At present, Delhi and Kerala figure among the states that have the highest number of daily new Covid-19 cases. On December 7, while Delhi reported 1,674 cases, Kerala recorded 3,272 cases. While on a few parameters--such as confirmed cases and tests conducted--the numbers in Delhi and Kerala at present are moving in tandem, a closer look shows that the Covid-19 experience has been quite different in the two states.
The trend in active cases in Delhi and Kerala (Figure 1) shows that the active cases in the southern state peaked during mid-October and have been on a decline since then. Delhi, on the other hand, has seen three peaks – end-June, mid-September and mid-November. As discussed in an earlier article, the actual figures for Delhi greatly diverge from the predictions of the Indian Supermodel for Covid-19 Pandemic (or National Super Model) developed by the Department of Science and Technology (DST). For Delhi, the latter had predicted a peak in mid-September and a consistent decline thereafter. However, the actual active cases saw a rise since mid-October, a third time since mid-April, which continued to increase till mid-November and have been declining since. For Kerala, the model predictions have been in tandem with the actual active cases although actual cases had peaked in mid-October while the model prediction was that in Kerala it peaks in November first week.
The current picture in the two states (Table 1) shows that although Kerala relatively has a greater number of confirmed cases, it also has more number of recovered cases. Also, the deaths that have happened due to Coivd-19 are far less in Kerala than in Delhi.
Table 1: Some comparative Covid-19 parameters – Delhi and Kerala (as on Dec.07, 2020)
In Kerala, for every 1,000 confirmed Covid-19 cases there are four deaths being witnessed on an average while in Delhi, there are about 16 deaths for every 1,000 confirmed Covid-19 cases. The much lesser number of Covid-19 deaths in Kerala could be because of better management of the epidemic and a better public health response by the state.
For one, although the number of tests being conducted in Kerala and Delhi are comparable, Kerala has consistently conducted higher number of RT-PCR tests than Delhi (Table 2). These tests are more accurate in capturing the Covid-19 positive cases. The Indian Council of Medical Research’s (ICMR) advisory states that “real time RT-PCR is the gold standard frontline test for diagnosis of COVID19” and instructs that all negative RAT must be cross-checked with an RT-PCR. In a recent reply by the government officials to an enquiry under the Right to Information (RTI), it has been found that in Delhi, between September 1 and November 7, 11% of those tested negative for Covid-19 in RAT were found to be positive in RT-PCR tests.
Table 2: Share of RT-PCR Tests in Total Number of Tests in Delhi and Kerala (in %)
However, it needs to be assessed as to why over the past few weeks both the states have seen a decline in the share of RT-PCR tests.
Looking at other comparative statistics on some of the medical facilities in place to tackle the Covid-19 epidemic in the two States, we find that Kerala is better placed than Delhi to combat it. Kerala has developed a three-tier structure to deal with varying degrees of Covid-19 cases—the Covid First Line Treatment Centres (CFLTCs), Covid Second Line Treatment Centres (CSLTCs) and the designated hospitals. The decentralised governance structure in Kerala and strong community engagement has played a very constructive role in dealing with the epidemic. Kerala’s past experience with emergency preparedness and outbreak response has come in handy in a quick response towards the Covid-19 crisis. Building a dedicated cadre working with the community at each level of governance has been very effective. Kerala is also one of the states that have historically invested more in strengthening public health systems.
Delhi, on the other hand, has had to grapple with augmenting the medical facilities and mobilising the entire public health machinery. In the first few months, the administration focused on augmenting capacity against projected needs – using hotels as isolation centres, attaching these with private hospitals for additional beds (though this was discontinued from July 29 onwards), constructing new facilities with the help of the central government and later issuing orders for home quarantine to ease the pressure on medical infrastructure. After a number of measures towards increasing the infrastructure for Covid-19, Delhi at present has about 18,813 Covid-19 beds as against Kerala’s 21,387 (compiled from the data provided by Kerala government). The figure for Kerala includes beds in three categories – ‘Covid hospital, CSLTC, other Covid Hospital’; it does not include CFLTCs to ensure comparability in the data for the two States.
The experience with the Covid-19 epidemic has clearly shown the importance of a well- functioning decentralised structure of governance in place, strong community involvement, and substantial investment by the government in building a strong public health system. These are the elements that go into formulating a comprehensive response to any public health crisis and also improve health outcomes for all sections of the society in the long run.