The spike is attributed to the easing of Covid restrictions during Onam, one of the major festivals of Kerala, which was celebrated on August 21 this year.

Kerala has been logging an average of 20,000 cases since May, accounting for half of the national caseload. However, on Wednesday, Kerala pushed the national caseload to 37,593 cases by contributing to more than 70 percent of the total cases. According to Health Ministry reports, 1, 65, 273 samples have been tested in the state.

Though the state government has tightened curbs ahead of Onam, medical experts and the administration has anticipated a spurt in cases and it may go up further, says Dr. Sulphi Noohu of the Kerala chapter of Indian Medical Association (IMA). Health care experts, including the IMA, have warned of a rise in the number of cases post-Onam festival season.

?However, Dr. Noohu adds that the situation is currently not alarming as there are fewer hospital admissions despite high numbers. On Tuesday, there were less than 2000 hospital admissions though the reported cases exceeded 24,000. Hospitals are not overwhelmed and are prepared to meet any emergency, he adds.

“The spike was expected. The numbers may further rise and it can go up to 40-50,000. We shouldn’t look only at the numbers. What is reassuring is that hospital admissions were less than 2000 yesterday. If we look at admissions in the past two months, it was around 2000 only,” he says adding that the effort will be to keep cases below the threshold.

The spike may continue till October, says Dr. Rajeev Jayadevan, Scientific Adviser and former president of the Indian Medical Association. Dr. Jayadevan points out that that the state saw the first peak in October last year after Onam. “It is a similar pattern,” he says adding that several factors are responsible for the surge in addition to the relaxation during festival season.

As cases go up, the state government has stepped up measures to curb the spread of the infection. On Tuesday, State Health Minister Veena George has said that the vaccination drive will be intensified and will make efforts to provide at least one dose of vaccine for all above 18 years by end of September. The government has also taken steps to implement fresh restrictions and accelerate the number of tests, especially in low vaccination districts.

“If anyone who has attended a public event tests Covid positive, everyone, who was present there should get tested, the minister said. There will be a special focus on districts such as Ernakulam, Malappuram, Trissur, Palakkad, and Calicut with high positivity rates.

Dr. Noohu says that a difficult situation will emerge only in case of an exponential rise in the number of infections. “It is not a cause of worry if hospital admissions don’t exceed 3000. Now that at least 60 percent of the population have received one dose of vaccine, the situation won’t be very alarming,” he says.

Dr. A. Althaf, convenor, of the state IMA epidemic control cell, feels that the government needs to strengthen ICU care by providing adequate manpower and logistics. “Though we have a robust healthcare system, if cases go up, it will be beyond our capacity. In districts with high TPR, ICU facilities should be strengthened,” he says.?

The state has seen muted festival season this time given rising cases and restrictions. Ahead of Onam, the government had implemented new guidelines mandating RT-PCR negative certificates or vaccination proofs for shoppers, which invited protests from traders. Last month, the Supreme Court has pulled up the state government for lifting restrictions during Eid celebrations.

Though high numbers are not much of a concern, the number of deaths is worrisome, says Dr. Altaf. “We need to bring down the mortality rate. Right now, 100 deaths have been reported daily,” he says.

The high incidence of Covid infections in the state has been a cause of worry in the past few months, while the rest of the country is seeing a downward trend in the second wave of the pandemic. Now that the state is responsible for a major chunk of total caseloads in the country, many wonder whether the Kerala model, which has been touted as a poster child for Covid management during the first wave, turned out to be a delusional one. Experts attribute the rising numbers to multiple factors. One of the main reasons is the presence of a large number of susceptible populations in the state, says Dr. Jayadevan. The latest ICMR seroprevalence survey has found that Kerala has the least seropositivity rate of 44 percent, which means that half of the population is still vulnerable to the virus.

The other reasons that drive the numbers are Kerala’s high testing and case detection rates. The rates are quite high compared to other states in the country, say experts. ICMR data shows that while Kerala detects one in five infections, Bihar reported one in 134 cases. The number of tests conducted by Kerala per million is 8, 08,058, which is one of the highest in the country. In vaccination too, Kerala is ahead of other states as more than 50 percent of the population have received at least one dose of vaccine.

It was estimated that 21 percent of the population has been fully vaccinated in the state.

Maximizing vaccination is the way forward to fight the virus, says Dr. Altaf, adding that lockdowns and restrictions wouldn’t provide permanent solutions. “Transmission possibilities should be scientifically controlled. For instance, if we allow dining in restaurants, it should be allowed in open areas and cross-ventilated spaces. Government should actively consider enhancing economic activities and partially opening schools,” he says.

The six-member team led by the National Centre for Disease Control (NCDC), which visited Kerala, has flagged negligence in home isolation and low contact tracing as one of the reasons contributing to the spurt in cases. Dr. Altaf says that though home isolation is responsible for the spread of infection within homes, it helps in the reduction of mortality rates. “Though home isolation leads to an active spread of the disease within homes, most of these people don’t require hospitalization. Thus hospitals are not burdened, “he says adding that high rates of vaccination have helped in the reduction of the severity of the disease.??