The unrelenting high coronavirus caseload in India’s southern Kerala state is hampering the country's recovery from the pandemic as infection rates elsewhere in the world’s second most populous nation fall significantly.
Nationwide coronavirus cases have dropped over ten times from the peak during the brutal second wave in April and May, that left nearly 250,000 dead and more than 22 million infected as the country’s healthcare system failed to cope with the surge.
But the coastal state of nearly 35 million residents is “simmering” with fresh infections driven by the delta variant of Covid-19, with it accounting for nearly two thirds of the nation’s daily Covid-19 infections.
The Indian health ministry said 26,115 fresh infections were confirmed on Monday, with 16,700 of those in Kerala, where the daily positive test rate continues to hover around 18 per cent.
Some 252 deaths were also reported, nearly half of them in the state, where 4.4 million infection cases and 23,591 deaths have been confirmed since the pandemic began last year.
Experts say the infection spell is mostly due to a large portion of the state’s population remaining unexposed to the delta variant when other parts of the vast country were reeling from the pandemic.
“Kerala has a higher proportion of the vulnerable population that is not yet exposed to the virus compared to the rest of the country,” Rijo John, a health economist from the state, told The National.
“While the second wave surge and its decline were faster and it collapsed the healthcare infrastructure in much of India, it simmered for a longer time in Kerala,” he said.
India has confirmed 33 million cases and more than 450,000 deaths since the country was hit by the pandemic.
It reported its first case of Covid-19 in Kerala on January 30 last year, after a student returning from Wuhan in China was found to be infected with the virus. By September, the country was engulfed by the first wave of the pandemic.
On average about 100,000 infection cases were reported on a daily basis during the first wave, but Kerala was hailed globally for handling the pandemic through testing, contact tracing, maintaining social distancing and mask wearing.
But a year later, Kerala has become India’s “pandemic capital”, with cases climbing since April 2021, when local elections were held in the state.
The situation further deteriorated after Onam, the August harvest festival, when the locals defied social distancing measures and gathered in huge numbers to celebrate.
Serologic surveys conducted by the Indian Council of Medical Research in July that detect the presence of Covid-19 antibodies in blood found a 44 per cent rate in Kerala, compared with 68 per cent nationwide.
Factors such as high population density, less rural-urban divide and a large mobile population in the state are contributing to the surge, along with a stretched healthcare force, experts say.
Kerala is India’s most literate state with the highest life expectancy. It also invests the most in healthcare.
Its healthcare system did not crumble under pressure during the start of the pandemic, unlike the capital Delhi or Mumbai, and there has been no shortage of hospital beds, oxygen cylinders or intensive care facilities.
The death rate also remains the lowest, at 0.5 per cent, compared with a national average of 1.3 per cent.
But unlike last year when the state was able to track and treat each infected person, this year it is struggling to contain the spread while also running a vaccination programme.
Nearly 89 per cent of the state’s population has received a first vaccine dose, with restrictions being imposed on public movement in places where infection rates are high.
“There is no worry. We have imposed micro-containment in affected places … social distancing, mask and other guidelines are being followed. We have strong infrastructure and personnel to manage the situation,” Dr Rajesh VR, Kerala's Director of Health Services, told The National.
“The vaccination [programme] is going on in a steady manner, even on the holidays. Patients are being treated for free,” Dr Rajesh added.
But locals have expressed dismay over the government’s handling of the crisis.
“It is shocking how things have changed in one year. I feel the government’s decisions like lockdown or restrictions came very late and ended up having no use,” said Vishnu Prakash, 30, an academic from Kochi city.
Dr Rajeev Jayadevan, vice chairman of Kerala's doctors’ association, said a combination of factors was driving the “slow burn process” in Kerala.
He said although the state remains “fertile ground” for the delta variant to percolate, it has so far effectively handled the surge, that is seeing a downwards trend in recent days.
“The good thing was that we have so far prevented the pandemic from turning into an inferno,” Dr Jayadevan told The National.