The signs that Kerala is gradually freeing itself from the grip of Sars-CoV-2 continues to be evident. For the seventh consecutive day, the number of confirmed cases has not shown any marked increase; from nine on April 8, it has marginally gone up to 12 on Thursday.
Nonetheless, north Kerala districts continue to pose major worries. Kasaragod had four new cases. Kannur, too. Malappuram had two. Thiruvananthapuram and Kollam had one each.
Like in the last couple of days, Thursday also saw the number of people recovered (13) outdoing new cases (12). As a result, a trend that began on April 7, of active cases falling, kept true on Thursday, too. If there were 259 active COVID-19 cases in Kerala on April 9, it fell to 258 today. On April 7, the number was 266. However, the number of confirmed cases in Kerala, including the cured, is 357.
Till this day, 97 patients had recovered, the highest in the country. This includes eight foreigners who were discharged today.
Like in the last five days, there has also been a drop in the number of people under surveillance in Kerala. From a peak of 1,71,355 on April 4, the number has shrunk to 1,36,195. The number of people isolated in hospitals, the high-risk cases, is also showing a gradual decline. From a high of 795 on April 6, this has come down to 723 on Thursday.
A 62-year-old heart patient who was under observation after showing coronavirus symptoms died in Thiruvalla on Thursday. He was admitted in the hospital here in the evening after his condition worsened. It is not yet clear if his death can be attributed to the virus.
100th-day shock
However, on the 100th day after the first COVID-19 case was reported in Kerala on January 30, the nature of fresh cases has shown a disturbing flip. If till now those who had come from outside had dominated the fresh cases that emerged daily, for the first time the new cases in Kerala were almost fully made up of immediate contacts on Thursday.
Of the 12 new cases, 11 were immediate contacts and only one had come infected from outside.
Till yesterday, 254 of the total confirmed 345 cases in Kerala had come from outside. Only 91 were their immediate contacts. Meaning, the virus's R0 or R-naught, a number that shows a virus's infective or reproductive capacity, is far less than one.
On average, an infected person in Kerala was not passing on the virus to even one person in Kerala. The global average is 2.6. It is said that an epidemic with an R-naught number less than one would gradually disappear without causing any major devastation. Kerala's has consistently been below 0.50.
Kerala's R-naught rises
But in just a day, the balance has slightly shifted though not on a scale to cause an alarm. Now, if 254 of the total confirmed 357 cases in Kerala have come from outside, 101 are immediate contacts. The R-naught factor is still below the safe 0.50 mark.
A larger number of immediate contacts suggests those coming infected from outside had been almost fully accounted for. But health experts warn that it could also be a sign that the virus had spread in the community. “If this trend keeps up for three days more, then we are encountering a community transmission,” a top health official said.
Perhaps why Chief Minister Pinarayi Vijayan also sounded a note of caution during his customary sunset briefing on Thursday. “Even now there exists a situation where even a small lapse could lead to devastating consequences,” Pinarayi said. He said with Easter and Vishu round the corner, people should make sure to strictly follow social distancing protocols.
Fresh fears in Malappuram
With a COVID-19 patient's son testing negative in Malappuram, fears of community transmission have cropped up in the district. All this while it was believed that it was the son, a 52-year-old 'madrasa' teacher who had returned from Saudi Arabia, who had infected the father.
Now, after the son was found uninfected, the baffled district administration is frantically on the lookout for the original infected. “If this person has not yet been traced and quarantined, there is a high possibility that he could have transmitted the virus to others in the community,” a top health official said.
Pothencode still under a cloud
The fears of community transmission in Thiruvananthapuram's Pothencode has supposedly blown over. Tourism minister Kadakampally Surendran, who is in charge of coordinating COVID-19 containment measures in Thiruvananthapuram, claimed on Thursday there was no community transmission in Pothencode. All the 200-plus samples of people who had close contacts with Abdul Azeez, the man who had died on March 31, have shown negative results.
Health officials, however, are not fully convinced. They argue that in the case of many Pothencode natives whose samples were taken it was not yet time for the virus to show up in the throat or nasal swabs. “The samples were taken on April, and it was too early. It is only during the last two days of the incubation period, which in many cases is 14 days, that the virus starts appearing in the throat,” a health official said.There is yet another unresolved issue in Pothencode. The origin of Abdul Azeez's infection has still not been traced. “We will have to do antibody tests in Pothencode to assess whether there are chances of community transmission in the area,” the official said.
Where are the rapid kits?
The delay in the arrival of kits is the other major issue. It is now said that the kits will reach only on April 13. They were supposed to reach here today (April 8). Only after the kits come can the Health Department carry out the most important task of assessing whether frontline health workers who are the closest to the patients are silent virus carriers. Such a study was important not just for the health of our doctors and paramedical staff but also for sustaining Kerala's fight against COVID-19.
Simultaneously, antibody tests have to be done in hotspots as latest evidence shows the presence of many asymptomatic patients. For instance, the Tablighi participant who tested positive in Alappuzha on April 8 had no symptoms. “It is now globally recognised that 85 per cent of those infected will have only the mildest of symptoms. Therefore, it is highly likely that many would not have even known they are infected but still would be unknowingly transmitting the virus,” a health official said.
Rapid tests, because it detects antibodies, in identified hotspots spots could reveal such silent carriers, and would help in quickly quarantining them before they could do more damage.
White man's paradise
Amid all these uncertainties are big triumphs. On Thursday, it was the discharge of eight foreign patients. Besides the Italian tourist Roberto Tonoso who had come to Varkala and the British national Brian Neil who were cured days ago, five more foreign nationals, one an 83-year-old and two of them 76 years old, have also been discharged from the hospital on Thursday.
The foreign nationals now getting ready to fly back to their homes are Lanson (76), Elizabeth Lance (76), Janet Leigh (83), Steven Hancock (61), Annie Wilson (61) and Jan Jackson (63). The last four tourists were shifted to a private hospital in Kochi on their request.
Brian Neil, though he is only 57, was the most affected by the virus. He was among the 19 British tourists who had to be deplaned on March 15 at the Nedumbassery airport. When his pneumonia worsened, the doctors of Ernakulam Medical College, in what is now seen as a bold and radical treatment, administered anti-HIV drugs to Neil. He miraculously survived.
