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A man in a protective suit stands next to a mobile Covid-19 testing kiosk outside the Ernakulam district administration headquarters in Kochi, Kerala state, India. Photo: AP

India’s great coronavirus mystery: why so many cases in Kerala?

  • The southern state accounts for two-thirds of new infections in India, despite having only 3 per cent of the population and a vaccination rate that, at 70 per cent, is higher than the national average
  • Is it the festivals, the population density, or a lax approach to quarantine? Or perhaps Kerala is simply honest about its figures, or so good at containing the disease last time round that too few people now have antibodies?
When the history books on Covid-19 in India are written, the mystery of Kerala – why this tiny state has recorded a disproportionately high caseload – will probably merit its own chapter.
For weeks now, while nationwide the virus has been receding dramatically after the devastating second wave, Indians have watched in disbelief as it has kept surging in the southern state. Only in Kerala. Nowhere else. The state’s numbers have soared from accounting for half of India’s daily new infections for many weeks to a staggering two-thirds currently.

On Sunday, Kerala recorded 29,836 cases, the highest number in eight weeks. That is 70 per cent of India’s 42,513 new cases, even though the state is home to barely 3 per cent of the 1.3 billion population. Everyone keeps waiting for the figures to plateau, only they don’t.

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Experts are warning of another big jump around October, the country’s peak festival season.

In response, the government is reimposing a night curfew from Monday but critics say this is like shutting the stable door long after the horse has bolted.

Kerala’s state government has controversially allowed festivals to be celebrated, leading to large gatherings. Every festival has been followed by a spike.

Concerned at the state’s consistently high figures, the federal health secretary Rajesh Bhushan has written to the government to express his concern and suggest measures, including ramping up containment, contact-tracing and testing.

The answer to the question “why” is inconclusive. It cannot be lack of vaccinations. Kerala health minister Veena George has said that over 70 per cent of the people have been vaccinated. Of these, 25 per cent have received both doses.

A medic tests a woman at a walk-in coronavirus kiosk at Ernakulam Medical Collage at Kochi in Kerala, India. Photo: Xinhua

Some say that the high infection numbers are, in fact, a sign of Kerala’s success. The argument goes that, unlike other states which may be fudging their figures to look “good”, Kerala is testing massively and reporting its figures honestly.

“Kerala is catching one out of every two infections compared to other states which are catching one out of 30-odd infections,” said virologist Dr Gagandeep Kang.

The news that people in Kerala keep stressing is that hospitals have not been overwhelmed. There is no shortage of ICU beds or oxygen. The mortality rate too has remained the lowest in the country at 0.5 per cent compared to the national average of 1.25 per cent.

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Apart from the state’s laxness over festivals, a team of health officials who were sent to the state by New Delhi last month to understand why the numbers were not coming down, found another cause.

Once a person has tested positive, they are not following quarantine norms at home. Instead of isolating themselves, they are mingling with the family and relatives and spreading it to them.

The New Delhi team found that 35 per cent of new infections had been caught at home. “This is due to laxity in maintaining social distancing norms in homes,” George told local media.

Cows take shelter from rain outside a closed shop during a lockdown imposed to curb the spread of coronavirus in Kochi, Kerala state, India. Photo: AP

“At Onam [a recent festival], I saw my neighbour celebrating with his family and friends. He had tested positive – he told us himself – but sat around with all of them with no mask. Then his wife and parents tested positive. What do they expect?” said Usha Pillai, a fashion designer in Kochi.

Bhushan has ordered George to ensure that home quarantine rules are followed and that if families do not have a separate room for self-isolation, the state must make sure accommodation is provided.

Other reasons given for Kerala’s roaring figures include that it is a densely populated state and has a large number of elderly people.

Yet another theory suggests that Kerala is the victim, as it were, of its earlier success. This theory goes that, since the virus was effectively contained earlier in the pandemic, it has left a large pool of people who have not had the virus and so are still vulnerable to it, unlike other states which were not so successful in earlier waves.

The latest survey of how many Indians have had the infection tends to bear this out. According to an Indian Council of Medical Research survey last month, 68 per cent of Indians nationwide had antibodies, indicating they had caught the infection. In some states, the figure was as high as 72 per cent. The figure for Kerala was 43 per cent.

A policeman questions a commuter on suspicion of violating restriction rules during a weekend lockdown to curb the spread of the coronavirus in Kochi, Kerala state, India. Photo: AP

Elsewhere, hope

While Kerala struggles to lower its caseload, the rest of the country appears to have drifted into calmer waters. Last week a milestone was reached when India managed to carry out 10 million vaccinations in one day for the first time, thanks to improved supplies.

Around half the adult population of 940 million has now been vaccinated: 37 per cent with just one dose and 10 per cent with two doses.

The World Health Organization’s chief scientist Soumya Swaminathan has told the Indian media that India may be entering a more “manageable” phase given the lack of exponential growth and peaks that the country experienced earlier.

“We may be entering some kind of stage of endemicity where there’s low-level transmission or moderate-level transmission,” she told The Wire website.

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The low figures are encouraging more states to reopen schools, though parents remain wary. New Delhi schools are expected to open on September 1.

More restrictions are expected to be lifted too although government officials keep stressing that no one knows if a third wave will come or not and therefore everyone must continue to be vigilant.

Increasingly, though, the opinion among experts seems to be that even if a third wave comes, it will be less harmful than the second.

Instead, the main worry seems to be that unless Kerala can get its numbers down, the state risks becoming a hotbed of mutations.

“The danger is the emergence of new and dangerous variants, which is why Kerala must concentrate on containing its cases,” said former Kerala health secretary Rajeev Sadanandan.

This article appeared in the South China Morning Post print edition as: Reason behind high caseload in Indian state stays elusive