Kerala COVID-19 lessons for India and Modi government

MALAPPURAM, India (Aug 26) (Reuters) – Indian Prime Minister Narendra Modi’s party has been vilified for its high COVID-19 cases, Kerala’s apparent poor history may contain crucial lessons for the country in containing the outbreak as authorities prepare for a possible third wave of infections.

Currently, the densely populated southern state, ruled by the opposition, reports the highest number of coronavirus cases in the country and represents the second highest national count, flattering figures than Modi’s Bharatiya Janata Party (BJP). has taken as a reflection of abused. local leadership.

However, a Reuters analysis of national and state data, and interviews with epidemiologists and health authorities in Kerala paint a different picture.

It shows that state containment measures have helped detect infections early, allowing authorities to better manage the disease and drastically reduce the mortality rate, a stark contrast to people dying in car parks and outpatient hospitals. lack of oxygen and beds in big cities like Delhi. the height of the health crisis a few months earlier.

“While the federal government may have its say on rapid antigen testing, it’s important to consider that state strategies have generally managed not only to keep mortality low, but also to be able to detect one in six cases in compared to one in 33 nationwide, ”said Rajib Dasgupta, head of the Center for Social Medicine and Community Health at Jawaharlal Nehru University in New Delhi.

The efficient detection rate and its population density more than double the national average explain the high number of cases in Kerala.

Similarly, at 0.5%, Kerala continues to have the lowest mortality rate among all but one sparsely populated state. The national figure is 1.4% and 1.3% for the country’s most populous state, Uttar Pradesh.

The difference is due to Kerala’s reliance on rapid antigen testing to strictly detect and isolate infected people at home, an approach the federal health ministry has harshly criticized, but which according to state officials has helped them better allocate beds. of hospital and oxygen supplies for those who really need them.

Government-recommended RT-PCR tests are more accurate, but take longer to produce results, that is, when a positive case of COVID-19 is confirmed, the infected person is likely to have developed severe symptoms and transmitted them to others. people in a vicious way. cycle of more infections and deaths.

Rapid test results in Kerala allow for isolated early treatment at home, which reduces the path of the virus to infections, state officials say.

These factors, along with the stressed medical resources in much of India, largely explain why the overall national mortality rate is much higher than that of the communist state.

Kerala officials also claim that a state support service that includes telephone consultation, supply of medicines and pulse oximeters that detect the oxygen levels in the blood of people recovering at home provides a bulwark in the battle against disease.

Delhi had a similar support structure, but collapsed as cases escalated.

“We have a different model and our mortality rate shows that our model is on the right track,” Kerala Health Minister Veena George told Reuters.

But Kerala officials acknowledge that the rapidly evolving pandemic can undo even the best plans designed unless the authorities are agile and flexible.

A MODEL TO EMULATE?

When Reuters recently visited the most populous district of Malappuram, Kerala, which reports the highest number of infections in India, a quarter of the 344 COVID beds at its largest hospital were vacant and the oxygen supply was wide.

The Indian Medical Research Council has recommended blockades for districts where more than 10% of tests give positive results. The rate is about 15% in Kerala and even higher in Malappuram, but shops and restaurants are open for business.

Kerala officials argue that they are able to keep businesses open as the state has the best test rate among the states of India (86 tests per 100 people, compared to about 33 in Uttar Pradesh), which means they are able to detect infections early and ensure timely treatment.

The model, epidemiologists say, can be replicated in a few other states with good health facilities, such as neighboring Tamil Nadu.

“Their surveillance is good, they detect cases early and the tests are very focused,” said about Kerala MD Gupte, retired director of the National Institute of Epidemiology who advises the federal government on vaccinations.

“Most people in Kerala have education, so that helps.”

India’s daily demand for medical oxygen jumped more than eight times in May from pre-pandemic levels, but Kerala avoided a severe shortage of hospital beds and oxygen that paralyzed many states when infections spread throughout the country. country experienced an explosive increase.

The federal health ministry did not respond to emails requesting comments.

VACCINE COMMITMENT

Minister George said the state was in the process of administering at least one dose of vaccine to all adults next month, the fastest pace among all states. Currently, the state has covered more than 55% of adults with at least one dose of vaccine, compared to 48% of all India, which wants to vaccinate all its adults in December.

Kerala, with 35.5 million people, has so far reported 3.8 million infections, or 12% of India’s total of 32.5 million. However, its 19,757 deaths represent only 4% of fatalities nationwide.

The Indian government recommends that 70% of all COVID-19 tests be performed by the RT-PCR method, while the Kerala rate is less than 50%.

“This is not the model of Kerala, it is a model of mismanagement,” said BJP President Jagat Prakash Nadda, a former health minister of India. dit last week.

He said Uttar Pradesh and Madhya Pradesh, ruled by the BJP, had better managed the pandemic, although a government survey estimated in July that more than 70% of residents in the two states had been exposed to the virus. The figure was 44% for Kerala.

The COVID-19 hospitalization rate in Kerala is only 3%, a state official said, compared to more than 5% nationwide when cases peaked in May.

TS Anish, a member of Kerala’s COVID expert committee, said the state was now focusing on vaccination.

“If you can vaccinate a large number, you will get infections, but your health system will not be overwhelmed.”

Reports by Krishna N. Das; Additional Reports by Chris Thomas and Jose Devasia Shri Navaratnam Edition

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