On May 15, 106 days after the first novel coronavirus case was reported on January 30, with over 85,500 cases, India surpassed China’s tally of 84,038 despite being under a harsh lockdown since March 25. Maharashtra, Gujarat, Madhya Pradesh and West Bengal with high case positivity rates are States of particular concern.

In 106 days since the first laboratory-confirmed novel coronavirus case was reported on January 30, on May 15, with over 85,500 cases, India surpassed China’s tally of 84,038. The death toll across India on Friday stood at 2,674 as against 4,637 in China. There are only 10 more countries that have more cases that India.

At the same time, the death toll alone in the U.S. went past the total number of cases in China, while the total case load crossed 1.4 million.

The number of fresh cases that India has been registering has been increasing since mid-March. On March 18, when China reported zero fresh cases, India had just 162 cases and three deaths. Despite the country being under lockdown since March 25, the number of new cases and deaths reported each day has continued to increase steadily; on average, over 3,600 cases have been reported each day since May 8.

This is of serious concern as contrary to the advice of the World Health Organization, India has not fully utilised the precious lockdown period to go after the virus by increasing manifold the number of tests carried out daily while simultaneously tracing, isolating and treating COVID-19 patients.

That even during the lockdown India has witnessed the shortest time, of 13 days, for cases to double compared with 14 other countries that have the most cases reported is testimony to the wide spread of the virus. One reason for this could be that coronavirus cases in other countries, barring Russia and Brazil, have already peaked or about to.

Unfortunately, even as the number of cases has crossed 94,700, India is yet to begin investigating community transmission despite the strongly suggestive findings of the sentinel surveillance among patients hospitalised for severe acute respiratory infections (SARI).

Given the high rate of asymptomatic transmission, high resurgence of the virus is inevitable when the lockdown is lifted.

With over 11,200 cases, Tamil Nadu has the second highest number of cases next to Maharashtra (over 33,000). But with over 4,000 tests per million, Tamil Nadu is testing nearly two times more than Maharashtra.

It is not the States that report more cases that is a cause for concern, but those that have reported fewer. While both Karnataka and Bihar crossed 1,000 cases only a few days ago, active case finding and testing of most people with a travel history early during the lockdown could be one reason why Karnataka has reported fewer cases. Similarly, surveillance and case finding of those with travel history early on has been good in Andhra Pradesh and could be a reason why it has reported fewer than 2,400 cases so far.

Maharashtra, Gujarat, Madhya Pradesh and West Bengal have reported high case positivity. This could either be due to good surveillance, which is unlikely, or wider spread of the virus in the community, at least in specific regions. If the latter be the case, we can expect huge numbers to be reported in the coming weeks.

No State, including Kerala, can thus be complacent.

Published in The Hindu on May 18, 2020