As cases cross 20,000-mark, a recap of how COVID-19 made its forward surge in Kerala

Confirmed cases in Kerala crossed 20,000 (20,894) on Tuesday, July 28, just three days before it would have been six months since the first case of COVID-19, in a Medical student from China's Wuhan, was reported in Kerala on January 30.

This is also the day when COVID-19 numbers broke through yet another uncomfortable ceiling: the number of people in hospitals in Kerala crossed the 10,000 (10,093) mark.

It took 93 days (three months and three days) for Kerala to record its first 499 cases, at the rate of 5.3 cases a day. The remaining 20,395 cases happened in the next 89 days, at the rate of nearly 230 fresh cases per day.

A betrothal with death

The virus has managed to scatter its seed fairly uniformly across Kerala. There are over 100 virus clusters across Kerala.

Besides public markets, particularly fish markets, marriage functions and funerals where people assemble in large numbers, and also institutions where large number of people work or live like industrial parks (88 workers in Kinfra Park, Thiruvananthapuram, were found positive when 300 tests were held) or convents (18 nuns in a convent in Aluva were found positive earlier), seem to delight the virus.

Over 30 who had attended a marriage in Chekkiad panchyat in Kozhikode were found positive. Eight in a family that had attended a post-death rite in Wayanad's Thavinjal panchayat were found positive on July 27. When 98 others who had taken part in the function were tested, the infection was confirmed in 43.

Till May 4, there were just three deaths. Now, 89 days later, the death toll is 67. (If seven cases not listed in the official tally are also included, the total deaths would be 75.)

Changing age profile

In the initial stages, when the first 499 cases were reported, more than 70 of the affected were in the 11-45 age bracket, and less than 8 per cent were in the 'above 60' bracket.

Though figures have not yet been collected officially, it is said the 'above 60' bracket would now account for at least 35 per cent of the cases. "Now more cases are in contacts. So we expect a shift of age to older population, which in turn will lead to higher mortality," said Dr P K Jameela, a member of the Expert Committee on COVID-19.

Already, 55 people who died of COVID were in the 'above 60' category.

Wuhan response

The first three cases, all from Wuhan - reported on January 30, February 1 and 2 - were isolated, their contacts swiftly traced and quarantined, and the virus apparently vanished, making it seem as if SARS-CoV-2 could be as easily dealt with like a mosquito that could be squashed flat with a well-timed hit.

For over a month there was no sign of the virus in Kerala.

Italian phase and first lockdown

But in the last week of February, a Ranni-based family returning from COVID-hit Italy sneaked out of the Nedumbassery airport.

On March 9, the three Italy returnees and, an old couple in their home, were declared positive. An Ernakulam-based Italy returnee, too, tested positive that day.

From then on, the COVID numbers started to rise daily, and reached a high of 28 on March 23.

In fact, the fresh cases nearly doubled from 15 the previous day. This was seen as grave and Chief Minister Pinarayi Vijayan declared a complete lockdown till March 31.

A day later, on March 24, Prime Minister Narendra Modi announced a 21-day lockdown.

Italian phase peaks

At that point, nearly 98 per cent of the cases were Gulf returnees, and Kasaragod was the worst hit district. March 27 saw a single-day spurt of 39 cases, 34 of them in Kasaragod.

For this daily tally to be breached, it took nearly two months. In between, Kerala sought to smother spiralling cases in Kasaragod through innovative containment tactics like triple lockdown and the swift creation of improvised hospital infrastructure.

Influx phase begins

On May 22, 42 fresh cases were reported, and 40 had come either from the Gulf or from other states. The influx of stranded Malayalis started to push up cases, and the cases were nearly equally spread over districts with Gulf connections, especially the northern districts.

The outbreak in Kasaragod was by then virtually contained, a huge.

Budding signs of community transmission

But the day also saw the state encountering an invisible danger, a development unrelated to the return of stranded Malayalis.

Among the 42 cases reported that day, there were two cases whose infections could not be linked to a source; a health worker in Kozhikode, and a pregnant tribal woman in Kannur who was admitted to the Kannur district hospital.

It was clear the virus was spreading silently through the community. One-and-a-half months later, when the July spike happened, the Chief Minister conceded that there was community transmission, but only in large coastal clusters like Poonthura and Pulluvila.

Triumph and despair

The May 22 numbers gave the impression that Kerala's achievements till then were being blown away by the inflow of Malayalis stranded outside.

A fortnight ago on May 8, the day after the first Vande Bharat Mission aircraft landed, only a single positive case was reported in Kerala and the state had just 16 active cases; 484 of the 503 reported cases had recovered by then. There were just three deaths.

It was from a peak of 266 active cases on April 6 that active cases fell to such a negligible number.

After Kerala touched 42 cases on May 22, it took another 15 days for Kerala to breach the 100 mark. On June 5,111 fresh cases were reported.

Along with the influx that began from May 4, the economy was also opened up from June 1. The artificial suppression of social contacts was over.

Still, it took nearly a month for Kerala to cross 200 fresh cases a day; it was on July 3 that 211 cases were reported.

July explosion

But from then on, cases just galloped. In July alone, 15,285 cases were reported, at the rate of 566 cases a day.

On July 28, when Kerala crossed the 20,000 mark, the district with the least number of active cases (Wayanad – 172) has more than 11 times the cases in the district with the highest number on May 8 (Kannur – 15).

On May 8, besides Kannur's 15, Kasaragod had one case and that was all. Now, all districts barring Wayanad have over 400 cases. Thiruvananthapuram has the highest with 3072 cases.

On May 8, there were 33 hotspots in Kerala. Today, there are 486. On May 8,310 people were in hospital observation though only 16 were positive. Today, 10,093 are in hospitals, and all are positive.

More tests, more positives

Larger numbers can be chalked up to wider testing. From July 7, over 20,000 tests were done daily. During April and May only 2000-2500 tests were done daily.

Till June 30, 2.25 lakh tests were done in Kerala. But in the next 28 days alone, 2.54 lakh tests, more than what was carried out in three-and-a-half months, were done.

Such extensive tests were picking up more positives. Till June 30 only 1.97 per cent of those tested turned positive. But by July 28, 4.4 per cent of those tested were positive.

Reality of local transmission

Along with more positive cases, the widespread testing also unravelled community transmission. Over 90 per cent of the 3,943 positive cases reported between May 4, when the influx began, and June 30, were imported cases. This meant that even a month after the unlock phase began on June 1, it were mostly the returnees from hotspots outside Kerala who were turning positive.

Local spread, therefore, was minimal, even negligible. But after the tests were ramped up in July, the share of imported cases in the total number of cases shrunk to just 45 per cent.

At this point, most of the spread is through local transmission. Over 40 of the dead had contracted the virus locally.