COVID-19: Time for government to concede community transmission in Kerala

Medical staff taking a throat swab of patient at the government hospital in Kottayam for COVID-19 testing. Photo: Gibi Sam

The evidence is piling up. Chief Minister Pinarayi Vijayan cannot go on insisting that there is no community transmission in Kerala.

Even random tests done on health workers to pick the scent of silent off-the-radar transmission have thrown up a positive result. What's more, it is becoming increasingly difficult, even impossible, for the government to trace back to the source of infection of many fresh COVID-19 cases in Kerala.

Newborn mystery

Take the case of the four-month-old child with a congenital heart condition whose death on April 24 was hastened by SARS-CoV-2. The child's parents have no travel history, and they had also tested negative for the virus.

There was a positive patient in the village (Payyanad in Malappuram) where the child was. But the house of the infected was at least a kilometre away, and the person had also observed strict quarantine.

Therefore, it looks likely the child could have got the virus from the two private hospitals she was taken to between March 16 and April 18. In one of them, Prasanthi Hospital in Manjeri, Malappuram district, she was admitted for three days, from April 18 to 21.

"A hospital is as good as a dead end. It could have been any of the hundreds who had visited the hospital. It is impossible to test all those who had come to these hospitals at least on the days the kid was there," a top health official said.

Surprise positive

Perhaps the most shocking confirmatory result on April 25 was that of an Asha worker in Kollam's Chathannoor was found positive by chance. Health officials say if anyone was still in denial about community transmission in Kerala, the Asha worker's result would have shaken them out of their illusion. The Asha worker is the first point of contact for those isolated in homes.

She was not in the list of suspected cases, and her carrier status was discovered by chance, only because the government set out on an exploratory mission to find out if the virus was spreading outside the surveillance network.

Hers was one of the 15 random samples of health workers in Kollam district that were collected as part of the 'sentinel surveillance', an exercise to detect the presence of the virus in vulnerable special groups and suspected geographical clusters.

Disguised surge

The deceptive nature of the virus was revealed when a headload worker in Kottayam market was tested positive on April 25. The headload worker's sample was taken for testing under the impression that he could have been infected by a truck driver who had brought watermelons from Dindigul in Tamil Nadu.

This driver was suspected because he had travelled all the way from Dindigul with the original driver of the truck who had tested positive on April 23.

However, the suspected driver turned out to be negative, and then it was revealed that the affected headload worker had come into contact with truck drivers from Maharashtra.

From son to mother, or vice versa?

The source of infection of the male nurse, who lives in Kottayam but works in a private hospital in Thiruvananthapuram, is also unknown. He was in strict home quarantine since March 24 but tested positive on April 24. His mother had tested positive. It is now surmised she had got the virus from her son.

This assumption would be under serious fire if none of the nurse's primary contacts - the driver who drove him from Thiruvananthapuram to Kottayam and his colleagues at the private hospital in Thiruvananhapuram - do not test positive.

Scapegoat Sharjah

At the moment, the infection in the seven-year-old girl in Sasthamcotta, who had tested positive on April 25, is being attributed to her Sharjah connection. She had returned from Sharjah with her parents on March 19, and they were in strict home quarantine for 28 days. The girl developed fever after her isolation period was over. And when she was finally tested positive, it was 35 days after her return from Sharjah.

After her quarantine period she had travelled to the nearest Primary Health Centre (Thrikkovilvattom), a normally crowded place, and also to a relative's house at Bharanikkavu from where no positive case has been recorded. The samples of her parents and some close contacts, like the uncle who took her to the PHC in a scooter, have been sent for testing. They have, however, not shown any symptoms.

Return date vs positive date: Widening gulf

Now that it is over a month since the last international flight was grounded, it is hard to sustain the theory that the returnees who are being declared positive very late, too, have smuggled in the virus from a foreign country.

There are over 25 Gulf returnees who had tested positive more than 25 days after their return. When the phenomenon was first noticed, it was said in certain cases the incubation period could be longer, even 28 or 30 days. But when the numbers started to swell, it was said there was nothing to worry as such delayed symptoms only indicated that the viral load was very weak.

But the numbers kept burgeoning, squeezing out even the last remaining space for 'smuggle theory'. Even then, the government has refused to publicly acknowledge the possibility that these returnees could have been infected after their return.

Blaming the Gulf is both convenient and lazy, like pulling up a habitual offender for all the thefts in an area without conducting even a semblance of a probe.

Cross-border bogeymen

Not just the Gulf, even other states are now blamed for the minor spurt in cases recently. On March 24, four in Idukki had tested positive and Chief Minister Pianrayi Vijayan was deeply worried about Kerala's borders. Fact was, two of them, a 65-year-old woman and her 35-year-old son at Elappara, had returned from Mysore on March 25, and they tested positive 29 days later.

A third woman based in Pushkandam in Idukki also tested positive. She had returned from Chennai on March 18; meaning she tested positive 43 days later. "It would be suicidal tto keep insisting that the woman got infected from Chennai," a health official said.

Abandoned trails

Forget the latest cases, the source has not been found for even some older cases. It is still not clear from where Abdul Azeez, the former policeman at Pothencode in Thiruvananthapuram who succumbed to COVID-19 on March 31, got his infection. All trails had led to nowhere.

It is also not certain how a Congress politician in Idukki, who it was once feared was a super-spreader and has now recovered, go infected. Though he was initially feared to be a super-spreader, after his travel history revealed a whirlwind tour of the whole of the state, he eventually ended up infecting just five.

But as the threat perception lowered, all attempts to hunt down the origins were called off.

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