What’s happening in Kerala?

Total cases
Kerala- 9,72,181
Nation- 1,08,47,790

Cases per million
Kerala- 27772 (taking population 35 million)
Nation- 8344 (taking population 1300 million)

Active cases
Kerala- 65,413
Nation- 1,41,118

Deaths
Kerala- 3,884
Nation- 1,55,195

1/n

Case Fatality Ratio/Rate
Kerala- 0.4%
Nation- 1.44% (3.6 times of Kerala)

Reported Deaths per million
Kerala- 111
Nation- 120

Total tests
Kerala- 1,01,44253
Nation- 20,19,00,614

Tests per million
Kerala-2,89,836
Nation- 1,55,308

(Type wise test data unavailable)

(2/n)

Kerala’s reported cases per million are 3.3 times of national average while reported deaths are 7.5% lesser than national average, while National Case Fatality Ratio is 3.6 times of Kerala’s CFR.

This hints that either Kerala is far more accurately reporting its (3/n)

Covid cases than rest of states of India. It had reached 27770 cases per million yet reporting 5400 new cases per day after decline from its peak of 8500 in October while national average was already on decline after its peak at 96,000 in mid September.

While, states (4/n)

Like Uttar Pradesh, Madhya Pradesh, Bihar, had less than 3000 cases per million which is 1/9th of Kerala’s and aren’t reporting much new cases most them being less than 1 case per million per day which is 155 times that of Kerala.

There are two possibilities here (5/n)

Either other states are hugely under reporting its cases (lack of public participation could be a reason for that) or there is some highly transmissible variant of SARS Cov-2 prevalent in Kerala which is also escaping immunity induced by previous infection. As it is visible
(6/n)

That general public attitude towards social distancing, masking, hand and respiratory hygiene and compliance to covid protocol is all up for toss nearly everywhere across the country, so it has little role to play for this difference in cases within different states (7/n)

The only way out to know about prevalent variants and mutations is genome sequencing regarding which unfortunately India had been largely unenthusiastic and irresponsible. We are yet to have any data on prevalent variants and mutations in India while only focus was (8/n)

After waking up from slumber in mid Jan was on UK variant B.1.1.7 clearly ignoring the fact that we can have our own variants and it’s crucial to identify and study them early before it’s too late. This is also crucial for effectiveness of vaccine and thus success of (9/n)

Vaccination drive in India.

India was supposed to sequence 5% of positive cases from jan there is no information about it, while UK was sequencing 10% of its positive cases before emergence of B.1.1.7 variant and now had throttled it up more, Australia sequences its (10/n) https://twitter.com/maneesh312/status/1341672754169298944

Nearly all samples.

Kerala though took initiative with sequencing 300 samples in 3 months in Nov, there is no information on that too till now.

Another way to assess the reliability of data of different states is to see how many cases (11/n) https://www.thehindu.com/sci-tech/health/kerala-to-commission-genome-survey-for-sars-cov-2/article33126471.ece

State is finding through its contact tracing mechanism and how many other wise. If earlier is in largely proportion that means state is acting pro actively and not underreporting cases while otherwise contrary can be inferred.

Another way is to see proportions of

(12/n)

Asymptomatic, mildly symptomatic, moderate and symptomatic cases. If major number Of cases are symptomatic it could be inferred that there is underreporting.

We don’t have any consolidated data for the same.

But there is no substitute to accurate reporting of cases.

(13/n)

As per data of https://covid19kerala.info/  majority of patients in Kerala are patients with contact history so it could be said that Kerala is more accurately reporting but this too doesn’t justify the gap of 155 times as compared to Bihar, UP and MP so only way to know (14/n)

Is massive genomic sequencing campaign to understand the underlying cause of this consistency in new cases.

We also need to see data on reinfection for evaluating this which of course like other data is not available.

There is hypothesis of cross reactive immunity (15/n)

From pre covid diseases making Indians less susceptible to covid but such claim haven’t been clinically examined. Moreover, this doesn’t explains consistent higher cases in Kerala and Maharashtra and why only these two states are witnessing this.

(16/n)