Kochi: Can the rate of Covid-19 infection in Kerala, witnessing a recent spurt largely due to return of its residents from high infection zones both within and outside the country, hit the accelerator during the monsoon season? Can the mutated virus make for a deadly combination with diseases that spring up during the monsoon season? It can, say experts.
A senior medical practitioner involved in the state government’s resistance against the pandemic has even called it a ‘Molotov cocktail’.
The fears in Kerala are as real as the dark monsoon clouds that have been gathering over the past few days. While Skymet had on 15 May forecast that the onset of monsoon over Kerala would be by 28 May, the India Meteorology Department (IMD) has revised its original forecast of 5 June and has now predicted that the south west monsoon will hit the Kerala coast by 1 June, Monday.
For the people of Kerala, these dates matter little as most parts of the state have started receiving heavy rains. The umbrellas are out, and the farmers are happy as they expect a bountiful rainy season.
But there is already some buzz in the IMD that Kerala is in for its August rains this year as well. The devastation that the August bout of rain has wreaked on lives, livelihoods in the past is deeply etched in the collective psyche of Malayalees. No one wants to go through all that one more time.
At his Covid status briefing Thursday, Chief Minister Pinarayi Vijayan said the state may have to brace itself to tackle another flood while fighting the pandemic. According to him, any evacuation plan would have to factor in various groups vulnerable to Covid while formulating relief and rehabilitation plans.
Costly lessons learnt, the government is making a conscious effort to open shutters of dams just as they start filling up, rather than wait till they brim over.
Shutters have already been opened at two small dams — Bhoothathankettu in Ernakulam district and Neyyattinkara in Thiruvananthapuram. Late Friday evening, an advisory from the Idukki district collector warned residents along the riverbanks of Periyar to be cautious. He declared an orange alert in the district, citing heavy rains in the catchment area for releasing 10 cumecs of water from Kallarkutty dam and 15 cumecs from Pamba dam Saturday and hence warned residents along the downstream riverbanks to be extremely cautious.
The monsoon diseases challenge
What the monsoon will bring with it is a spurt in quite a few communicable diseases, mainly dengue, leptospirosis and ordinary fever.
Consider the data on communicable diseases provided by the Kerala government. As many as 454 people died of a variety of fevers in 2017, with dengue claiming 165 lives, leptospirosis 80, H1N1 and ordinary fever 76 each. The number of people succumbing to these diseases came down significantly to 276 in 2018 and 234 in 2019. The dengue figures in the state that stood at 21,993 cases in 2017 came down to 4,651 in 2019, causing 14 deaths.
This is what worries medical teams fighting the pandemic across the state, like the one led by Dr Sajith John, assistant nodal officer of the Covid control room annexe functioning out of the Indian Medical Association headquarters in Kochi.
“Kerala has its share of fever deaths every year and in some years it gets big. The problem we are likely to face is a higher risk of mortality for those contracting Covid when already in the grip of a disease like dengue, which triggers hypo-tension and thrombocytopenia that result in drastic platelet drop,” said John. “That in turn could lead to a massive dip in immunity, which can prove fatal if combined with Covid. We all fear a severe rise in co-morbidity cases.”
Dr Amar Fettle, Kerala’s State Nodal Officer for Covid and H1N1, echoed those views.
“Now, the focus of the entire state health machinery is on tackling Covid. To the extent, there is hardly any breathing space to address vector borne diseases like dengue and other communicable diseases like leptospirosis, H1N1, short febrile illness commonly called viral fever — all common during the monsoon season,” Fettle said. “This time round, the public should not wait for advice from health department workers about taking preventive measures against mosquito breeding and rat infestation. Neither do they need to be told about the takeaways of keeping their premises clean of all kinds of waste materials as the health department, including vital field staff, is so busy with Covid.”
He added, “The public should not be indifferent to these threats, as that is something the state can ill-afford. Also, they should not be caught in a Covid-induced mindset that keeps them from getting treated for other diseases.”
Speaking to ThePrint, Dr Muhammad Asheel, Executive Director, Kerala Social Security Mission, said, “Dengue fever is cyclical and its resurgence happens every three years. Therefore, after hitting an all-time high in 2017, we are in for another bout of high incidence this year. But the virility of the infection is expected to be only one-sixth of that in 2017, but it will be three times as strong as last year.”
Covid preparation could subdue other diseases
The abiding faith as expressed by the medical fraternity is that because of the immense care taken by the entire community, with its unique ‘break the chain’ campaign that resulted in going that extra mile on the personal and community hygiene fronts, chances are, the breakout of almost all communicable diseases will be subdued this year.
“This is wishful thinking by the medical fraternity. More likely than not, myriad problems will be thrown up by differential diagnosis. Because, it will be quite a task to zero down the symptoms of dengue, chikungunya and Covid,” Asheel said. “Add leptospirosis to the mix and this monsoon could really make it a bad monsoon season from the health perspective.”
The flip side is the stark reality that Kerala has yet to see a genuine second wave, given the artificial control imposed by the lockdown. And just as dust settles on the fresh cases from high infection zones outside Kerala coming home to roost, it could be the turn of a genuine second wave of Covid, triggered by the likes of dengue, leptospirosis, chikungunya and the common fever.
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