The last of the foreign returnees who must have come infected landed in Kerala on March 22. This was the day, prompted by the COVID-19 scare, the international flights were stopped.
So if we accept what the WHO said and assume that the incubation period of the virus or the time it takes to break out as fever or dry cough is 14 days, even the last person who came into Kerala from outside should have shown symptoms at least by April 5. Now, if two days are granted for the test results to be published, the last man who had flown in with the virus should have been declared positive at least by April 7.
But even after this date Kerala has seen a steady stream of foreign returnees testing positive. Between April 7 and 14, there were 18 new positive cases, at least seven of them turning positive after 20 days.
A Dubai returnee in Kannur, for instance, had tested positive after 26 days. Another returnee in Palakkad turned positive only on the 24th day. Doctors Onmanorama talked to said most of these “late bloomers” had only mild symptoms.
COVID-19 being a brand new malady, health officials are not sure why the delay was happening. But they say studies conducted in China's Wuhan and Italy had found that in rare cases the incubation period could extend up to even 33 days.
However, even top officials in the core team of Kerala's battle against COVID-19 consider this to be a convenient answer. The delay in turning positive could also be the result of other disturbing factors. This, they say, is a trend that should quickly go under the microscope.
Lazy reporting
One, what if those in quarantine had developed symptoms even before 14 days but had ignored minor symptoms like cold or sore throat and, therefore, were late to report for the test? This would mean that they were in their houses during their most infective period, throwing open the possibility of them having passed on the virus to others in the family. Whether they have done so will be known only when the results of their close contacts are published. This will take another day or more.
Compulsory testing after 14 days
The nearly asymptomatic nature of a good chunk of patients in Kerala is already troubling authorities. Therefore, it can easily be assumed that many in quarantine, too, could be asymptomatic but still infected. Given the possibility, why did the government not go for the mandatory testing of foreign returnees after they completed 14 days in quarantine regardless of whether they had symptoms or not.
“Ideally, it should have been done,” a health official said on the condition of anonymity. “But our testing facilities are limited. At the most, we can do 1000 to 1200 samples a day. Now we have hundreds of people swarming taluk, district and medical colleges asking that their samples be tested,” the official said.
Besides, samples of health workers and those with respiratory distress are also being routinely tested. And then there are the repeat tests to be done on patients who had already tested positive. In short, the government does not have the capability to show the requisite urgency in testing the samples of foreign returnees in quarantine.
Theirs are tested only when they report symptoms. But the fear is, by the time they report they might have already passed on the virus.
NRK with 'made in Kerala' virus
There is a scarier possibility. What if some of these foreign returnees had got seeded with the virus not when they were outside the country but inside Kerala? “After their return, say some five or seven days later, it is likely they had come into contact with someone who was already infected, especially in districts like Kasaragod and Kannur where the numbers are high? In that case their symptoms will show up only later,” a health official said.
If this scenario is true, then the source of infection of these persons will remain a mystery. Then, authorities will have to look out for the marauding demon of community transmission.