Kerala has been preparing to ease out of the lockdown in full confidence that the third stage of disease transmission or the community spread of COVID-19 has eluded the State. However, all such claims are beginning to fall flat. Now that Kerala has begun to report multiple cases of COVID-19 from various parts of the State — especially that of health workers — without any clear epidemiological link, it is becoming evident that silent disease transmission has been happening in the State.
The outbreak has so far been slow and mild in Kerala only because the imposition of the lockdown just as the graph was beginning to climb effectively slowed disease transmission in the community.
Epidemiologists point out that the frenzy over how Kerala “flattened” the epidemic curve, widely celebrated in international media, seems to have lulled the State into believing that contact tracing and quarantining can solve most of its issues.
Kerala did some extremely good work as far as the initial containment of the disease is concerned, through systematic quarantining of imported cases of infection and aggressive contact tracing.
“Kerala is still in the very beginning of the epidemic and we have not even seen the graph climb, to talk about flattening the curve. In a population of 3.5 crore, which is 100% susceptible to this new virus, 450-odd cases is definitely not the peak. I fear that we have been taking our tryst with COVID-19 very lightly. Our problems are only beginning because we are going to see COVID-19 peak in the rainy months ahead, when we will have to deal with all our annual infectious disease outbreaks,” a senior public health expert said on condition of anonymity.
Steep increase likely
Once the lockdown is lifted, in two weeks, the State could see an explosion in cases. The lockdown just bought the State some time to prepare itself and prime the health system to face the oncoming storm.
“Because of the nature of the virus — that it can spread even when a person is in the asymptomatic or pre-symptomatic period — it is quite definite that it will get established in the community and that it will be there till a significant section of the population is infected . The severity of the outbreak will depend on who gets infected,” he added.
Lockdowns will have to be repeated region-wise for initial control of the outbreak and diagnostic testing (PCR) will have to be seriously increased so that new cases are picked up and isolated immediately to contain spread.
Role of private sector
It is thus perhaps time to talk about the specifics of the State’s mitigation plan, how many isolation and critical care facilities are readied in public and private sector and list these district-wise.
How well has the State been involving the private sector in preparing the mitigation plans and whether it has assessed the preparedness of individual private sector hospitals is another question. It is only on Saturday that the government announced that private hospitals too can test for COVID-19.
Kerala so far has had little experience in treating severe cases, as almost all of its cases have been mild and with just two or three patients requiring ventilation. It is thus perhaps also time that clinicians, critical care physicians and intensivists in both private and public sector got together and discussed the latest developments in managing severe COVID-19.
