As Kerala struggles to manage the surge in the caseload of COVID-19, the challenge is to change the narrative that the State’s health system has the capacity and the expertise to contain the pandemic. The new reality is: now that the new virus has started seeding here, it will affect a significant proportion of the population before it disappears. Public health experts warn that unless this is understood by the administration and conveyed to the public, they cannot be prepared for the long haul ahead.
‘Not like Nipah’
“The fundamental aberration in Kerala’s containment strategy is that it has been built wholly around the strategy it had adopted and succeeded with Nipah. While both are airborne diseases, the disease epidemiology of Nipah and COVID-19 are totally different. Nipah outbreaks historically have been small and self-limiting and we managed to contain it in a short time. On the other hand, even when information on the new coronavirus was trickling in from Wuhan, we were well aware of the nature and scale of the spread of the disease. Yet, no academic or technical consultations were done before it was decided that the Nipah strategy can be applied for COVID-19 containment,” says a senior public health expert.
The narrative has been around ‘conquering’ COVID-19, discounting the experiences of Italy and Spain where the health systems were ravaged by SARS-CoV-2.
“Their experience should have made it obvious that while we can intensify preventive and containment measures, our focus should be on extensive disease surveillance in the community and building critical care capacity to save lives. But the State has failed in picking up early warning signs about a possible silent transmission in the community and to act upon it,” he says.
Many undetected cases
The first phase of community/sentinel surveillance in April-May, wherein the State did approximately 8,000 PCR tests (augmented and sentinel surveillance), had detected eight cases. The data, had these been properly interpreted, should have told the State that at least 20,000 undetected cases were lurking in the community at the time and that the influenza like illness (ILI) and severe acute respiratory infections (SARI) surveillance should be done in a decentralised manner.
Again, for a week from June 8, the State launched sero surveillance studies across districts using antibody kits. The survey was given up after the first round results which threw up ‘unexpected results’. Official sources confide that the positivity (both IgM and IgG) reported had been in the range of 3-19%. But the report remains under wraps even now.
Private sector’s role
The State has now intensified surveillance amongst the high-risk population and in market places and slums. “Now that the reality of community transmission has become more acceptable, the only thing left to do is to adapt the health system to ensure that the huge spike in cases stays below the surge capacity. The next is enhancement of the surge capacity. Here, it is the private health sector, which has the bed and the critical care capacity. The government has already cleared the way to rope them in,” a senior health official said.
