1 state, multiple outbreaks: Why Kerala is often the first to record diseases

Fears of a COVID wave are back as the country recorded an increase in infections – on Wednesday, India logged 614 cases, the highest since 21 May. Of the total caseload, Kerala contributed the most – reporting 292 fresh COVID-19 infections and three deaths. In fact, the rise in COVID cases attributed to the JN.1 sub-variant was also first detected in the southern state of Kerala on 8 December when an elderly woman from Karakulam in Thiruvananthapuram district tested positive for the new sub-variant. Back in September, Kerala was also the first to record two deaths owing to the Nipah virus. Prior to that monkeypox was also first detected in Kerala. This begs the question as to why is it that Kerala almost always reports the first cases of such diseases in India? We delve deeper and get you the answers. Kerala’s COVID burden Of the 614 COVID infections in India on Wednesday, Kerala carried the most burden of 292 fresh COVID-19 infections and three deaths. Authorities have said that with the three deaths reported in the state, the total number of people who died due to COVID in Kerala since its outbreak three years ago reached 72,056. [caption id=“attachment_13530602” align=“alignnone” width=“640”] Of the 614 COVID infections in India on Wednesday, Kerala carried the most burden of 292 fresh COVID-19 infections and three deaths. File image/Reuters[/caption] More importantly, the state was the first to record the JN.1 sub-variant on 8 December in an elderly woman. Doctors had then said that she had mild symptoms of Influenza Like Illness (ILI), but has since recovered. Kerala Health Minister Veena George has assured the media that there is no need for any concern. “It is a sub-variant. It was just found here. Months ago, this variant was detected in a few Indians who were screened at the Singapore airport. It is just that Kerala has identified the variant here through genome sequencing. There is no need to worry. The situation is being closely monitored.” Data also reveals that the nation has reported a total of 19 COVID deaths so far in December. And of these 19, 10 were in Kerala. Other outbreaks in Kerala And it’s not just COVID. The southern state has witnessed multiple health scares with the outbreak of diseases such as Monkeypox, Chikungunya, Japanese encephalitis, Acute Encephalitis Syndrome, West Nile encephalitis, Dengue, Viral Hepatitis, Nipah and Swine Flu. In recent times, the state has also seen cases of Zika virus as well as anthrax. According to a report in South First, the state has, in the last two decades, been the first to report as many as 10 viral and non-viral disease outbreaks. Back in September, Kerala became the first to record cases of Nipah virus; five people were identified to have contracted the disease and two of them subsequently passed away. Moreover, this was the fourth Nipah virus outbreak in Kerala. The most deadly was in 2018, with 18 laboratory-confirmed cases and five suspected cases, 17 of whom died. [caption id=“attachment_13530562” align=“alignnone” width=“640”] Health officials at an isolation ward of Ernakulam Medical College in Kochi. Earlier, in September, Kerala became the first to record cases of Nipah virus; five people were identified to have contracted the disease and two of them subsequently passed away. File image/PTI[/caption] Kerala also reported India’s first case of monkeypox in July 2022. The first case was reported from Kerala’s Kollam district, and then cases were found in Kannur and Malappuram. August of 2021 also saw Kerala health officials battling a Zika virus outbreak. In 2021, the state recorded a total of 66 cases, mostly from Thiruvananthapuram. The first case was confirmed in a 24-year-old pregnant woman on the outskirts of the capital on 8 July. The southern state in 2022 also reported the presence of anthrax in Athirappilly of Thrissur district. Kerala, according to a report in The Hindu, has also become increasingly susceptible to zoonotic diseases. Leptospirosis continues to be the killer zoonotic disease in the state, with 290 deaths in 2022, followed by scrub typhus, which claimed 24 lives. State data further reveals that H1N1, swine flu, has seen a 914 per cent increase in 2023. The Times of India reports that while there were 94 cases last year, 954 cases have been reported till November. Reasons for Kerala’s vulnerability There are a multitude of reasons as to why Kerala is the first to record diseases and subsequently becoming a hotbed of them. First and foremost, Kerala’s geography contributes to the frequency of outbreaks. Wildlife and animal husbandry experts believe the state’s sizeable forest cover — and its intense monsoon pattern — make it susceptible to outbreaks. Experts note that the state has witnessed several zoonotic outbreaks owing to the shrinkage of natural habitats and their proximity to human settlements in a densely populated state. Take for example, the Nipah virus. A Reuters special investigation noted that humanity’s drive for resources is destroying the wildlife habitat of bats – which carry tens of thousands of viruses – and creating conditions ripe for a bat-borne disease to spill over to humanity. Dr TS Anish, community medicine chief of Thiruvananthapuram Medical College, was quoted as telling The Hindu, “Civet cats have almost become urban animals as their natural habitats have been wiped out. These animals are believed to be the mediators for the pathogen that caused Severe Acute Respiratory Syndrome (SARS). Bats, which lost their natural habitats, moved into human habitations. These animals are now considered as the reservoirs of Nipah and Ebola virus.” [caption id=“attachment_13530572” align=“alignnone” width=“640”] A man wearing a mask reads a newspaper at a bus terminus in Kochi, Kerala. Given their literacy levels, people in the state are very aware and have volunteered for testing of diseases, leading to their discoveries. File image/AP[/caption] Another reason for Kerala being the home of such diseases is the state’s population. People of Kerala are spread across the globe, with a large number of students studying medicine and many expatriates working as doctors or nurses around the world. They face the occupational hazard of viral attacks and may unwittingly spread undiagnosed diseases to others when they travel back to India. There’s also the state’s management and health system. The state has rigourous testing and the state’s population is also highly aware. Dr Chandrakant Lahariya, an epidemiologist and expert in public policy and health systems, explains that when the first case of monkeypox was reported from Kollam in Kerala, the concerned person who returned from the United Arab Emirates (UAE) underwent a test after he found that his contact abroad had tested positive even though he was asymptomatic. Renowned epidemiologist Dr Giridhara Babu speaking to South First added, “Many times the state has been criticised for reporting an outbreak. That should not be done. Its active surveillance mechanism, capacity-building exercises for healthcare workers, frontline staff, community engagement and strategic interventions have not just been helpful in detecting viruses, but also in keeping the disease outbreaks in control.” It is left to be seen if COVID does make a strong comeback in the state, but Kerala is known for handling outbreaks and, in fact, virologists and epidemiologists have hailed its robust surveillance mechanism. With inputs from agencies