Thiruvananthapuram district on Tuesday crossed a disturbing milestone in its increasingly problematic COVID journey. The total confirmed cases has spilled over 10,000 (10,432). The number 10,000 has been notched up in less than 49 days.

On July 1, three months after the first COVID case was reported in the district on March 13, there were just 228 confirmed cases. From then on, at the rate of 213 cases a day, COVID cases burgeoned to 10,432 by Tuesday.

The first sign of concern was spotted on August 7, when 54 cases were reported in Thiruvananthapuram. The coastal areas looked the most vulnerable. On August 10, fresh cases crossed 100 (129) for the first time. And in four days, the number touched 201. From then on, cases were reported at the rate of over 300 a day.

On Tuesday, when the total confirmed cases crossed 10,000, the district also recorded its highest single-day tally: 489. Thiruvananthapuram now accounts for 22 per cent of the total confirmed cases in Kerala (47,898).

Malappuram, which has the second highest number of COVID cases in Kerala, has just a little over half of Thiruvananthapuram's cases: 5554.

Southwesterly infection

The COVID wave was first noticed along the coast. Its rise and sweep was such a shock that the government declared community transmission in the Poonthura belt, which included Poonthura, Beemapally, Puthenpally and Manikyavilakom wards. This is perhaps the only instance where a state government had admitted to community transmission in the whole of India.

The ignition point is said to have been a large fish market in Kumarichantha, in Manikyavilakom ward. When the unlock period began in June, wholesalers from the Thiruvananthapuram coast resumed commercial links with neighbouring Tamil Nadu by road and sea. Along with truck and boat-loads of fish, they imported the virus from hotspot regions in Tamil Nadu.

It was not just through the coast that the virus made inroads into the district. Its southern border with Kanyakumari, with its innumerable by-roads and secret alleyways, was the other weak spot.

After the coastal clusters, Parassala panchayat that bordered Tamil Nadu was the other major cluster.

The virus then started spreading deep into the centre of the district from the south (Parassala) and west (the coast), mimicking the trajectory of the southwest monsoon.

Return of migrant workers

The return of Tamil migrant labourers when the unlock phase began without registering with the COVID Jagrutha portal, and the refusal of employers to both check the medical status of these returning workers and the absence of proper quarantine facilities in workers' quarters, set off the first big institutional cluster in the district. Over 130 employees of a popular hypermarket had tested positive.

The Parassala-Kanyakumari border turned out to be dangerously porous. It were not just returning migrants but people from hotspots across the border entered Kerala freely for commercial or family matters. "We were told that people from Tamil Nadu came in just for shopping and went back. How can we ever track such people," said Dr P K Jameela, a member of the expert committee advising the government on COVID matters.

"There is no other district in Kerala with such an uncontrolled inter-state movement," she said. In Palakkad and Wayanad, the borders were thoroughly sealed. "It is also a fact that these places do not have as much secret inter-state pathways as at the Thiruvananthapuram border," Dr Jameela said.

Fisherman's dilemma

As the porous borders smuggled in the virus from the south, on the west the virus had quickly spread along the entire coast, from Anchuthengu in the north to Pozhiyoor in the south.

Not only are the coastal folk highly inter-connected but they also establish close outside links in the form of fish markets and fish vendors.

"The fishing business is by nature a crowded enterprise. It is usual for coastal folk from all areas to converge at fish landing centres, at Vizhinjam and Muthalapozhi harbours. And from there they fan out to the rural and urban areas of the district and also take the fish to crowded markets where non-coastal folks arrive in large numbers. By the end of June the spread had begun," said a top health official posted in Vizhinjam.

But even after triple lockdown was imposed in the coastal areas, retailers in the coast were allowed to purchase goods from wholesale markets like Chala in the city. Many residential colonies near Chala were found infected.

Making matters worse, coastal folk are still reluctant to take tests. "They just cannot think of moving out of their homes. We have been told that even symptomatic people are refusing to take the test. Even the opening of first-line COVID treatment centres in their panchayat has not changed their mindset," Dr Jameela said.

A seemingly unending stretch without work was burning both their stomachs and their patience. Rebellions that spat at social distancing norms were staged in virus clusters like Poonthura, Pulluvila and Anchuthengu.

Death as spreader tool

If it was this desperation for survival, to sustain lives and livelihoods, that worsened the spread in major clusters, death also played a part in fanning the virus across the district like in many regions across Kerala.

"Gatherings at funerals, especially along the bordering areas like Parassala, had amplified the spread," said a top official with the Directorate of Health Service.

On Tuesday, five more cases have been confirmed positive in Madavoor panchayat near Varkala, taking the total number of positive cases linked to a funeral in Madavoor to 17. Over 50 cases were reported from an underprivileged colony in the capital city where a family had returned after taking part in a funeral in Tamil Nadu. Kuttichal panchayat, too, saw a funeral-linked spike in cases.

Healthcare collapse

The burden of cases has dangerously stressed major hospitals in the district, especially Thiruvananthapuram Medical College. More than half of the resident doctors in the general medicine wing of the Medical College were confirmed with COVID.

Non-COVID departments like surgery and orthopaedics were also badly affected as patients, unaware of the virus working inside them, visit these departments for other ailments. It also did not help that doctors and staff in non-COVID wings were not provided even basic protection against COVID.

Jail explosion

It is now believed that even the biggest institutional COVID cluster in Thiruvananthapuram - Poojappura Central Jail - began from the Medical College. 469 of the 975 prisoners in Poojappura jail, nearly 50 per cent of the inmates, had tested positive.

"Initially we thought they were seeded by the staff who have regular contacts with the outside world. But now we have reason to suspect that they were infected during their visits to the Medical College," said S Santosh, DIG of Prisons (Headquarters).

"We take the inmates to the Medical College almost on a daily basis for lab tests or for some medical examination. All inmates in the jail hospital were found infected. The doctor and staff at the jail hospital were also found infected," the DIG said.

Nearly confirming this hypothesis, DIG Santosh said that only less than 10 staff in the central jail were confirmed positive.

Future shock

Though crossing 10,000 is in itself a scary stage, health experts fear this could only be the beginning of an explosion of cases. Two factors that would bring people suffocatingly close are of particular concern. One, pre-Onam shopping. Two, the resumption of fishing activity.