The Southern Indian state of Kerala is supposedly the healthiest among 28 Indian states. This reputation comprises one of the reasons why the state is called ‘God’s own country’.

This has been brought about by certain health indices which places the state on par with Scandinavian nations.

These superior indices are; (figures for rest of India have been given in parenthesis)

Maternal Mortality Rate of 53.49/ 5 lakh live births (178.35)

Infant Mortality Rate of 7/1000 live births (29.07/1000 live births)

Under-5 Mortality Rate of 10/1,000 live births (36)

Average Life Expectancy at birth of 77.28(70.77)

Birth Rate of 14.1/1,000 population (17.64)

Death Rate of 7.47/1,000 population (7.26)

Life Expectancy at birth for females of 79.98(72.09)

However, not all seems to be hunky dory for Kerala in recent times. The state has been a veritable hotbed for communicable diseases leaving an indelible botch on Kerala’s enviable health front

At the time of writing, 13 students of the Veterinary and Animal Sciences at Pookode in Kerala’s Wayanad district were infected with the Norovirus. The students might have contracted the rarely heard of virus which causes diarrhea, vomiting, abdominal pain and fever through handling infected animals while going about their course. This virus spreads through contaminated food and water, through person-to-person contact and through fomites. In the present situation, it may be due to a combination of these factors, as students live in cramped environs of hostels and partake of food and water from the same source.   

Keralites had also been at the receiving end of Nipah Virus infection thought to be spread by fruit-eating bats.  The first outbreak in 2018 localized to Kozhikode and Malappuram districts claimed 17 lives. After that outbreak was effectively contained, a 23-year-od student was diagnosed with Nipah in Kochi on 4 June 2019. Though 300 people were placed under observation no further case was reported in that instant. A third occasion when Nipah was reported in Kerala was in September of 2021 in Kozhikode, when a 12-year-old boy died in kozhikode. Luckily 17 people who were on the contact list of the boy who succumbed tested negative. Later this outbreak was also declared controlled after 140 close contacts tested negative and no more patients reported with the dreaded infection, notorious for severe mortality and transmissibility.

Kerala’s share of communicable diseases does not end there.

Leptospirosis or rat fever is a zoonotic disease (that transmitted by animals) caused by a bacteria of the genus Leptospira, and is transmitted through contact of abraded skin and mucous membranes with water or mud contaminated with urine of infected rodents.

Rat fever has been a major threat to Kerala with more than 1,000 cases reported annually. It causes highest number of deaths among all communicable diseases in Kerala. The number of cases of rat fever and deaths caused by it in Kerala were 1821 and 104(5.7%), 1359 and 229(16.9%) in 2006 and 2007 respectively. Rat fever has seen steady increase in terms of incidence and mortality from then on in Kerala.

Another villain to join the list of Kerala’s share of communicable diseases is Dengue fever.

This is caused by a virus belonging to the Flaviviridae family, and is principally transmitted by the mosquito Aedes   Aegypti, that multiply in stagnant water. Kerala recorded highest number of dengue-related deaths (165) and the second highest number of cases in the country (21,993) after Tamil Nadu in 2017. This was the highest ever dengue-related fatality and cases reported in Kerala.

Kerala’s experience with the current Covid-19 pandemic proved to be an enigma to the medical community, especially epidemiologists. The state’s tryst with the Corona virus commenced on January 30 2020, which marked the first ever case of Covid-19 in India.

Fresh from her spectacular success in taming the Nipah viral infection, Kerala showcased stellar results initially on the Covid front too. This was perceived by many as benchmark for dealing with the pandemic which was beginning to bring the supposedly healthier and advanced Western hemisphere to its knees.

Kerala’s initial success was made possible by imaginative campaigns like ‘Break the Chain’, stringent adherence to the SMS protocol, through exemplary inter-ministerial coordination. Kerala’s dream run with Covid-19 ended when she opened her borders to Non-Resident Keralites residing in other Indian states and countries, especially the Persian Gulf countries.

Kerala’s cases of Covid-19 skyrocketed to an extent where Kerala alone contributed more than 50% of India’s daily cases for 28 consecutive days between August 23 and September 19 2021. As of September 19 2021 13% of Kerala’s 35 million population contracted the disease, the highest in any Indian state. Despite these shocking figures, Kerala’s  Covid-19- related mortality rate at 0.5 deaths/100 confirmed cases  was the least compared to the rest of India. This dreaded infection caused by the virus SARS-CoV2 spreads principally from person-to-person and through fomites.

Reasons for Kerala turning a veritable hotbed for communicable diseases despite her overall superlative standards on the health front are multifactorial

  • Kerala’s population density. Kerala with a total area of 38,863 sq.km (urban 3365 sq.km and rural 35,498 sq.km) harbors a population of 3, 18, 38,619, with a high population density of 819 persons/sq.km., which is nearly thrice the national average. Dense population favors spread of communicable diseases, especially airborne ones that spread through respiratory passages like Covid-19.    
  • Kerala’s lowland regions which account for 10% of her total area runs along the coastline and embodies beaches,, swamps and lagoons, besides backwaters, paddy fields and coconut plantations. The abundant water bodies that ideal breeding ground for mosquitoes, which spread diseases like dengue, malaria, and Chikungunya.
  • Among variety of seasonal, annual and perennial crops grown in Kerala, cocoa and pineapple are of tremendous significance as dengue vectors have been found to breed there.
  • Plastic continues to be the most telling villain, as is the case globally contributing to spread of communicable diseases.  Kerala generates 480 tonnes of plastic waste per day. On an average, a family in Kerala generates 60 grams of plastic waste per day.
image courtesy indiatoday.in

 Plastic waste includes carry bags, plastic bottles and caps, ice-cream cups, plastic-coated disposable utensils, used in parties, mineral water bottles, pouches and refill bubbles. Plastic, which is a bio non-degradable material form a major chunk of waste that is strewn and thrown most recklessly in public places, empty plots and roadsides. Plastic form non-destructible crucibles that hold water, especially after monsoon and floods. Mosquitoes breed in these micro stagnant water bodies, adding to spread of mosquito-borne diseases. Plastic also clogs drains and canals adding to water stagnation and flooding, both of which allow widespread breeding of mosquitoes. Unless the government displays uncompromising political will to ban plastic, irrespective of micron size, mosquito-borne diseases will continue to plague Kerala’s citizens. 

  • Inept waste management is another factor contributing significantly to communicable diseases. Waste is seen to lingers for long periods of time into the day in public places in Kerala. Disposable plastic plates with food stuck to them attracts rodents, which in turn lead to rodent-transmitted diseases like rat fever. Such waste also attract stray dogs and cats which lead to zoonotic diseases like rabies, as incidents of stray dogs attacking humans inflicting mortal wounds were commonplace at a time. Uncollected waste consisting of plastic and packing materials like thermocol  in turn is swept into drains and canals by flood waters during rainy seasons or my cleaners employed by local government bodies who conveniently sweep them into drains and canals, to set forth a vicious circle of flooding, mosquito breeding and disease transmission.   
  • Kerala’s weather has turned vagarious in recent times. The state witnessed back-to-back floods in 2018, 2019 and 2021. Kerala’s two monsoons, the Southwest and Northeast recently  have shown to a tendency to bring in copious rain to cause floods and inundation, which in turn lead to spurt in water-borne diseases viz; Cholera, dysentery, typhoid and hepatitis, along with mosquito-borne ones viz; malaria, dengue, chikungunya and other zoonotic ones like leptospirosis.