On May 19, Kerala reported 112 deaths due to COVID-19, crossing 100 deaths on a single day for the first time. In the days after that, the state officially reported 128, 142 and 176 deaths respectively on each day, every time recording the highest single-day toll. COVID-19 cases had surged into tens of thousands on a single day in the last half of April, and reached its peak mid-May. However, in the days afterward, the Test Positivity Rate – a measure of the number of people turning positive in every 100 – reduced steadily, falling from 30% to 22%. While the reduced TPR has been a source of relief, the number of deaths increasing steadily to the 200 mark has caused some concern.
"The reason behind the rising COVID-19 deaths will be looked into, even as it is expected that the cases will surge," Kerala Chief Minister Pinarayi Vijayan said during a press conference. Even as the state has had one of the biggest surges in the country, it has always managed to keep the percentage of deaths low at 0.4% of those infected. This has now in fact reduced to 0.31%. The total number of official deaths as of May 22 is 7,170. Dr Padmanabha Shenoy, a Kochi-based rheumatologist who has been analysing COVID-19 data says, “The death curve is always delayed by at least two weeks of the case curve. People who are dying now were infected about two to three weeks ago. So this increase in the number of deaths is expected.” Media pressure on under-reporting of deaths could also be a reason for the increased number of fatalities being reported now, he adds.
Certain public health professionals like Dr Arun NM of Palakkad Medical College have been pointing out an incongruence in the number of official deaths being reported as COVID-19 deaths and the actual number of deaths.
Kerala has come under criticism, like many other states, for underreporting deaths. The state in many instances has reportedly not added deaths of people who had any sort of co-morbidities, though World Health Organisation (WHO) guidelines clearly say that COVID-19 has to be mentioned as the cause of death.
“It is also to be noted that the district-wise data does not always co-relate to the number of cases. Ernakulam, which has the most number of cases, has fewer deaths than Thiruvananthapuram,” Dr Shenoy adds. The most deaths reported so far are from Thiruvananthapuram – 1,420, out of 2,25,415 cases. However, Ernakulam which has reported 2,89,510 – 60,000 cases more than Thiruvananthapuram – has recorded less than half the deaths, at 667.
Some districts have started reporting more deaths after media intervention too. For example, Palakkad district was showing less number of deaths, but after a Malayalam channel's expose on underreporting, the district has reported more cases in May.
In all of 2020, the maximum number of single-day deaths reported was 35 on December 12. In 2021, even as the surge began after the lull of the initial months, deaths reported had steadily remained in two-digits. By the end of April, the number crossed 40 for the first time and then increased steadily by more than 100 in the weeks afterward.
“Three tracks need to be considered here – the number of cases, the number of patients in the Intensive Care Unit (ICU) and the number of deaths. In the first track, the number of cases, the surge came about a couple of weeks ago and then there has been a slow but steady decline. This could be due to public measures to reduce contact, like the lockdown and triple lockdown and such. Either out of fear or out of inconvenience, people stopped going out. This has helped reduce contact. And after a week of lockdown, the cases began to decline,” says Dr Amar Fettle, state nodal officer for COVID-19.
After a person is infected it may take five to seven days for hospitalisation to happen – if the symptoms get worse. It takes another 10 days for a serious patient to be transferred to ventilator support. The time lag between a case being reported and a death happening is about two weeks.
“Now that the surge in cases has come down, the ICU cases would be less a week later, and further later, the deaths too shall reduce. You have to also understand that earlier the number of cases was in four digits, this has now become five digits. So it is a proportionate increase in deaths. The treatment of COVID-19 has only gotten better than earlier. So there is nothing alarming here,” Dr Amar adds.
(With input from Dhanya Rajendran)