It has been more than a week since Kerala's COVID-19 infection curve has remained flat.
On Friday, the number of fresh cases confirmed was seven, marginally lower than the 12 declared positive the previous day. Once again, recovery has outrun new infections, a trend that began five days ago. If there were seven new patients today, nearly four times that or 27 people had recovered, the biggest rate of recovery till date.
This has brought about a sharp decline in the number of active cases to 239, back to April 1 levels. The numbers started to fall after April 7, when active cases touched 266. As of Friday, 124 patients have recovered, the highest in the country. This includes eight foreigners who were discharged on April 9.
Kannur and Ernakulam, which has the highest number of confirmed cases after Kasaragod, have shown the highest rate of recovery. As many as 35 of the reported 63 cases have recovered in Kannur. In Ernakulam, 16 of the 25 confirmed cases so far have been cured.
The rate of recovery in Kasaragod, however, is worrisome. The confirmed cases are 164 but only 23 have recovered till now. The new state-of-the-art COVID Care Centre in the district is expected to turn things around.
Like in the last six days, there has also been a drop in the number of people under home and hospital surveillance in Kerala. From a peak of 1,71,355 on April 4, the number has shrunk to 1,29,751. The number of people isolated in hospitals, though it was coming down for nearly a week, has shown a marginal increase on Friday. From 723 on Thursday, it has gone up to 730 today.
Vital sign monitor
Till April 3, the virus was reasonably active and the COVID-19 curve had looked like the ECG readout of a healthy individual; a repetitive pattern of sharp spurts and sudden lows.
If a flatlining of the ECG indicates zero electrical activity and therefore death, does the sudden flattening of the COVID-19 curve in Kerala suggest a similar fate for the virus? “We cannot be certain at this stage, at the most we can say the virus has gone dormant,” a top health official said.
In-house infectors
A major reason for the guarded response is the sudden shift in the balance of cases. From April 9, the immediate contacts in the daily list of confirmed cases have outnumbered people who had come infected from outside. This suggests that those without any travel history are now showing up positive. Till now Kerala was trying to protect its citizens from getting infected by those coming from outside with the virus. Now that the foreign returnees had been isolated, treated and cured, it is time to make sure there is no community transmission from the persons they had infected.
Till last week the share of immediate contacts in the total confirmed cases was lower than 25 per cent. In a week, this has touched 30 per cent.
On April 9, 11 of the 12 confirmed cases were primary contacts or those infected by people coming from outside. On Friday, six of the seven confirmed cases were immediate contacts. Kannur had two and Kasaragod had three. The remaining two who tested positive were in Malappuram, and they had come after participating in the Tablighi Jamaat in Delhi.
The R-naught factor, or the number of people a virus carrier can infect in Kerala, is also baffling health officials. It is said Kerala's average R0 is less than 0.50, a soothing number that suggests that a patient in Kerala does not on an average infect even half a person.
Increased reproductive capacity?
However, on April 9, four in a family in Kannur were found infected by an 81-year-old who had returned from Saudi Arabia. And this included his 70-year-old wife and 13-year-old grandson. Today also saw two in a family getting infected by a person who had returned from the Gulf. “Till now we were under the impression that the virulence was very low in Kerala,” the health official said.
Earlier, there were instances of infected people either unknowingly or wilfully getting into contact with a scary number of people and attending mass gatherings – like the politician in Idukki or the lady who had returned from Umrah in Malappuram or the retired policeman in Pothencode who was the second person to die of COVID-19 in Kerala – and still not infecting anyone. “We need to see whether a new trend is emerging,” the official said.
Silent superspreaders
Then, there is also a rising fear of asymptomatic patients. At least four people who had tested positive had not shown any symptoms. Last day, two women who had accompanied their husbands in a large contingent to Nizamuddin, and did not participate in the Jamaat, were found positive. Their husbands and the other men, who did attend the meet, have still not shown any symptoms.
A new realisation has dawned that asymptomatic patients could be superspreaders.
The only way to put to rest any doubts is to conduct rapid tests on highly vulnerable groups, especially health workers, Tablighi returnees and their contacts and also clusters like Thalassery in Kannur where a large number of people had returned from the Gulf.
But this is expected to happen only after April 13, when the antibody kits are expected to arrive.
