In his COVID-19 press briefing on June 11, Kerala Chief Minister Pinarayi Vijayan said that the state would go on a war-footing to mitigate the possible third wave of COVID-19. Isolation wards would be set up at Community Health Care Centres and major hospitals across the state including building isolation blocks in the Kozhikode and Thiruvananthapuram Medical College Hospitals. The preparation would also include increasing the number of paediatric Intensive Care Units (ICU) in the state.
As part of its strategy to counter the third wave, the state will scale up infrastructure for the treatment of pregnant women and children, the two categories that have been left out of the vaccination drive. While pregnant women are considered more at risk of severe COVID-19, some experts have cautioned that children could be affected during the third wave. Incidentally, on June 25, the Union government revised its policy, and has now allowed pregnant women to take the COVID-19 vaccination.
Health Minister Veena George had also stated that besides scaling up paediatric facilities, the state will also give specialised training for doctors. “In the first wave, 4% of children below the age of ten were affected by COVID-19. It was 8% between the age group of 10 and 20. While the percentage is the same for the second wave, the total number of children affected has increased as the total number of cases increased," explained Dr A Santhosh Kumar, retired superintendent of Sree Avittam Thirunal Hospital (SAT) in Thiruvananthapuram. SAT hospital is a maternity and child care hospital and Santhosh, who retired in May this year, is part of the state’s policy-making for the third wave.
In an interview to a YouTube channel, Dr Santhosh said if infected by the novel coronavirus, 90-95% of children have mild COVID-19, while less than 1% become critical and need hospitalisation. “This is because the ACE-2 receptor is not fully developed in children, making pneumonia among kids comparatively low,” he said. ACE-2 receptor is a protein that provides an entry point for the coronavirus to hook onto and infect a wide range of human cells. "The priority is not to expose the children to the infection so that they needn't be hospitalized," Santhosh told TNM.
On June 14, Health Minister Veena George convened a high-level meeting to effectively tackle a possible third wave, with an action plan having been chalked out. The minister had directed to vaccinate as many people as possible. Kerala hopes to reduce transmission in the possible third wave by speeding up vaccination. The aim of the Health Department is to vaccinate 2 to 2.5 lakh people per day. The target is to vaccinate at least 50% of the adult population. Kerala as of June 28 has administered the first dose of the vaccine to more than 1.06 crore people, while over 30 lakh have been fully vaccinated. The focus officials said is to vaccinate the vulnerable population in Kerala. "Those who have been vaccinated include those infected with Delta Plus variant, but they had mild COVID-19. We are aiming to complete COVID-19 vaccination of those above 60 and to speed up inoculation of those between the ages of 45 and 60. Vaccination should be completed for those who are vulnerable and those who have comorbidities, But it depends on the availability of vaccines too,"a source of the health department told TNM.
The state also plans to increase the production of oxygen so as not to have any shortage. Kerala presently has an oxygen surplus with a production capacity of 204 tonnes per day of liquid oxygen. The objective is to reduce the deaths in the third wave too. The focus remains in ensuring persons with co-morbidities are shifted to treatment centres or hospitals before their oxygen saturation drops. Strengthening of manpower resources is also key, said officials. The source in the Health Department also told TNM that post-COVID care is another priority.
"In the third wave we would be focusing on post-COVID care particularly on stress management, anxiety issues of those who survived the disease and that of the family of the victims. It's tougher for families to cope when they receive bodies of their loved ones that are fully covered. We need to develop a support system for that," the source added.
Even as Kerala scales up its health infrastructure to manage a possible third wave, the state is currently grappling with the second wave. On June 27, Sunday, the state recorded 12,118 COVID-19 cases with the Test Positivity Rate (TPR) standing at 10.66% - far higher than the 5% the Union government recommends to lift lockdown restrictions. "We haven't reached the plateau yet, the test positivity rate is still above 10%. The state hasn't reached a phase where we can be fearless, we haven't contained the second wave yet. But that doesn't mean that we haven't geared up for a possible third wave. We had been discussing the second wave even during the first wave and likewise about the third wave during the time of the second wave," the source said.
"Since the beginning, the state has been focusing on flattening the curve, to ensure the health infrastructure isn’t overwhelmed, and ensure people are not left without a bed in hospital or without oxygen, " the source said. And while the health official conceded that there has not been a steady drop in COVID-19 cases, unlike neighbouring states, she said the TPR is stable, with no expected rise unless there is a complete unlock particularly during Onam, which falls in September.