The Kerala government has been criticised by the Union Health Ministry for its lack of transparency in reporting COVID-19 deaths, thus raising doubts regarding the state's claim that it has managed the pandemic well.

The Union Health Ministry in its death analysis report had asked the state to add 8,684 deaths, that have been unaccounted for, as COVID deaths, from a time period that covers 22 October to 22 November. The fatality rate in the state has gone up from 0.3% to 0.73%.

Now, the allegation that Kerala has not been declaring all COVID deaths or including all deaths of COVID-positive persons in its official list of deaths is something that has been raised right from the latter end of the first wave of the pandemic. Health authorities have failed to offer a clear explanation for the inconsistencies in the reporting of COVID deaths, especially the unusual disparities in COVID mortality rate between districts.

The Quint spoke to health experts to analyse why this backlog has occurred and how this reflects on the state's handling of COVID-19.

The Supreme Court, on 29 November asked the state governments why very few families had claimed the ₹50,000 ex-gratia compensation that is given to those who have lost their loved ones.

The bench led by Justice M.R. Shah asked the Chief Secretaries of States to provide the Centre with details about the number of deaths recorded in each State, the number of claims received by them individually, the compensation paid so far, and whether grievance redressal committee in each district had been constituted. The court also asked the states if online portals for disbursal of compensation have been created or not.

This is when Kerala was forced to regularise the death reporting process online directly from hospitals, and the state also began the death reconciliation exercise.

The Centre’s report highlighted that Kerala contributed to 65.7% of country’s cases but 45.2% of country’s deaths in September 2021. The report stated that it was “shocking” that from 22 October to 22 November, the state reported a backlog of 8,684 deaths along with 1,789 new deaths. This backlog was 83% of the total 10,473 deaths reported during the period. The MoHFW said the death reconciliation exercise “reveals inadequacies in the recording and reporting mechanism.”

Dr Fettle told The Quint that the state health minister had on 29 November called for a meeting of all the district medical officers and surveillance officers to discuss the backlog and the measures to be implemented to keep the new variant at bay.

Health experts told The Quint that the state has had a mechanism in place by which if a person succumbs to COVID, the reasons should be convincing to the treating doctor to declare it as a Covid death. Initially a committee assisted the doctors in scrutinising deaths, but after their failure to account for this data accurately, the state government dismantled the central committee. The doctors were given complete authority so that there would be real-time reporting of Covid deaths in the state.

Later, following the Supreme Court ruling, the Central government stated that any death of a person infected within 30 days should be considered as Covid death.

Health Minister Veena George recently in an Assembly session promised transparency and said that the data will be verified before it is added so as to avoid duplication.

While the whole country is witnessing a slump in COVID cases, Kerala continues to present a unique picture in terms of disease transmission. COVID cases have remained on a plateau consistently for over six months, but experts have raised concerns that the number of tests done have come down drastically to between 50,000-60,000 tests daily.

On 3 August 2021, Kerala conducted the highest number of tests in a single day — 1,99,456 — when more than 70% tests conducted were antigen and 54,151 samples were tested using RT-PCR. However on 28 November, only 51,577 samples were tested of which 35,268 were tested using RTPCR.

However, it is important to note that the number of persons hospitalised and the requirement for oxygen beds and Intensive Care Units have come down drastically. Only about 7% of the active cases are in hospitals, with approximately 1.6% admitted in oxygen beds and 1.4% in ICUs.

“The fact that the state hid or — if you would like to say — didn't have the right mechanism to ensure honest reporting of the COVID deaths has affected the treating process. Data is crucial as health experts can rely on only this to work on strategies to handle the crisis,” said a senior health official.

Amid the emergence of a worrying new COVID-19 variant and its spread in around 15 countries and more, Kerala has deployed health workers at all the four airports in the state in order to collect samples and conduct testing of people coming from foreign countries, said Health Minister Veena George.

“All those who are travelling from at-risk countries have to be in quarantine for 7 days. They have to do the RT-PCR test again on the eighth day and if they’re negative they still have to observe further isolation of 7 days. So, they’ve to be in quarantine for 14 days,” she said.

“We are planning to send mobile units to the homes of those who tested positive and even the other passengers so that we can avoid spread. All international returnees will be made to observe their health for 14 days after return,” said Dr Fettle.

While Kerala accounts for the second most number of COVID cases in the country, the state is also plagued by the contagious viral infection Norovirus. At least 57 people, including 54 students and three workers, in the hostel of St. Mary’s College, Thrissur have contracted the virus, as confirmed on 28 November. Causing a health scare is the unusual heavy rains in Kerala that has contributed to rise in flu and dengue cases. As per the National Vector-borne Disease Control Programme, 4,399 dengue cases and five deaths were reported in Kerala in 2020. Till September this year, 3,027 dengue cases and one death were recorded.

Several experts pointed out that the heavy rains have been one of the key reasons for the spread of COVID.

“When we were recording a spike in COVID cases, we faced heavy rains as well. The healthcare staff was hard pressed, as we had to handle a lot of other infections as well. Also during these times it is impossible to ensure people are wearing masks. The unseasonal rains played havoc with our COVID appropriate behaviour,” said Dr Fettle.

Dr Fettle said that Kerala’s saving grace has been the healthcare sector’s strict adherence to protocols and also a responsive helpline.

“Apart from the centre’s Disha helpline, we have two helpline numbers. And this connects to 60 open lines, manned by 1,200 persons, that is available 24x7, irrespective of the time or weather. We have advised our tellers to alleviate anxiety among people and clarify doubts,” he added.