Over the last week, the number of cases added increased 191%
Kerala, the state that once boasted of remarkable gains in COVID-19 containment, is again in the middle of an uncontrollable case surge and ensuing strain on health infrastructure.
The test positivity rate (TPR) in the state rose to an all-time high of 44.88 per cent on January 23, 2022 when the active caseload crossed 260,000. Over the last week, the number of cases added increased 191 per cent, the state health department noted.
Hospitals are seeing more admissions than they have the capacity for and a growing number of health workers are testing positive for COVID-19.
Over 400,000 patients in the southern state are under observation and quarantined at home, according to government statistics. Around 26 per cent of the COVID-19 patients are on a ventilator and oxygen bed occupancy increased 101 per cent in the week ending January 22. On January 23, 44,449 of the 101,252 people who tested for the infection were positive.
Around 38 COVID-19 deaths were reported over the last week, pushing the state’s toll to 51,816.
Leniency questioned
The government’s containment strategy in response to this surge has come under the scanner.
In the initial phase, Kerala boasted of better standards in COVID-19 care citing low TRP rates, said state Opposition leader VD Satheesan. “Now the TRP is going out of hand but the government is not initiating any steps to curb the growth.''
The state government reimposed weekend lockdown January 23, a move whose efficacy has been questioned. The number of attendees at funerals and weddings has been capped at 20.
District-level conferences of the ruling Communist Party of India (Marxist) party, however, are still being held, with at least 150 delegates taking part apart from media persons and cadres. Party state conference scheduled in Kochi and its national conference in Kannur are also likely to be major crowd-pullers.
CPI(M) leaders, in the light of the unfolding crisis, have said they will avoid huge rallies and public meetings.
Powerful trade and commerce bodies have been criticised for breaching social-distancing norms for business. A private mall opened in the state capital Thiruvananthapuram three weeks ago, for instance, has been recording a daily footfall of 45,000.
Widespread outrage against the lack of stringent restrictions to control the case surge has pushed the government to outline a graded response strategy. The 14 districts in the state have been classified under three zones A, B and C depending on the caseload at hospitals. Restrictions will be imposed accordingly.
In the A zone districts with the least hospitalisations, cultural, political, religious and social events, including weddings can be held with the participation of a maximum of 50 persons. Ernakulam, Alappuzha, and Kollam districts are in the A category.
B zone districts will be those with over 10 per cent hospitalisations and double the rate of ICU admissions than in January 1. No cultural, political, religious, or other events will be allowed in these.
All religious events and rituals will have to be conducted online. However, marriages and posthumous events will be allowed with 20 persons. Thiruvananthapuram, Palakkad, Idukki, Pathanamthitta and Wayanad are in the B zone.
Districts where over 25 per cent of the total hospitalised patients have COVID-19 will fall under the C zone. No public events, political meetings, and religious programmes will be allowed in these districts. Theatres, swimming pools and gymnasiums will also be shut. All classes, except final year graduation, post-graduation, 10th and 12th will have to be conducted online. Residential and educational institutions can function as ‘bio-bubbles’.
As of January 21, no district in Kerala were found to be in this category.
Kasaragod, Kozhikode, Kannur, Malappuram, Thrissur and Kottayam are not in any of the three zonal areas, according to the new norms. In these districts, prevailing restrictions based on weekly infection population ratio will continue, the government announced
Public health challenge
Government and private hospitals in the state are grappling with acute shortage of human resources in the face of the fresh infection surge. At least 1,750 healthcare workers tested covid positive last week, according to government data.
Those on duty are burdened with patient care as well as additional clerical work due to the staff crunch. This includes uploading lab data to the ICMR portal and updating the admission and occupancy registers.
“Doctors, nurses and other healthcare staff are extremely stressed,” observed NM Arun, a public health professional in Palakkad, adding that they face the risk of getting infected again.
Every healthcare staff in the state is vaccinated and the immunisation rate among the general public is also very high. But instances of infection among fully vaccinated people and those with booster doses have raised concern.
Speciality hospitals with better facilities remain underutilised even as new, urgent responsibilities are being thrust on understaffed and crowded hospitals, health experts said. “The systematic deficiencies in government hospitals are higher. They add to the pandemic fatigue that causes the staff to feel burnt out,” pointed out Dr VK Babu, a Kannur-based public health activist.
The number of COVID-19-related hospitalisations in the state is lower than during the first and the second waves. “People are not very fearful of the prevailing two variants, and they prefer teleconsultations from home,” said P Samuel Koshy, president of the Indian Medical Association's Kerala unit. However, there is a surge in cases of unnecessary admissions, he added.
Most of the new infections are mild, indicating the variant circulating now is omicron, according to health experts.
The graph is all likely to peak in the next two weeks, said health minister Veena George.
In the meantime, the state government has introduced new guidelines for optimising the monoclonal antibody (mAb) cocktail of casirivimab and imdevimab in COVID-19 care. It said there is a tendency of misusing the drug among hospital authorities and doctors.
The new guideline mandates the decision to use mAb be taken by the relevant institutional medical boards, strictly following the guidelines and based on appropriate variant-detection tests approved by the Indian Council of Medical Research. The mAb is effective only against a delta infection and not omicron.
The misuse is happening mainly in the private sector, said the government communication.
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