Friday, May 27, 2022

‘Focus On Numbers Alone A Skewed Way Of Analysing Pandemic’

"We need to look beyond just the number of cases while making an assessment. Ideally, the progression of any pandemic should be seen from its first incidence to its last and not in a time period of just a few weeks," says Kerala CM Pinarayi Vijayan

‘Focus On Numbers Alone A Skewed Way Of Analysing Pandemic’
‘Focus On Numbers Alone A Skewed Way Of Analysing Pandemic’

Kerala chief minister Pinarayi Vijayan speaks to Preetha Nair on the report of the National Centre for Disease Control (NCDC) team sent to the state by the Centre and the state government’s efforts to contain the pandemic. Excerpts:

The NCDC team said in its report that low vaccination, negligence in home isolation and low contact tracing are the main reasons for the Covid surge in Kerala. The report highlights Malappuram district’s positivity rate of 17.4 per cent….

We welcome the central team’s feedback. However, we suggest that a few experts from each state should together form a national-level expert team. They should be asked to develop a study design and share it with all the states seeking their remarks, and then conduct visits so the incidence of the pandemic in each state and Union territory can be understood. Subsequently, reports should be published on the further actions to be taken.

Kerala has been vaccinating its people consistently. Of the eligible population, 54 per cent have got the first dose and 22 per cent the second dose. We have done it efficiently, with zero wastage, and our numbers are more than double the national average in terms of fully vaccinated people. As the Delta variant is raging through the country and the world, we have taken all ­efforts to flatten the curve and delay the peak. The fourth seroprevalence survey by the Indian Council of Medical Research (ICMR) shows that Kerala has the lowest seropositivity among all states, which underlines that our efforts were successful in fighting the virus. At no point has Kerala faced a shortage of hospital beds nor have there been any complaints regarding non-availability of oxygen. Not even a single patient has died for want of oxygen in Kerala. The case fatality rate remains the lowest in the country at 0.5 per cent, almost one-third of the national average. When a new case is detected, their primary contacts are immediately tested. Most of them are found positive due to the high infectiousness of the Delta variant, and figure in the detected cases instead of being reflected in contact testing. When most cases are within a household, the average number of primary contacts will be less.

The positivity trends in a particular district, say Malappuram, are to be seen over a period of time. Populous districts with the highest density of seronegative populations will always be more vulnerable. The district administration is taking all measures and the pandemic will be contained there too.

Kerala has been logging over 20,000 cases for the past couple of weeks, while other states are showing a downward trend. Did the ‘Kerala model’ go wrong?

We need to look beyond just the number of cases while making an assessment. Ideally, the progression of any pandemic should be seen from its first incidence to its last and not in a time period of just a few weeks. The fight against Covid is like a marathon and not a sprint. With a high population density, a high percentage of the elderly, prevalence of lifestyle diseases and so on, Kerala has had to tackle several odds in its battle against the virus. Despite the adversities, the ICMR survey states that more than 55 per cent of Kerala’s population is seronegative. Even after one-and-a-half years of battling the pandemic, if Kerala has been able to keep more than a half of our population safe, it speaks volumes of our strong preventive measures, effective people’s involvement and the proactive healthcare system. Naturally, when a large section of the population is still susceptible to the virus, they are likely to get infected. The high detection of cases is a result of the high number of tests done in Kerala. Tests per million are 808,058—among the highest in the country—and done in all villages, towns, cities, even in remote areas. Interpretations from the sero survey show Kerala’s average number of missed cases is quite less compared to the national average. Kerala is picking up one in every five infected cases, whereas the national average is only around one in 30.

Another important factor is that Kerala is doing strategic testing. To make tests cost-effective and efficient, people in the higher risk category are targeted more for testing. Positivity among them will obviously be high, but the advantage of detecting them is that they are brought on the treatment track as early as possible to reduce fatalities. With such efforts, the number of cases will be high. We need to look at a broad set of parameters to assess the effectiveness of any system’s fight against the pandemic. While analy­sing case fatality rates, we need to look at the mortality among frontline workers, hospital occupancy, oxygen availability, the incidence of mucormycosis and survival, testing and treatment protocols, and costs, among other things. We also need to look at the rate of vaccination, which is the most effective means to resist the virus. To focus solely on the number of cases over a very short period is a skewed way of understanding and analysing the pandemic.

With Onam around the corner, traders are upset about new guidelines mandating RT-PCR negative certificates or vaccination for shoppers and call them unscientific. On the other hand, there is pressure from the central government against easing curbs. How does your government strike a balance between lives and livelihood?

Safeguarding lives and livelihoods of our people is the most important aspect of our fight against Covid. Public safety is the first and foremost thing for us, so getting vaccinated or obtaining RT-PCR negative certificate is not unscientific. In Kerala, the RT-PCR test is free at government labs, while private labs charges only Rs 448. We are in constant discussions with the trading community to ensure that their needs are also catered to while framing guidelines to fight the pandemic.

BJP leaders allege that your government was doing politics of appeasement by easing curbs during Eid, which led to a spike in cases. The Supreme Court also criticised it. A political row is brewing over the opening up during Onam….

The question of appeasem­ent does not arise. To cater to the needs of people, some mild relaxations were allo­wed in a few instances earlier, while strictly adhering to the Covid protocols. Now, we have further tightened the protocols taking note of the Supreme Court’s sentiments. So far as Kerala’s Covid response goes, we leave no stone unturned in our efforts to contain the spread.

You have maintained that the Centre’s poor vaccine distribution policy is one of the main reasons for the Covid situation. You have demanded more vaccines….

When the vaccination drive was planned, the Centre should have factored in the susceptible population and the comorbid population in each state. With such considerations, weightage factors could have been worked out to distribute vaccines. ICMR’s sero survey was available way back in December. The survey’s third round indicated that Kerala’s seropositivity was around 11 per cent, which means around 90 per cent of the population was susceptible to the virus. Similarly, details of other states were available with the Centre. If they had considered all those factors and worked out an appropriate vaccination strategy, it would have helped states with highly susceptible populations in reducing fatalities during the second wave. Ideally, all eligible people should be vaccinated in one go, just like newborns get the vaccination. If there is idle vaccine capacity within the allocation made through private hospitals, then states should be allowed to tap into it at the cost at which it is given to the Centre. The objective is to vaccinate all those who are eligible as quickly as possible to curb the spread. If they get inf­ected even after vaccination, the disease is less severe, and eventually Covid will become a manageable disease. Thus, the secondary costs in terms of the adverse economic situation and its cascading impact on all aspects of life get mitigated.