a dozen states had already surged, Kerala’s second wave started about a month and a half after that, and I believe many epidemiologists would agree too that Kerala is still catching up with the Delta Variant.
He further highlighted that as per the findings of the sero survey by the Indian Council of Medical Research (ICMR) that was done in May, Kerala’s seropositivity which is the per cent of the population with antibodies after being infected by the virus was only 44.4 per cent compared to the national average of 70 per cent. This also indicates that the state still has to catch up with the second wave like the other parts of the country, as per Dr John. Therefore, the state is expected to continue reporting a high number of cases.
Echoing the same thought, Dr Anish TS said that with the available data it is evident that the lockdown strategies were effective in Kerala and that’s probably the reason the seroprevalence in Kerala is much lower than that of the country. This means a chunk of the population in Kerala is now prone to infections.
Dr Anish also said that Kerala has been conducting high surveillance through tracking, tracing and testing. Among the larger states, Kerala conducted over 8.57 lakh tests per 10 lakh population as of August 17 Maharashtra, which is another worst-hit state, conducted only about 4.49 lakh per 10 lakh population in the same period. The survey done by ICMR has also found that Kerala has detected the most number of cases in the country which implies that the state has the least underreporting of COVID-19.
High Breakthrough Infections
Earlier this month, the Government of India said that till now, there have been more than 1,00,000 breakthrough infections in the country out of which 40,000 were reported from Kerala. Breakthrough infection refers to COVID-19 infections in a fully vaccinated person so the virus breaks through the protection being provided by the vaccine. Breakthrough infections usually take place about two weeks after taking the second dose of the Covid vaccine, according to Dr Lahariya.
Pathanamthitta district of Kerala has reported the highest number of breakthrough infections where over 14,900 people got infected after their first vaccine dose and over 5,000 got infected after both doses, according to the state government. While talking about the rising breakthrough cases in the district, Dr Anish said,
Over 80 per cent of people in Pathanamthitta district have been fully vaccinated and because of which the proportion of breakthrough infections is higher than the rest of the state. Also, not all 40,000 people who got COVID had received both doses. The majority of them were given the first dose only. Also, we know, most of these infections are very mild; cold-like symptoms.
He further said that the Delta variant of Covid is notorious for escaping the immune response mechanism of the body and thus this variant is causing more breakthrough infections not only in Kerala but in other parts of the country and the globe. Talking about the condition of the patients suffering from Covid breakthrough infections, Dr Anish said,
Breakthrough infections are mild and may not even be picked up. The symptoms are like that of Covid but milder. So, you have to conduct contact tracing, many people should be tested to pick up the breakthrough infection. In Kerala, we have got about 1.5 crore people who have received at least one dose of vaccination and out of that 40,000 breakthrough cases means only three per 1,000. It is actually all over the world- the rate of breakthrough infection is around 2-10 per 1,000.
Adding to this, Dr Anish TS lauded the state for being able to identify breakthrough infections and also sharing a maximum number of samples for genomic sequencing.
Dr Chandrakant Lahariya believes the number of breakthrough infections in Kerala is not worrying as it is in a similar proportion to the state’s contribution of 40-50 per cent to the daily caseload that is of 40-50 per cent. Giving out the reason for the same, he said,
Though we pay a lot of attention to breakthrough infections, what we need to remember is that the efficacy of vaccines is around 80 per cent which essentially means that out of every 100 people, around 20 people are still susceptible and that is why we keep reminding them to keep wearing masks. Remember, vaccinated people do get infections and reported studies have found 8-10 per cent of breakthrough infections. The current number is far lower than what ideally should be happening, so I am not worried. What should be done, however, is collect samples from breakthrough cases for genomic sequencing and check if breakthrough infections are happening due to circulating variants or is there any other variant. We should do more analysis rather than getting worried.
Is There A New Variant That Is Defeating Vaccines In Kerala?
As the cases rise in Kerala, the central government has asked the state to conduct genome sequencing of breakthrough cases to study the genome of the coronavirus and see if there is a new mutant of the virus that is defeating the immunity built by the vaccines currently being given to the people. However, according to Dr John, there has been no detection of a new mutant variant as yet. He said,
Kerala has been leading among many states in terms of doing the genomic sequencing. About one-third of genomic sequencing in India has been done in Kerala and Maharashtra together. There is no indication of any different variant as of now. Most of the variant spreading in Kerala right now is believed to be Delta.
The Road To A New Normal
According to Dr Anish, even though vaccine breakthrough infections are increasing, there is still a strong evidence to suggest that the severity of infection in breakthrough cases is much lower if a person is vaccinated. He said,
We have over 100 Covid deaths per day and we are working on reducing our death rate. But these deaths are not due to breakthrough infections. If people are vaccinated, the severity of infection is much lower, particularly if you have taken both doses.
As on August 17, Kerala had administered 2.5 crore vaccine doses. These include 1.82 crore people who have been given the first dose and 67.84 lakh people who have received both doses. This implies that 54.6 per cent of the total population of over 3.34 crore people, as per the Population Census, 2011 has received at least one dose of the vaccine.
Though the COVID-19 cases in Kerala are increasing, the data suggests that most of the patients are being treated at home or in isolation centres. As per the official bulletin, in the last 24 hours, 2,409 COVID-19 patients were hospitalised. During the same time, over 27,000 people have been added to home and institution quarantine whereas, over 38,000 added to quarantine or isolation. Despite a rise in COVID cases, the state is parallely moving towards phased reopening with tourist places like beaches welcoming visitors. Explaining the current COVID situation of Kerala and the state’s strategy, Dr Anish said,
Imposing lockdown-type strategies again will have a very high economic impact and the social impact also. We are trying to mix up the mitigation strategies and the containment strategies so we are going for more like a micro containment. If a particular area has got a large number, maybe more than 1 per cent of the population is affected that whole area will be under lockdown. In other areas, we are allowing some type of relaxation so that people can live. This is actually a mixing of lockdown with mitigation strategies that is taking place in Kerala.
According to Dr Lahariya, considering the uncertain nature of the pandemic, it’s natural to open up with the strict implementation of public health measures. However, he believes that unlock has to be more granular. Explaining the same, he said,
For example, allowing only those individuals who have received both shots of the vaccine to travel in train is not a right approach. In my opinion, such an approach should be followed with fairly well, advance notice to the people. For example, they should be told that if three months later, if people are not vaccinated, they will not be allowed to board the train or something. At this point of time, in my opinion, people who have received even one shot of vaccine should be allowed, other granular approach needs to be followed which is not happening and that’s kind of restrictive. Key thing is that the essentials of life should not be denied. Going to a mall or cinema hall is not essential in some sense and the benefits of putting restrictions by the government are far better than any deprivation.
With phased unlock and COVID vaccination, the entire country is looking towards getting back to normalcy. To achieve that, the central government has set a target of vaccinating its adult population of 92 crore by the year end. Will Kerala be able to achieve that goal? Answering the same, Dr Anish said,
Let’s understand Kerala’s vaccination drive through a car analogy. You are driving at a speed of 20 km/hr. You can comfortably drive at 40 km/hr as well and if the road allows, you can take the speed up to 60 km/hr. Similarly, Kerala has the capacity to vaccinate 5 lakh people every day but right now it’s not being able to do that because of two reasons – lack of continuous supply of vaccines and in between there are managerial issues as well. Even if the state administers two to three lakh vaccine doses a day, it will be able to vaccinate the entire adult population. But, currently, that’s not happening. On some days, when vaccination is done in a campaign mode, the state administers over 5 lakh doses a day but sometimes less than one lakh doses are given. The average speed is 50,000 vaccinations a day and with that speed, it will take us long.
NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.
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