Southern Indian state Kerala was lauded for its tackling of the pandemic. However, a recent rise in cases has raised questions over the state's response to COVID-19.
Mukund P Unny, a lawyer based in Delhi, decided to go back to his hometown in Kerala in May. Air travel in India had just resumed following weeks of being suspended by the coronavirus pandemic.
"Once I reached home, a health administrator visited me and informed me on how to follow the mandatory home quarantine. I was told whom I can reach out to in case I showed symptoms," the 28-year-old told DW. "A mental health counsellor also called to check up on me. I felt much safer here," he said.
The southern Indian state of Kerala recorded its first three cases of COVID-19 in January. The state's Health Ministry subsequently traced contacts and isolated over 3,000 people who had come in contact with the patients, who were students returning from Wuhan, the city in China where the pandemic began.
Initially, it seemed as if Kerala had its COVID-19 outbreak under control. There were often days when the communist-led state reported zero new cases.
It lay in stark contrast to the rest of India, where cases were rising rapidly. India is now the third worst-affected nation in the world, behind only the US and Brazil in terms of the total number of infections.
When it appeared that Kerala managed to contain the virus' spread, the state was lauded nationally and internationally.
In a discussion series on the post-pandemic world, entitled "Kerala dialogue," Nobel laureate Amartya Sen attributed the state's seeming success to its focus on education and public health.
New jump in cases
However, COVID-19 cases in Kerala began to spike in July. This was originally attributed to the return of workers from elsewhere in India and abroad, especially from mothballed construction projects in the Gulf states.
Then community transmission in Kerala was detected. The state's chief minister, Pinarayi Vijayan, said two coastal villages near the capital Thiruvananthapuram had outbreaks that were not tied to new arrivals.
Kerala is now considering imposing regional lockdowns. Authorities are emphasizing measures like masks and physical distancing.
After 70 infections were traced to people attending weddings and funerals, the government issued guidelines restricting the number of guests to 20 per event.
On July 28, Kerala reported its biggest single-day spike, with 1,167 cases, as the state crossed the 21,000-mark of total cases.
"India will experience multiple peaks," global health researcher Anant Bhan told AP news agency. The expert, who's an adjunct visiting professor at the Yenepoya Medical College and Centre for Ethics, Mangaluru, said that India needed to increase testing.
More testing needed
Kerala authorities maintain that their proactive public information campaigns and prevention measures have made an important difference in case numbers.
Rijo M. John, a health economist at the Centre for Public Policy Research (CPPR) in Kerala, told the Press Trust of India that the state's 4.6% COVID-19 positive testing rate remains much better than India's average of 11.7%.
The figure is important to find out if authorities are testing adequately. Countries or states with a high positive rate are unlikely to be testing sufficiently to find all cases. The World Health Organization (WHO) has suggested a positive rate of around 3-12% as a general benchmark of adequate testing.
Meanwhile, the case fatality rate in Kerala of around 0.30% is also among the lowest in the country. However, John said that more tests need to be done in Kerala, as infections continue to rise.
"It's also ominous that cases are now doubling in 10 to 11 days whereas nationally it's 18 to 20 days," he said.
Kerala is one of only three Indian states, other than West Bengal and Assam, to have officially declared community transmission.
The federal government in New Delhi still insists that community transmission is not taking place in India.