Nutritional Status and COVID-19 among Older Persons in Kerala, India

Abstract

Background and Aims: The COVID-19 pandemic has posed an unprecedented public health crisis globally irrespective of age. There is no doubt that the older population (above the age of 60) is the most vulnerable age category due to multiple co-morbidities, which often is not in their favour. Age category, types of co-morbidities and nutritional levels indeed play a pivotal role in determining mortality rates. This paper focuses on Kerala, a southern Indian state and how it maintained low mortality levels due to COVID-19 during the first wave despite being the state with the highest proportion of the older population. The present study argues although the state possessed a robust health system and had an active engagement of the public health sector with its citizens through local governments, it was the state's meticulous planning, innovative schemes centred around older persons such as reverse quarantine, the prevailing excellent nutritional status among its population and initiatives to ensure good nutrition through food security schemes like 'essential grocery kits' and 'community kitchens' that helped to develop the body's resistance to infection and thus played a significant role in flattening the curve for Kerala's older adult COVID-19 deaths effectively, thereby achieving a high recovery rate and low rates of fatality during the first wave of COVID-19 in Kerala. Methods: Pre-COVID-19 health conditions of older adults in Kerala were analysed through Kerala Ageing Survey (KAS) panel data and Longitudinal Ageing Survey in India (LASI) data. Percentage analysis, Logistic regression method and Cox hazard regression methods were used to analyse the effect of nutritional levels on health and mortality among older adults in Kerala. Publically available COVID-19 data from the Government of Kerala and the Government of India were used to analyse the COVID-19 death rates. In addition, changes in dietary patterns and other preventive measures taken to fight against COVID-19 were investigated through qualitative response. Result: The study found that nutritional status influences mortality and co-morbidities among older adults in Kerala in the pre-COVID situation. Furthermore, the study found that though nutritional indicators, that is, overweight or obese, significantly increases the risk of comorbid conditions among older adults, good nourishment reduces the risk of all-cause mortality. The study also found that Kerala's COVID-19 fatality was much lower when compared to India and developed nations like the US, UK and Italy. Even if Kerala is one of the highly COVID-19 affected states, the effective nutritional intervention by the Government of Kerala through its various schemes to build up the general immunity of the state's citizens, especially high-risk groups; thereby achieving low COVID fatality in the state.Conclusion: Based on Kerala's experience, nutritional factors influence the population in building up the body's resistance to infection against COVID-19. Even though the fatality rate is very low, obesity coupled with non-communicable diseases affects preventive measures of the state. There is an immediate and persuasive need to find new and more efficient clinical studies apart from socio-epidemiological studies, which could play a pivotal role in determining COVID-19 health outcomes.

Keywords: COVID-19; India; ageing; food security; health policy; malnutrition; nutritional status; odds ratio; population density; social isolation.

Figure 1.

Conceptual framework of nutrition and COVID-19 mortality and survival among older persons. Source: Developed by the authors. Original model available at Bellamy C. The State of the World’s Children 1998: Focus on Nutrition. UNICEF, UNICEF House, 3 UN Plaza, New York, NY 10017; http://www.unicef.org1998.

Figure 2.

Percent distribution of COVID-19 deaths by age and sex in Kerala 2020–2021. Source: https://dashboard.kerala.gov.in/deaths.php Deaths up to February 16, 2021, as of 21/02/2021

Figure 3.

Monthly COVID-19 deaths (%) among older persons in Kerala, March 2020 to February* 2021. *Deaths up to February 16, 2021 (As of 21/02/2021) Source: https://dashboard.kerala.gov.in/deaths.php

Figure 4.

Case fatality rates (%) of COVID-19 by states in India, up to February 16, 2021. Source: https://www.mohfw.gov.in/

Figure 5.

Comparison of COVID-19 Case fatality rate of selected countries and Kerala. Source: https://ourworldindata.org/coronavirus

Figure 6.

Percent distribution of deaths by age in Italy and Kerala. Source:https://www.statista.com/statistics/1105061/coronavirus-deaths-by-region-in-italy/; Source:https://dashboard.kerala.gov.in/deaths.php Deaths up to February 16, 2021, as of 21/02/2021 for both Italy and Kerala.