The Indian state that went from Covid hero to hotbed in under a year

When Covid-19 infections spread across India during the first wave, the southern Indian state of Kerala that boasts a 100 per cent literacy rate led the fight against the virus and laid down the road map for the rest of the country.

Kerala saw Covid-19 cases in single digits in April 2020, rising to not more than 200 per day till July that year and KK Shailja, its former health minister, featured on magazine covers and glossy newspaper spreads as the hero destined to steer the state towards health and normalcy.

Fast forward to exactly a year later, the coastal state accounted for almost 40,000 cases within a span of just 24 hours in May, at the time the deadly Delta-driven second wave was sweeping India.

Cases cooled down around June and plateaued further in July across the country, but in Kerala the virus had entered almost every house. It appeared that once a success story, Kerala had become the most active-blinking red state with tens of thousands of infections.

From April till 27 September this year, Kerala recorded 3,514,205 cases in a prolonged wave and most likely the highest any state has seen this year, second only to the western state of Maharashtra, home to India’s financial capital Mumbai. On some days in this period, Kerala accounted for as much as 70 per cent of the nation’s daily infections.

So what went wrong?

Experts say it’s a combination of the ideal conditions a virulent contagion like Covid-19 needs to thrive in: a majorly vulnerable population, population density, the letting down of guard, lockdown fatigue, and a statewide festival that brought thousands of revellers out onto the streets.

Officials and experts believe that Kerala’s own success came to haunt it a year later, as nearly 60 per cent of its population remained vulnerable to the virus, a seroprevalence survey – charting the percentage of people carrying antibodies against the virus – showed in May this year.

The findings of a serosurvey conducted by the Indian Council of Medical Research (ICMR) between 14 June and 6 July listed Kerala at the bottom of the 11 states surveyed. Madhya Pradesh led with 79 per cent seroprevalence, while Kerala trailed with 44.4 per cent.

It is not a failure, but Kerala paying for its success, says Rajeev Sadanandan, adviser to Ms Shailja on Covid-19 management. Locals explain how every house and neighbourhood fell into the grip of Covid-19.

Once Amala Pasha caught the virus, she knew she would infect her two-year-old toddler. She could not have quarantined without her daughter and within a few days, her daughter also came down with Covid-19. The toddler, Covid-19 positive and in quarantine with her mother, ran a very high fever earlier this September.

“I had no choice,” Ms Pasha tells The Independent over the phone from Panampilly Nagar in Kochi city where a local wave emerged in the last two months. While India was recovering from a deadly second wave that claimed thousands of lives and and livelihoods – the largest health disaster the country has seen in decades – cases were spiralling in Kerala.

“Everybody has it. Almost all the people around us have been infected, or are recovering or are in quarantine,” says 31-year-old Ms Pasha.

The cases surged mildly in July but dipped unnaturally in August. Experts point out that it was due to reduced testing by the government. It painted a false picture of hopefulness among Keralites.

Onam, Kerala’s biggest festival celebrating the annual harvest season, was observed with the usual fervour. “We went all out,” locals say. This is when the Delta variant was very much prevalent.

Data shows that testing slowed down in the beginning of August, just ahead of Onam.

Rijo M John, a health economist tracking Kerala’s Covid-19 curve for over a year now, explains: “This gave an inadvertent feeling that cases are decreasing in Kerala. The decline in cases was not organic as portrayed in numbers. This prompted people to let their guards down and move about freely, further allowing the virus to spread.”

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Lockdown fatigue was another reason why the infections flared up in the last 3-4 months even as the spread in the rest of the country was being brought under control.

“The laws and the restrictions with respect to Covid-19 safety protocols were not enforced on the ground. Strict watch was not observed in Kochi where people were seen out in public despite the silent virus sweeping across the society,” Mr John, a resident of Kochi, says.

Some faulty policies, he says, cost Kerala as the administration imposed irrational and unscientific lockdown relaxations like weekend curfews, timing curfews for shops, and midnight curfews.

Kerala being a consumer-centric society means people were bound to step out, and purchase, especially during the Onam celebrations, says Mr John.

“A government policy in such a situation should allow the crowd to spread out, not gather at a sensitive time. If you keep a shop open for longer, it reduces the chances of gathering and crowding but in a limited time frame, the crowding increases,” he says.

On top of all, the Delta variant was the “joker in the pack” that was not foreseen, says Mr Sadanandan.

“Since similar episodes had occurred in many other countries, such as Manaus in Brazil, we should have anticipated the possibility and should have been watching for variants,” he says.

However, the state had a silver lining in how it coped with the pandemic. Kerala’s health system in the period between July and September did not show signs of collapse unlike other Indian states, say local experts and journalists.

A national sample survey shows a heavy reliance on state’s health infrastructure, as only two per cent of the people who used private healthcare did so because of poor quality of government health services.

After being battered by prolonged infections and eventually bringing them under marginal control, Kerala is set to open.

The state is eyeing aggressive vaccination. It projects that before December more than 80 per cent of the population aged above 18 would be vaccinated and Kerala will reach a level of normalcy, with risks limited to breakthrough infections.

More than 70 per cent of Kerala’s eligible population has been fully vaccinated as of 28 September and 91.71 per cent of its target population has been partially vaccinated against the virus, official data shows. This is among the highest anywhere in the states and cities of the Indian subcontinent.

But Ms Shailja, the celebrated former health minister credited with steering Kerala out of many health crises, flagged serious issues in supply of vaccine doses by the central government led by Indian prime minister Narendra Modi.

“We are crying for more vaccines. The government should amp up the production of second dose and even regional manufacturers around Kerala are ready to help the federal administration. But the Centre [PM Modi’s government] is not sharing the formula of vaccines,” Ms Shailja tells The Independent.

She says vaccines for Covid-19 are a common good and in the national interest.

At a time when India has not even vaccinated 20 per cent of its population, it has decided to continue exporting jabs to its western allies. “How can we do that when we do not have enough vaccines for our country?” Ms Shailja says.

India lifted the self-imposed trade ban on Covid-19 vaccines on 21 September, almost six months after it had to halt supply due to domestic shortage.

One of the worries that remain are children returning to classrooms.

Teachers have warned the government to watch out for health impacts of unvaccinated children entering schools, as it prepares to open up educational institutions from 1 November in a staggered manner.

“We want to know what will be a teacher’s attitude upon learning a child in their classroom has Covid-19,” asks Theresa Bini, a teacher in Aluva worried about children carrying the infection back home to parents and grandparents. “I am worried about my students, because look, everyone will get it.”