Keeping the coronavirus numbers artificially low by testing fewer people will be counterproductive

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It is surprising that West Bengal government, which was initially quite proactive on several fronts to tackle COVID-19, became diffident in ramping up testing and case finding after the first death was reported. If there is clearly a reluctance to divulge the true extent of spread of the virus, the hesitation is pronounced in the case of sharing mortality figures.

West Bengal, which reported its first novel coronavirus case on March 18, has now reported a total of just 922 cases. The State has reported 48 deaths but has not counted 72 who died of comorbidities.

Though the fourth populous State, West Bengal ranks fourth lowest in terms of the number of people tested and is way lower than the four BIMARU States of Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh. Against a national average of 721 tests per million, West Bengal has a dismal 212.6 tests per million. But what is disturbing is the general reluctance and unwillingness of the government to ramp up testing and acknowledge deaths from the disease as such. 

This comes as a surprise given that the government was initially quite proactive on several fronts to tackle COVID-19. It was the first State to move from containment to mitigation to contain the spread when it announced a complete lockdown before Prime Minister announced it nationally. Chief Minister Mamata Banerjee was seen doing all the right things including demonstrating how social distancing is to be practised and setting up quarantine centres in every district.

Unfortunately, the same enthusiasm was found missing when it came to testing, and the State’s trajectory to win the war against the virus took a terrible turn since the first death was reported. While it is not clear if testing has improved, there is clearly a reluctance to divulge the true extent of spread of the virus. The hesitation is pronounced in the case of sharing mortality numbers. Worse, it has become the only State to not include infected people with comorbidities who died to the final toll.

At over 13%, the case fatality rate is very high in West Bengal while the detection rate continues to remain the same, which is a reflection of poor surveillance and failure to actively look out for fresh cases. When surveillance is good and testing is ramped up, the number of cases reported is bound to increase, as was seen in Kerala, Maharashtra and Rajasthan, and even South Korea in particular.

As Kerala has demonstrated, early detection of cases and tracing of contacts, quarantining and testing will not only help in containing the spread but also markedly reduce the case fatality rate.

Trying to keep the numbers artificially low by testing fewer people or not divulging the actual numbers and tracing their contacts allows the virus to spread unchecked. At some point, poor surveillance and delay in testing will overwhelm the health system and result in even more deaths, something that no government would be proud of. A higher number of cases is only a reflection of how active the State has been in waging a war against the virus, while a higher case fatality rate serves as evidence of poor response.

With the lockdown now extended by two more weeks, the government should follow the advice of the World Health Organization and cover lost ground by aggressively testing and isolating cases, and tracing contacts.

Assembly elections next year should not be a reason for both the Union and the State governments to politicise a public health issue that has been declared a pandemic.

Published in The Hindu on May 4, 2020