Figures: Truth Opinion and Challenge

Destroying Models

Opinion and truth, make a strange couple. Opinions, are created. It can even destroy truth.  Loud anchors and doctored visuals dish out facts distorted beyond recognition, tell-tale marks intact, persuading us to believe. As truth lie buried deep, opinions cloud our thoughts and dictate our actions. Welcome to the world of prime-time TV discussions!

The prime-time discussion one day was dedicated to the figures of seroprevalence in the country. Results of the fourth round of national sero-survey conducted by the ICMR had just become 'known'. Some participants seemed genuinely concerned. One, visibly upset, was breathing fire.  

“Look at the serosurveillance figures! Kerala is the lowest in the country! Their immunity is the lowest. One of the smallest states, the biggest contributor to covid cases in the country, more than half the country’s cases from there.”

In another outburst on a regional channel a self-depreciating participant lamented,

“The Kerala model, touted as the best was an illusion.”

A state, acknowledged for its efficiency in handling epidemics, was under intense criticism.

People with poor immunity? Super spreaders?

What is the Truth?

Speaking Figures

Yes; Kerala really has the lowest seroprevalence figures in the country.

State	Seroprevalence	State	Seroprevalence
MP	79.00%	Punjab	66.50%
Rajasthan	76.20%	Telangana	63.10%
Bihar	75.90%	Jammu & Kashmir	63.00%
Gujarat	75.30%	Himachal Pradesh	62.00%
Chhattisgarh	74.60%	Jharkhand	61.20%
Uttarakhand	73.10%	West Bengal	60.90%
UP	71.00%	Haryana	60.10%
Andhra Pradesh	70.20%	Maharashtra	58.00%
Karnataka	69.80%	Assam	50.30%
Tamil Nadu	69.20%	Kerala	44.40%
Odisha	68.10%

Kerala is also reporting large incidence of daily new Covid infections. Kerala component exerts significant influence on the national figures.

     * Figure corresponding to 23^rd Jul seems to have been clubbed with that of 24^th. [i]

On 3^rd Aug, of all the new cases reported in India, 55.54% was from Kerala alone, a huge jump from 45.78% the previous day.

In all fairness to seething anchors, most of them clearly with not-so hidden agenda, and party spokespersons, present solely for pushing political ends, every word of the facts placed were indisputably true. However, the inferences drawn and accusations being heaped were bordering the ridiculous. Claims of great work by spokespersons of parties in power and accusations of incompetence by others, both beg rebuttals. Commercial and political compulsions demand rhetoric. 

 

Implications of Seroprevalence

Seroprevalence indicates the population segment that has developed antibodies. People develop antibodies to novel coronavirus, either through infection or vaccination. One doesn’t necessarily have to fall sick with infection to acquire antibodies. Asymptomatic and unreported infections also produce antibodies.

According to the survey, 79% of the population in Madhya Pradesh, as against just 44.40% in Kerala, has already acquired the antibodies. As a corollary, it also means that above 65% of those in Kerala are still susceptible to covid infection. States with high seroprevalence are likely to have lesser cases of covid infections since they may be close to achieving herd immunity.

Why does Kerala have such low seroprevalence?

  

Complacency?

Initial days of infection clearly overwhelmed the infrastructure. There were countless heart wrenching stories of people dying without getting beds in hospitals. Many having managed beds, faced shortages of ventilators and even oxygen. Isolation of patients was the only way to control the wildfire-like spread. Thus came the National lockdown, followed by series of State controlled lockdowns. Everyone, everywhere was shouting “social distancing” to ‘flatten the curve’! The flat curve containment strategy aimed to slow down the rate of infection, preventing medical facilities from being overwhelmed.

Kerala was the first state to report covid infection. Given an estimated total population of 3,53,36,581as on 08 Aug 2021, it has cumulatively reported 34.9 lakh cases of covid, second only to Maharashtra, leaving all populous states behind! It means that only 9.88% of its population has contacted covid! What about seroprevalence numbers? There is a gap to be bridged!

The apparently low, 44.40% seroprevalence effectively means Kerala succeeded in restricting infection and keeping about 65% of its population away from infection even well into the second wave, no mean feat for the densely populated state. The state actually flattened the curve and successfully staggered the spread. By any standards, it is an amazing epidemic control activity. Political animosity, inability to read and understand figures should not diminish the sheen of a gigantic achievement.

Mortality and Infection

The numbers in the public domain are those which the states officially report. It is commonly believed that all states, despite vehement denials, underreported covid infection and mortality. Such reports with statistics are in the public domain, though not officially authenticated. Interestingly, even those reports reveal that Kerala has the least under-reporting!

Deaths, irreparable loss for those affected, do become statistics. Despite best efforts Kerala too reported many deaths.  

Deaths, when considered as a percentage of infection, Kerala seems to have controlled, despite rising figures of infection. Primary health centres and the medical fraternity deserve credit.

The state’s covid mortality rate is also well below the national average. 

Achievements aside, why is infection increasing?

Policy flaws? Implementation deficit? 

Is there something that we are missing out?

 

Price of Compliance?

Experts hold the aggressive delta variant responsible for the return and increase in infection world over. If the delta variant alone was responsible, then numbers would have shot up across India. That is apparently not happening.

Why is Kerala then different from others?

Wide spread underreporting aside, it is possible that the population in other states have already been exposed to the virus and have already acquired antibodies. Therefore, they now show lesser numbers. Kerala enforced masks amongst the population. Keralites who had taken instructions very seriously now find themselves most susceptible to the virus! Numbers certainly point to it.

With neighbours insisting on RTPCR tests each time, ignoring vaccination certificates, crossing over into Tamil Nadu and Karnataka has become a costly affair for Keralites.

Kerala seems to be paying a price for compliance.

 

Boundaries of Science

The scientific community has consistently changed its opinion about Covid and its spread. From ‘spread by physical contact’ that led to harsh ‘social distancing norms’, medical fraternity seems to have now settled for ‘aerial route’ as the favoured mode of spread. The society has moved a long way from patient victimization to home isolation and micro containment policies. 

Accept it or not, it is very clear, that Covid is here to stay for good and that we will have to live with it. Our survival so far, is less about our scientific and medical competencies but more about survival compulsions of the virus itself. Corona virus is mutating fast, not for acquiring more lethality, but with the aim of prolonging its own longevity, which can happen only if its human host is alive.

Hold our pride and arrogance back, it is the existential compulsions of the virus that grants us the mercy of survival. We need to augment our efforts in that direction. Hitting herd immunity at the earliest is our best escape route.

 

We, The Herd

Coronavirus is not bound by geographical, political or religious boundaries. It does not differentiate between caste, creed, colour, gender, and doesn't bother for any reservation schemes. Politicians can manage data and manipulate visibility. But the virus seems to deliberately ignore them and prove all divisive theories wrong. The only effective way forward is to consider all the people around as part of the same herd. Faster the herd attains immunity, better it is for each member of the herd. This is possible only through very aggressive vaccination programs and not by sustained isolation.

 

Vaccine Management

Vaccination may not prevent infection. but as of now we know, it protects. It hits even those vaccinated but with relatively less severity.

The most susceptible region as of now is Kerala. Authorities must move in quickly and vaccinate each one in Kerala. It’s a tall order considering the current process of vaccination. As on 08 Aug, only 62,69,657 people in Kerala have received both the doses. It makes just 17.74% of the population. That leaves the authorities a humongous 82% of the population to be protected.

In absolute numbers, considering the total requirement of 7,06,73,162 doses for 3,53,36,581 people, a total of only 2,13,03,626 doses (1,50,33,969 first & 62,69,657 second) have been administered till 6^th Aug. It leaves the administration with the burden of administering 4,93,69,536 doses more. Considering the state’s vaccination abilities, (5,06,397 doses on 24 Jul and 4.91 lakh doses on 24 Jul) the target is not difficult to achieve. If Kerala can earnestly adhere to four lakh shots a day, it will still take 124 days to cover the population.

 

The Challenge

The Health Minster has a challenge on her hands. The real challenge is vaccine availability. That rests with the Central Government. It will be prudent for the central government to push the maximum quantum of vaccines to Kerala, with lowest seroprevalence.  With an efficient network of primary health centers and medical workers at par with the best in the world, the task can be considered accomplished.

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[i] All figures used for the graphs here have been culled from the government site in the public domain. The figures against 23^rd Jul have been shown as zero. However, the figures of 24^th show substantial spike indicating likelihood of the two days figures getting added.