Covid cases: Why Kerala may be a 'victim' of its own 'success'

NEW DELHI: After a year of anxiety over rising Covid numbers, India is finally heaving a sigh of relief. The Covid cases in the country have been on a steady decline for the last few months.


Ironically though, Kerala, which led the nation in combating the virus initially, seems to be struggling now to contain its Covid numbers.

While the overall number of cases have been falling across the country, the virus has been spreading across Kerala since last few months.


On February 3, Kerala overtook Karnataka in total Covid cases to emerge as the second worst-affected state in India after Maharashtra in terms of virus caseload.


Currently, the state has the highest number of active cases — nearly 45% of country's total.


The rise in the number of cases in Kerala has left everyone guessing as the state was hailed as a success model for controlling the pandemic during the initial days of the outbreak.

A recent report released by the government of Kerala has shed some light on why the state may be at the receiving end of the coronavirus pandemic.

Strange as it may sound, Kerala's initial effectiveness in identifying and controlling the spread of infection are the likely reasons for the present rise in the number of cases in the state, according to the the report.

Virus in Kerala not as widespread as rest of India

According to the latest sero survey report released by the Indian Council of Medical Research (ICMR), the antibodies against coronavirus were prevalent in 21% of the country's population. However, in Kerala, antibodies were prevalent in only 11% of the population the survey revealed.


The virus in Kerala, the report said, did not spread as widely as in other states of the country because of the effectiveness of robust containment measures adopted by the state administration.

In the initial days of the pandemic, the state prudently implemented measures such as quarantine, contact tracing, rapid detection of cases through improved access to tests and isolation of Covid-19 positive cases. The state initiated clusters’ formation at the beginning through surveillance and implemented containment and 'break the chain' measures within the clusters.

Large population susceptible to virus

All these effective measures meant that a large population in Kerala was not exposed to the virus initially unlike in other states of the country. It is this large population in Kerala that has now become vulnerable and are still susceptible to Covid-19.

As per the sero survey, 5 out of the 30 clusters in Kerala had a seroprevalence of zero. This means that there are still communities in the state where Covid-19 has not penetrated.

In places, where a large portion of the population has developed antibodies, there are limited opportunities for the virus to infect people. Hence, the spread of the virus is not as widespread.

In places, where communities have been left untouched by the spread of coronavirus, there is considerable scope for the virus to infect people.

The presence of clusters with zero seroprevalence in Kerala means that the virus cases will continue to rise in the state, the report observed.

Transparent identification and reporting

The study further stated that the proportion of unidentified cases in Kerala is much less than the national average.

By extrapolating the results of the sero survey, it was found that Kerala has identified and reported 1 out of 6 actual cases. On the other hand, the country has identified reported only 1 out of 30 actual cases.

In other words, for every 100 actual cases, Kerala has successfully identified and reported nearly 17 cases, while the country has only been able to identify and report around 3 cases.
Different strain of Covid-19 virus?

There is another theory that suggests that a different strain of Sars-CoV-2 virus may be responsible for a surge in cases in Kerala and Maharashtra.

"We will have to investigate whether any mutant strain of coronavirus is under circulation in the state which is causing a spurt in the daily infection," director of All India Institute of Medical Sciences, Dr Randeep Guleria told news agency IANS.

Restriction on movement and demography

Guleria said that the state witnessed a surge in the cases after it lifted restrictions on the movement. He also said that demography of the state could be one of the other reasons for the rise in the number of cases.

"A large number of people there (Kerala) are elderly and suffer from comorbid conditions. This fact could also be impacting the emergence of Covid-19 in the state," added Guleria.

Dr, Lalit Kant, former head, epidemiology and communicable diseases, Indian Council of Medical Research said that demography plays a huge role in disease spread. "Age structure of the population and presence of chronic illnesses among them are few of the deciding factors of a disease spread," he said.

Dr Kant said the prevalence of chronic illnesses and the share of the elderly population is quite high in Kerala and Maharashtra. He quoted NFHS-5 findings which indicated that every third person in Kerala and every fourth person in Maharashtra is obese. "In Kerala, up to 38% of the population was found obese while it was reported 25% in Maharashtra," Kant said.

"Similarly, Diabetes is also quite high in both states. Kerala accounts for 27% while 12% in Maharashtra found exhibiting the disease," he added.

Former ICMR chief also shared that 30% of Kerala's population are patients of hypertension while its prevalence in Maharashtra's population is around 25%.

As per NFHS-5, the projected percentage of population above 60 years in 2021 of Kerala is 16% while it is 11% in Maharashtra.

The way forward

With a large population of Kerala still susceptible to the virus, the state's hopes now rest on the vaccination drive. The state government wants Kerala to be considered as a priority state for the Covid-19 vaccination drive. The state government also wants people of the state to strictly follow Covid compliance measures like physical distancing, wearing masks and ensuring hand hygiene till a significant proportion of state's population are vaccinated.

(With inputs from agencies)