Kottayam: Young Keralites have been found contracting COVID-19 mostly as nearly half of the total positive cases in the last half year since the viral pandemic reached India have been in the 20-40 age group. But, alarmingly, the fatality rate among the old who test positive for coronavirus is disprportionately higher. Overall, 68.85% of patients who died of COVID so far in the state were aged above 60 years!
The data proving the wide variance in mortality among the young and the old has unsettled authorities as they had taken some advance measures to secure the senior citizens.
In the last week of April, as Kerala was getting ready to relax the COVID-19 lockdown restrictions and return to some semblance of normalcy, the government received the report of ward-wise population data it had sought to work out a plan to combat the pandemic.
According to the data, collected with the help of Anganwadi employees, 11% of the 42.49 lakh people over the age of 60 in the state needed extreme care to ensure they did not fall victim to the disease. The government took the report seriously and it announced reverse quarantine. But has that been effective? Let's find out through some hard data.
The first confirmed COVID case in Kerala was reported on January 30. The first death due to the infection took place on March 28: the victim was a 69-year-old native of Ernakulam.
At that time, Kerala had only 182 confirmed cases of COVID. But, four months later, on July 26, the number had increased rapidly to 19,025, with the latest total death toll standing at 61 (unofficially 79), as per figures released by the government.
This, in effect, means that the mortality rate due to COVID in Kerala is 0.32 per cent. This is much lower than the 1.65 per cent in Tamil Nadu and 2.37 per cent for the whole of India.
Kerala has the seventh-lowest COVID mortality rate among all the states and Union Territories in the country. Gujarat has the highest death rate of 4.21%.
In March, Kerala had 238 people who had tested COVID positive, but only two patients had died. In April, while there were 256 confirmed cases, there was only one death. In May, 772 COVID cases were reported and the death toll was eight.
The highest COVID death rate in the state was 1.04% in May. In absolute numbers, the highest number of deaths was reported in June and July, but the mortality rate has generally stayed low in relation to the total number of cases during these months.
In June, there were 3,172 COVID positive cases in Kerala; the number of deaths was only 15, or a mortality rate 0.47%.
In July, there have been 14,583 confirmed cases so far and 36 deaths - a mortality rate of or 0.24%, which is also the lowest monthly death rate so far since the first case was detected in the state.
Only solace
The Kerala Health Department is relieved that it has been able to keep the death rate low despite the rapid spread of the disease, including through contact. However, the figures are a little worrying when the age of those who have died of COVID is considered.
As part of its efforts to limit the impact of COVID-19, the state came up with a reverse quarantine plan. It involves completely quarantining the elderly and the sick and enciuraging healthy young people with low risk of contracting the disease for activities outside.
According to available data, 49% of COVID patients so far in Kerala are aged between 20 and 40 years. Also, only 992 people over the age of 60 have been infected so far - that is 6.98% of the total patients.
But the mortality rate raises questions about the effectiveness of reverse quarantine. Till July 26, most of the deaths - at 42 - were registered among people aged above 60.
There has been no death in the 11-19 age bracket and among those aged over 90 so far.
Those aged between 60 and 69 account for about 35.59 per cent of all COVID deaths in the state. About 29.5% of the deaths have been of people aged between 70 and 79 years. Overall, 68.85% of patients who died of COVID were aged above 60 years.
People who came from outside the state have accounted for 37.29 per cent of the deaths. About 22.03 per cent of those dead had no travel history. According to government figures, about 5.08% of deaths were contact cases. However, what is worrying is that 35.59 per cent of the deaths were of cases without any known source of infection.
Of those dead in the 60-69 age bracket, seven patients had come from outside Kerala, two were infected through contact, while six had no travel history. The source of six dead patients could not be ascertained.
The increase in the number of deaths among patients aged between 60 and 79 with no known source of infection has come as a setback for the efforts to fight the disease and keep the elders safe. In the last week, only one death has been reported among people who came from outside Kerala. In the remaining dead cases, the source of the infection was not known. It is in this backdrop that the need for further strengthening of reverse quarantine rises.
Blame it on comorbidity
Of the 61 deaths due to COVID so far, 47 people had comorbidity. According to the Health Department, 10% of the elderly in the state are under treatment for cancer, heart and kidney diseases. In the first phase, the reverse quarantine was intended to provide extra care to such people.
About 59 per cent of the elderly are on regular medication for various diseases. The second phase was to ensure the reverse quarantine of these people.
The third phase of reverse quarantine was strictly enforced after expatriates started returning to Kerala from May 7.
More vigil
Reverse quarantine of those above 65 years of age, infants and children has been made stricter in the wake of community transmission of the disease being confirmed in Kerala. They are also banned from places of worship.
Health workers prepared the report on the elderly by going door to door to collect details. They are now busy with the follow-up activities.
Authorities are trying to ensure that expatriates are not put in quarantine in homes with elderly people. There are also ensuring that elders with special needs have a separate room with toilet facility to themselves and that the other members of the household maintain social distancing from them.
The COVID Jagratha Samitis (COVID vigilance committees) were formed to monitor those in quarantine and ensure the safety of the elders. The committee consists of ward members, ASHA workers, young 'Sannadham' volunteers, Kudumbashree workers and police persons.
For the elderly who feel lonely at home, authorities ensured counselling facilities, palliative care/home visits by ASHA workers. This way, the reverse quarantine aimed to ensure that the elderly had 'minimum' contact with the outside world, thereby reducing the chances of them needing a visit to the hospital.
Omissions in count
Kerala has not included the deaths of three people under COVID-19. A person who died of drowning on July 12 in Kollam and a Thiruvananthapuram resident who died in Kottayam tested positive for the disease. However, COVID was not shown as the cause of their deaths because they did not die of the disease.
A Tamil Nadu native undergoing treatment in Thiruvananthapuram died on July 21. His name was also not included on the list of deaths in Kerala. Similarly, the death of a Mahe native on April 11 at Pariyaram Medical College was also not included. The Centre, however, has put their names on the list of deaths in Kerala.
There are also complaints that many deaths are added to the government list very late. That is why the daily unofficial list shows a higher death toll than the government's figures. According to unofficial figures released on July 26, COVID deaths have been confirmed in all the 14 districts of Kerala.
Chief Minister Pinarayi Vijayan's daily press briefings have indicated that the government is aware of the need to strengthen the existing COVID restrictions in view of the community transmission of the disease and the growing numbers of cases with no known source.
