A report card of States as coronavirus cases cross one million in India

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With surveillance not being commendable, the 10.3% test positivity rate nationally in the last few days is a clear indication that a very large pool of infected people in the community remains undiagnosed. The number of tests done daily has now crossed three lakhs but the high-test positivity rate underscores the need to increase the daily tests by at least a few-fold.

India was hoping that the extended lockdown alone might help it win the battle against novel coronavirus, but in recent weeks the deadly microbe has instead been spreading with renewed vigour in many States. So much so that on July 16, the number of people with confirmed infections and the number of deaths crossed grim milestones — one million and 25,000, respectively.

If it took 109 days to reach 1,00,000 cases but just 15 days to double, the number of days taken to add each additional 1,00,000 cases has been shrinking; the last two additions of 1,00,000 cases to reach one million took just three days each.

While the ever-increasing number of fresh cases reported each day could be ascribed to increased testing, the underlying reason for case rise is undoubtedly the wide spread of the virus in the community. If the pattern of growth of new cases detected daily continues at the current rate, the two million mark may be breached in about three weeks.

With surveillance not being commendable, the 10.3% test positivity rate nationally in the last few days is a clear indication that a very large pool of infected people in the community remains undiagnosed. Though the number of tests done daily has now crossed three lakhs, the high-test positivity rate underscores the need to increase the number of daily tests by at least a few-fold.

With asymptomatic cases being sizeable and restrictions in movement being eased, any delay in tracing, testing and isolating the infected and their contacts will only lead to an unimaginable spread of the virus.

As already seen in a few Indian cities, a cascade of events beginning with a delay in disease detection can overwhelm the health-care system to negatively impact the case fatality rate, which is currently very low.

Kerala, Karnataka and Andhra Pradesh, which initially appeared to have contained the virus spread, have seen sharp surges. If Bengaluru bucked the trend in the early stage, it has become a standing example of how the cookies crumble when cases spike and the system is not fully geared for the challenges.

Aggressive tracing and testing helped Chennai reduce the surge. But the coming days will reveal if the 12-day lockdown in June had greatly contributed to this. While Delhi appears to have hammered down the test positivity rate in recent weeks, overreliance on rapid antigen tests, which have low sensitivity, raises concerns about true case detection.

While Maharashtra pulled off a coup in Dharavi through outstanding work, the State, as in the case of Tamil Nadu and Karnataka, has been witnessing a spike in other districts. The test positivity rate is 19.9% in Maharashtra, the highest in India.

With a 9.1% test positivity rate, Gujarat has made no attempts to greatly increase daily tests but instead appears to be disingenuously limiting the number of daily tests to keep fresh cases per day under check. With 4.5%, Gujarat also has the highest case fatality rate followed by Maharashtra (3.9%) and Madhya Pradesh (3.3%).

Telangana too, with a test positivity rate of 18.4%, has made little attempts to increase daily tests, which have crossed 13,000 only in the last couple of days. Telangana defies the trend of rising cases during the pandemic, raising serious concerns about its numbers.

Examples such as New York, Italy and Spain have shown that it is never too late to bend the curve. But for that, States need to fight the virus, not manage the data.

Published in The Hindu on July 18, 2020