SARS-CoV-2 has made a mockery of the hotspot classification in Kerala. Thursday had 10 fresh COVID-19 cases, and six of the new cases were from Idukki and Kottayam that were placed in the lowest-risk 'green zone'.
Both these districts have been moved under the 'orange zone', where all other districts except Kasaragod, Kannur, Kozhikode and Malappuram are placed.
The other four new cases have been reported from Kozhikode, which has two, and Kollam and Thiruvananthapuram, which have one each. Because the recoveries on the day were lower at eight, the number of activities that were showing a fall since April 6 has gone up to 129, the second consecutive rise.
Cross-border infiltration in Idukki
Idukki, which had not seen a positive case since April 2 and was therefore placed in the green zone, has witnessed a minor eruption of fresh cases; four turned positive in Idukki on Thursday. All the four had reportedly sneaked across to border towns like Theni where the outbreak is severe and returned. They could have also been infected by people coming in undetected from border areas in Tamil Nadu.
Chief Minister Pinarayi Vijayan, during his sunset briefing on Thursday, said borders would be sealed. "Anyone who is not a local found in these areas would be arrested," he said. Border police stations would also begin bike patrols to prevent any local from moving to the other side.
Stealthy border crossings are now seen a major threat for entire border areas from Manjeshwaram in the north to Parassala in the south. The lone positive case reported in Kollam on Thursday was a 77-year-old woman, the primary contact of a 30-year-old Kulathupuzha native, Manikantan, who had gone for a funeral in a Puliyangudi, a COVID-19 hotspot just across the border in Tamil Nadu.
The woman lives just 100 metres away from Manikantan's house and is said to be a frequent visitor to all the houses in the neighbourhood. The houses in this lower-middle-class area are said to be stacked side-by-side, with not much space between them.
One of the two who has tested positive in Kozhikode is also a Tamil Nadu native who was recently lodged in a destitute home near the Kozhikode Medical College.
Danger signs in Kottayam
Kottayam, which did not have a single positive case since March 2, had two fresh cases on Thursday. One of them is a nurse working in a private hospital. It is not yet clear how she got infected.
The other patient is one of the 17 men a driver transporting vegetables from Tamil Nadu is said to have come in contact with at the Kottayam market. This driver, who is now isolated in Ernakulam Medical College, has still not tested positive. He was in fact co-driver of the truck. He took over after the original driver of the truck had tested positive on April 21.
Technically, Kottayam's first positive patient after a long time was a 65-year-old woman who had returned with her husband from Australia. Though a Kottayam native she was quarantined at Kambammettil, at the border in Idukki. She was not allowed to enter Kottayam.
Small breather for Kannur
There was some respite in Kannur on Thursday. Since April 6, at least one positive case was reported from the district daily. This trend came to a halt on Thursday. But the recovery rate has still not picked up in Kannur. Only one recovered on Thursday, leaving the district 60 active cases.
Poor recoveries
Thursday also saw recoveries falling below the number of confirmed cases. The number of cured was only eight. Six of the cured are from Kasaragod, a district that effectively neutralised the virus threat. The district that had 172 confirmed cases now has just 20 active cases, a recovery rate of 88.37 per cent.
Gulf trouble again
Among the new cases, there were also two foreign returnees, one in Kozhikode and the other in Thiruvananthapuram. The Kozhikode patient, a 33-year-old man who belongs to Azhiyoor, had returned from Dubai on March 20. He has tested positive 33 days after his return.
The Thiruvananthapuram patient is a native of Puthenchantha in Varkala. He had returned from the Gulf on March 19. He has now tested positive on the 34th day of his return.
One month incubation?
Any foreign returnee testing positive from today (April 23) would have reached Kerala at least 30 days ago; this is because the last international flight landed in Kerala on March 22.
Even studies done in China and Italy had not found more than one or two cases where the incubation period had exceeded 30 days. At the latest count, at least 15 returnees had turned positive after 30 days of their return. In the last two days itself, there have been five.
Take the three who had tested positive on April 22 in Kannur. 33-year-old Kolayad native landed at Karipur airport on March 19. She had tested positive 34 days after she returned. Another patient, 57-year-old Pathayakunnu native landed at Karipur on March 21. She was declared positive 32 days later. It was on March 21 that 30-year-old Kanichar native reached Kannur. She tested positive 31 days later.
Asymptomatics and virus litter
The extended incubation theory has now been junked. Two other possibilities are now being weighed. One, the new positives would have got their infection not from any Gulf countries but from Kerala itself, from some asymptomatic patient they had come into contact with after their return.
Official figures say that 80 of the 111 confirmed cases in Kannur alone had not shown any symptoms. Therefore, the chances of a large number of asymptomatic patients outside the surveillance have multiplied. If this is the case, then community transmission had already happened but in a low-key manner.
Take a family in Kozhikode's Edacherry, for instance. All the family members, all 10 of them, have been declared positive. It is true that two in the family had returned from the Gulf but the virus was first spotted in the head of the family who had no ravel history. Health officials in Kannur say here is a high possibility that someone in the family had got infected from a mystery patient outside. The source of infection of the four-month-old child, who is now on ventilator support in Kozhikode Medical College, has also not been traced, giving rise to further fears of silent transmission.
Chief Minister Pinarayi Vijayan, however, has ruled out community transmission n Kerala. Nonetheless, he said rapid antibody tests would be done on a large population, especially health workers, to confirm there is no such silent transmission of the virus.
The second is, the initial symptoms would have erupted perhaps after the fifth or sixth day of the infection but was manifested so subtly and mildly that they or anyone near failed to notice. What the late PCR tests were now picking up are the viral remnants, or "virus litter" as some scientists would love to call it, in the throat and nasal serums that have ceased to be infective.
No proof yet of asymptomatics' non-infectivity
Fact is, no one really knows whether those with supposed 'virus litter' are infective or not. For this, the viral culture of the person's sample will have to be done. At the moment, Kerala has no such facility.
Or an antibody test could be done. If IgM antibodies are detected it is an indication that the virus is still active. If what the test detects IgB antibodies, too, in the sample, it can be safely said the person is past his infective capacity.
But this too will have to wait as Indian Council of Medical Research has temporarily halted the use of antibody kits that have come from China citing huge inaccuracies.
