Thread by @RijoMJohn

All the focus is on #Kerala's #COVID19 cases as it contributed ~68% of new cases in India y'day.

Politically, it's become a major tool of attack against the state & its government.

This thread tries to make some sense of the COVID19 numbers from Kerala.

1/

Many are asking why Kerala is reporting so many cases while the rest of India seems to have flattened it.

Yet, I'm actually surprised why Kerala is reporting only so many cases when it should be actually reporting 40K+ daily cases already.

2/

The current rise in cases was inevitable with the somewhat irrational lockdown relaxations & increased mobility that is visible over the past several weeks. It is only the reduced testing that is still holding the reported cases well below 40K.

https://twitter.com/RijoMJohn/status/1423278031846592522?s=20

3/

The TPR was under control & steady at around 12% till about Aug 3. Since then, we have been seeing a steady decline in testing, followed by a marginal decrease in cases but rising TPR. The fall in cases was definitely not organic during this time.

4/

7'day avg. daily testing had decreased from 1.7L to 1L leading up to #Onam2021 on Aug 21 as the avg. TPR went up from 12% to 17%. Tests were increased to 1.65L y'day which also saw a sudden rise in reported cases with a TPR of 19%.
5/

If #Kerala did at least 2L tests now it must be reporting ~40K cases already. The state had shown the capacity to do 2L tests on multiple days late Jul/early Aug. With TPR close to 19%, it's obvious that current reported cases are missing out on a lot of actual cases.

6/

Important questions remain.
❓Why state is still reporting a huge number of cases?
❓Is it a new variant?
❓Is it the beginning of a 3rd wave?
❓Will it collapse Kerala's healthcare system as it occurred in many other states?

I have my own answers for each.
7/

Why state is still reporting a huge number of cases?

The below article I had written gives a reasonable explanation & most of it still holds.

Bottom line: #Kerala still has the highest proportion of the population with no COVID19 antibodies in India.

8/

https://twitter.com/RijoMJohn/status/1420069966984802309?s=20

Is it a new variant?

No. Close to 90% of the samples in Kerala are still Delta variant, a variant that was the primary reason for the majority of cases during the 2nd wave in rest of India.

#Delta is still catching up in the Kerala population.
9/

Is it the beginning of a 3rd wave?

I do not think so. Delta varient-led 2nd wave in India did not come from Kerala. Unless Kerala's current rise in cases is from a new variant (which is not the case), there is no reason to panic that this will lead to a 3rd wave.
10/

Will it collapse Kerala's healthcare system?

#Kerala's healthcare system was nearly saturated (but not collapsed) during the 2nd wave peak when it was reporting 40K cases with 28% TPR.

I expect it'll reach the same in coming days & the authorities must be prepared for it.

11/

Avg. reported deaths had reached 191/day, 3 weeks after the 2nd wave peak. The current avg. is 131/day.

With cases expected to cross 40K, the deaths may increase in the coming days too. But, vaccinations may be a saviour this time around.

12/

#Kerala has already vaccinated 75% of its adult population with at least a single dose (one of the highest in India).

55% of its entire population has received at least a single dose, again one of the highest.

This may be a saving grace this time in terms of fatalities.

13/

While the capacity is nearing saturation in some districts, it's not yet in a panic situation with sufficient capacity still remaining overall.

But, it's time to be highly conscious of the situation ahead.
14/

It may be a wise decision to go in for a complete lockdown now for a week or two to arrest a sudden surge & spread the cases over a longer period to minimize the load on the healthcare system as it used to do in the past.

Take vaccinations at full speed during this time.

15/

I believe the current surge will slow down in a week or so &, by then, the natural infection & vaccinations would've taken the population-level COVID19 immunity in Kerala to 60% to 70% level bringing it closer to the rest of India, but with much less human toll.

16/

However, what is important is to make sure not to overcrowd the healthcare system, increase vaccination pace, increase testing & tracing keeping an eye on TPR so we don't lose identifying too many cases.

Kerala must soon consider a short duration full lockdown.

17/