These two states have become the bellwether for what is to come with cases typically rising here before other regions
.jpg)
Some 66 per cent of India's 7,584 new COVID-19 cases was reported from Maharashtra and Kerala, according to government data released June 10 morning.
These two states have become the bellwether for what is to come with cases typically rising here before other regions follow suit.
Kerala, with a population of 33.4 million (2011 Census), has a cumulative caseload of 6,569,058 as of June 7, 2022, the state government’s COVID-19 dashboard showed.
Maharashtra, a far bigger state with 112.3 million people, has seen some 78,93,197 cases since the beginning of the pandemic.
These figures are an underestimate, despite a robust testing mechanism, according to experts.
As much as 44.4 per cent of the population in Kerala and 58 per cent in Maharashtra were seropositive, according to the 4th national sero-survey of 11 states conducted by the Indian Council of Medical Research (ICMR) between June 14 and July 6 in 2021.
Around 70 per cent of the population in Kerala had natural immunity, according to the state government's third round of sero-survey conducted in September 2021.
Mumbai, which accounts for a bulk of Maharashtra's cases (1,765 of the 2,701 fresh infections in the state on Wednesday, had a 90 per cent seroprevalence, according to the fifth sero-survey conducted by the Brihanmumbai Municipal Corporation (BMC) in August and early September 2021.
A major chunk of the cases being recorded in the two states are likely re-infections, experts said.
Mumbai-based infectious diseases expert Dr Ishwar Gilada estimated some 20-25 per cent of the cases he’s treating now are re-infections. Dr Lancelot Pinto, pulmonologist at Mumbai’s Hinduja Hospital, is seeing a greater proportion of reinfections — at 80-90 per cent of the cases in the past month. “My limited observation is that those getting re-infected now first got infected during the delta wave,” he told Down To Earth (DTE).
Dr Anoop Kumar AS, member of the expert advisory panel on COVID-19 management for the Kerala government, believes almost 75-80 per cent of the cases he’s treating currently are re-infections. “Some 80 per cent of them are vaccinated. Thus we are not seeing severe pneumonia cases any more,” he said.
But why do these two states keep making headlines in terms of their COVID-19 caseload? Several factors are at play.
A better testing mechanism may be a major driving factor. “The absence of large reported case numbers from other states may simply indicate a lack of sufficient surveillance,” Gautam Menon, professor of physics and biology at Ashoka University, told DTE. Kerala-based health economist Rijo John underlines that case reporting could also be a function of the way testing is done and the type of testing used.
Experts from the region also believe frequent international travel from the two states is a key contributing factor. “Every time there is an outbreak in the Middle East or Europe, cases start increasing in Kerala a few weeks after. We are seeing this trend now as well,” Dr Kumar said. High population in Kerala and parts of Maharashtra — particularly Mumbai — is another reason why cases remain high, experts believe.
The epidemiology of COVID-19 in Kerala has been different when compared to other parts of the country. If we look at the test positivity rate — number of people testing positive out of the total tests conducted — Kerala’s has never gone below 1 per cent.
“This has happened in several parts of the country but I’m not sure if that's a real zero or a result of insufficient testing,” Dr Rajeev Jayadevan, co-chairman of the Indian Medical Association’s COVID-19 National Task Force, told DTE.
Therefore, unlike the rest of the country, it is really not possible to count distinct COVID-19 waves in Kerala; the TPR graph looks like a continuous mountain range. But if you plot India’s TPR on a graph — three clear peaks emerge, he explained.
In the same vein, research diabetologist from Kerala, Dr Jothydev Kesavadev, underlines salient features. “Kerala has the largest number of diabetes patients, elderly population, and the longest life expectancy. In these terms, the state has more similarities to the US than other parts of India. These are key reasons why the COVID-19 epidemiology has been different here,” he told DTE.
Environment also plays an important role in how the disease transmits. COVID-19 spreads via airborne particles, and an ideal humidity environment makes the droplet live longer and transmit successfully. “If it's too dry, for example, evaporation of droplets is quicker, and it becomes difficult for the virus to survive outside the host,” Dr Jayadevan explains, underlining that the prevailing weather in Kerala and parts of Maharashtra is conducive for droplets to survive longer while airborne.
Experts believe that instead of focusing on the caseload, we should understand that with deaths and hospitalisations low, it’s an indication of how to handle a surge well. “We shouldn't hound on states that are honest and, in fact, should learn from them,” Dr Gilada said.
The robust surveillance and data collection system in Kerala and Maharashtra can offer us a wealth of information in terms of understanding the SARS-CoV-2 virus better.
“These two states provide good benchmarks for the progress of the pandemic across India. That said, these states may not be typical — they are older and richer than other highly populous states and with better levels of health care,” Menon underlined.
There is more granular data for Kerala than Maharashtra, but a section of experts believe not enough high-quality clinical and epidemiological work is coming out. “Hundreds of thousands of patients were admitted in hospitals and we have data on all of them. But the sad part is we don't have enough research publications,” Dr Kesavadev said.
Kerala and Maharashtra have the potential to strengthen our understanding of COVID-19.
Several questions can be explored based on the data these two states have collected. Experts said these include: How long does natural immunity actually last; how many times a person can get reinfected; if a particular demography more susceptible to this; how many vulnerable people have not been vaccinated and why; how many patients were given steroids and if they need follow up programmes; What is the exact reason for death (death audit); What has the collateral damage of the pandemic been.
“It would be good to understand the variety of clinical presentations of COVID-19, especially with the more recent variants,” Menon said.
A better understanding of what predisposes those infected to milder or more severe forms of the disease would be one major input to our current understanding, he added.
We are a voice to you; you have been a support to us. Together we build journalism that is independent, credible and fearless. You can further help us by making a donation. This will mean a lot for our ability to bring you news, perspectives and analysis from the ground so that we can make change together.
.png)
Comments are moderated and will be published only after the site moderator’s approval. Please use a genuine email ID and provide your name. Selected comments may also be used in the ‘Letters’ section of the Down To Earth print edition.