A Prescription For Kerala’s New Health Minister Veena George

Kerala’s new Health Minister, Veena George, has kept a fairly low profile since she took office late last month.

Part of that reticence may be attributed to George having to fill her predecessor’s shoes — much-vaunted, much-feted corona-slayer, Shailaja Teacher, whose serial bunglings over the past 16 months were papered over by a doting mainstream media, only too eager to concoct a liberal heroine.

But, with a second wave of the Wuhan virus showing no material signs of abating in Kerala, it is time Veena George and her boss, Marxist Chief Minister Pinarayi Vijayan, were handed a fresh prescription.

The situation, as it stands on date in Kerala, is one of growing concern:

One, cases are declining, but in a fluctuating, non-uniform manner.

Two, the variance from district to district is particularly disconcerting.

Three, the test positivity ratio (TPR; daily cases by daily tests) has been hovering around the 15 per cent mark for nearly 10 days now; this indicates directly that testing is inadequate.

Four, to prove this point, testing levels have slipped consistently since late May.

Five, the cumulative positivity (total cases by total tests) is at an unhealthy 13 per cent, and has been so since late May.

And six, the old accusation of undercounted deaths, resulting in an abnormally low mortality rate of 0.4 per cent, continues to manifest itself with statistically-implausible linearity.

Veena George’s first priority then, is to increase testing levels to over 1.5 lakh samples a day. Such levels are achievable, as her Left government showed in early May, when the Centre cracked the whip.

The problem is consistency. When things get out of hand, the Marxists ramp up testing for a few days, but then slacken off.

As the purple curve in Chart 1 above shows, there is no period in the past year and a half, when testing levels were raised to necessary levels, and maintained there, until the TPR declined to under 5 per cent in a sustained manner, in a fortnight.

That is, however, a purely administrative hurdle, which a competent health minister can overcome within 72 hours, if she sets her mind to it.

This nonsense of testing levels dipping to half over weekends also has to end with immediate effect.

If the virus doesn’t take a break, how can a government?

George has to understand once and for all, that if she cannot trace and isolate the contagion with necessary felicity, then she will be playing a deadly, failing, game of catch-up, at the cost of the people of Kerala.

The second key parameter is cumulative positivity. This is different from TPR (which is only a daily indicator), in that it provides a more representative picture of where a province is at, in the war against the Wuhan virus.

A simple thumb rule, based on empirical evidence from hundreds of jurisdictions over the past year in India, is that a region may be deemed as having edged back to normalcy once its cumulative positivity comes down to under 4-5 per cent.

The best example is Uttar Pradesh, where the state’s administration prevented the cumulative positivity from rising above 4 per cent, in the first instance, and then bent the curve back down in a matter of weeks. And the route, by which Chief Minister Yogi Adityanath managed to achieve this stellar success, was by massively ramping up testing levels.

Now, it may seem unfair to compare states, and under different circumstances, one might have avoided doing so, but George has to understand, somehow, that there is no alternative to this approach. Plus, as the person on the spot, she does not have the liberty of throwing up her hands and blaming someone else.

A comparative chart of UP and Kerala epidemic data brings this out clearly:

In the chart above, the bold lines are of UP, and the dashed/dotted lines are of Kerala.

Note how UP immediately ramped up testing to almost double within days, when the next wave became apparent there in mid-March (bold, purple line).

Also note how the curve continued to rise till the end of May, meaning, that the UP government sagely persisted with higher testing levels even after it stamped out the menace, just to be on the safe side.

On the contrary, the Kerala testing curve (thin, dashed purple line) rose only a fortnight after cases started spiking, and even then, lagged behind the virus in a desultory manner, with weekend breaks.

No wonder the Kerala daily cases curve (thin, red dashed line) is still on a gradual, fluctuating descent, a month after Uttar Pradesh brought case counts there sharply down (bold, red line).

It is the same with positivity. The TPR in both UP and Kerala rose in parallel, but while UP used testing and micro-containments to reverse an alarming trend before it breached the dangerous 20 per cent mark (bold, green line), the TPR in Kerala just continued to rise and rise. In fact, Kerala’s current TPR is where UP was two months ago.

Odder still, is how the TPR in Kerala has plateau-ed for the last 10 days. This is nearly unique in India, and is perhaps the saddest indicator, of just how inadequate testing has been in the state. (The TPR is an extremely sensitive curve, and either goes up or down – it hardly ever plateaus except when under 1 per cent).

Even Karnataka, which was just as badly hit by the epidemic, has finally managed to get matters under some control. A comparative chart below tells it all:

Both Karnataka and Kerala mirrored each other over April and May, be it on testing, case counts, or positivity. But see how the TPR in Karnataka finally began to reduce from June onwards (bold, green line), at the point marked by a red arrow in the chart above, while the TPR in Kerala lingered in a painful plateau.

The difference, once again, is on account of increased testing levels in Karnataka (bold, purple line) since late May.

The fourth major discrepancy is the wide variation in epidemic behaviour from district to district in Kerala. This is exacerbated by the utter absence of daily testing data at the district level.

If Veena George is at all serious about doing her job, then she will have to immediately resume daily publication of district level testing data for starters.

Only then will analysts be in a position to gauge whether the epidemic is indeed being managed correctly, or not.

The fifth issue is mortality rates. While it is heartening that deaths have been low in Kerala, for the mortality rate to stay linearly at a remarkably low figure of around 0.4 per cent (against a national average of over 1 per cent), even when the case counts rise in non-linear fashion, doesn’t add up (Swarajya pointed this out repeatedly since the epidemic began, but the Kerala government has yet to respond).

Consequently, as urged by Swarajya on multiple occasions previously, George will have to share her government’s policy on death classification, and be prepared for a spate of RTI enquiries on this subject, once the contagion recedes.

This is because such low mortality rates raise intriguing queries; inter alia, if indeed such low rates are on account of Kerala’s best medical practices, then they need to be identified, listed, reviewed, and shared post haste with the rest of the world, so that more lives may be saved.

The sixth point is about livelihood. George has to understand that the only way people will regain their spirit is if they can regain their livelihood – and that will happen only when retail reopens.

As things stand, with dodgy local data, a fluctuating TPR, and the cumulative positivity still at 13 per cent, she should know that the treasury will start ringing again only when sales resume, and for that, the epidemic has to be brought firmly under control first.

That, however, does not seem likely as long as large clusters continue to fester, and are merely contained, but not eradicated, by debilitating lockdowns with inadequate testing.

Now, a Marxist’s understanding of economics may be patchy at best, or voodoo-esque at worst, so talk of reopening retail or resurrecting private enterprise may seem like a devious Bourgeois plot.

Nonetheless, Veena George must appreciate that her primary duty is to stamp out the epidemic within the next three weeks, by increasing testing levels, maintaining them consistently, progressively employing micro-containments instead of widespread lockdowns, and releasing district level testing data on a daily basis, to bring the TPR down to under 4-5 per cent, and the cumulative positivity to under 8 per cent for starters, in a transparent manner.

Only then will lives be saved, and spending recommence.

She can do it, if her government shows the will, and the nous.

All data from Covid19india.org