A recent newspaper article purported to bust some myths about the Kerala model and its success in handling COVID-19, but presented itself as the venting of frustrations of those smarting at both the praise public health experts shower on a ‘Left’ government, and at the relatively poor performance of several distinctly non-Left states in India.
In The Adventure of Silver Blaze, Sherlock Holmes is alerted to the identity of the culprit by the curious failure of the dog to bark when someone entered the prize stallion’s stable at night. In the above mentioned article, there are two missing clues that testify to bias. One relates to the case fatality rate. The even more ominous silence is on vaccination.
Two Missing Clues
In his eagerness to trash the Kerala government’s management of COVID-19, the author fails to broach the case fatality rate — the proportion of the infected who die. For Kerala, it is 0.5 percent, the lowest of all states in India. For the country as a whole, it is nearly three times as much. Consider also the fact that the proportion of the population that is aged over 60 — the group that is most vulnerable to COVID-19 — is 157.5 percent of the national average in Kerala. For the country as a whole, the proportion of senior citizens is 8 percent, and for Kerala that ratio is 12.6 percent. In fact, of the 16,955 people who have died of COVID-19 in Kerala, 73 percent were aged 60 or more.
Of course, to the jaundiced eye, of the kind that valorises the fit and dismisses the vulnerable as weak and unfit, the fact that Kerala harbours such a large population of potential occupants of a geriatric ward is a sign of societal weakness. For supporters of the Kerala model, it is a sign of the state’s success in extending life expectancy at birth, which is the highest among all the states of India.
It is the data on excess deaths that will ultimately determine how effective each state has been in containing COVID-19. The reporting of COVID-19 deaths is deficient, almost all over the world. Only when you examine how many people have died, in relation to what should have been the number of deaths if the past trend had progressed without change, you get an idea of what is the actual toll of COVID-19. If someone had pain in the chest but did not or could not get to see a cardiologist in time because of COVID-19, and died, it should be added to the pandemic toll. Similarly for missed dialysis, delayed chemotherapies, postponed elective surgeries with fatal consequences.
These more holistic numbers will come up in the decennial census, whatever deliberate or incidental underreporting of COVID-19 deaths took place. Before the census, the Sample Registration System data gives a good idea. An estimate of excess deaths for the country as a whole by the Centre for Global Development, Washington DC, puts excess deaths at 4.9 million, more than 10 times the official COVID-19 toll. An exercise by the Indian Express found excess deaths in Kerala, excluding the official COVID-19 toll to be the lowest among all states, at 1.12 times the level in 2019, while it is almost three times for Madhya Pradesh.
The Vaccine Gap
What about vaccination? The biggest failure of COVID-19 management in India is the central government’s failure to procure vaccines in time. The Serum Institute of India (SII) invested its own money, and funds given by the Gates Foundation, to gear up to produce millions of doses of the Oxford-AstraZeneca vaccine in October. The Government of India offered no funding or orders. If the government had placed a large enough order on the SII and given the company upfront payment and pre-purchase commitments, on the basis of which it would have raised capital on its own, at least when, towards the end of December, the British health regulator gave its emergency use authorisation for the vaccine, India would have been vaccinating people in the first four months of the year. Millions of lives would have been saved.
The above mentioned article, in its focus on Kerala’s, and therefore, the Left’s, reputation, questions the relevance of the sero-positivity numbers released by the fourth round of the Indian Council of Medical Research’s all-India survey. It found that 68 percent of people in India have COVID-19 antibodies, on an average. People acquire antibodies either because they have been infected or because they have been vaccinated. Since vaccination rates are still low — 8 percent of the population are fully vaccinated, while 28 percent have received the first jab — the high positivity rate shows that the prevalence of the infection has been far higher than what has been reported.
In contrast, Kerala’s sero-positivity was found to be 44 percent, that too with the highest incidence of the non-infection cause of antibodies, vaccination. Kerala’s vaccination rate today is 41 percent of the population, for the first jab — the highest rate in India, except for Mizoram.
Instead of acknowledging this success, one should not trash the entire survey by asking if the lower-than-national-average sero-positivity among the states that held assembly elections recently (Kerala, West Bengal and Assam) shows that all that talk of election rallies triggering infections was nonsense. In the process, what is ignored is the possibility that but for these rallies, the sero-positivity rate in these states could have been lower still.
Missing The Target
If vaccines had been available during the first half of 2021, India would have beaten back the virus, and especially Kerala, with its successful containment, as revealed by the low sero-positivity, despite a high proportion of the aged and high numbers of returning migrants from the Persian Gulf region.
A sore point mentioned in the article is Kerala’s suspension of restrictions for Bakr-Id. It must be noted that the government relaxed restrictions for Onam last year, for Christmas and for Bakr-Id. It is, indeed, regrettable that when Saudi Arabia can defer a Haj, on account of the pandemic, and the Pope give his Easter address to an empty Vatican square, the Government of Kerala cannot find the wherewithal to ask its people to celebrate at home, observing COVID-19 protocols.
Kerala’s high test positivity is held against the state. For a population of 35 million, Kerala has conducted 28 million tests, equivalent to 80 percent of the state’s population. In Assam, the number of tests carried out is equivalent to 56 percent of the population.
The charge of Kerala being anti-science is based on its effort to import a COVID-19 cure reportedly invented by Cuban scientists. This ignores not just the attempt to cure COVID-19 with magic potions in certain non-Kerala quarters but also the effective management of the disease in the state using distinctly non-magical public health measures.
In fact, yet another charge against Kerala, of patriarchy, is that former health minister Shailaja Teacher has not been included in Pinarayi Vijayan’s new council of ministers. Why miss Shailaja Teacher, except for her sound performance as health minister? That sound performance was in managing COVID-19 in Kerala effectively.
Kerala’s handling of COVID-19 has shortcomings, but it is designed to manage the disease, not the public outcry against mismanagement. If other states manage as well, tens of thousands more Indians would live.
(This first appeared in in www.tkarun.substack.com)TK Arun is a senior journalist. Views are personal and do not represent the stand of this publication.