Covid-19 surge in Maharashtra linked to delay in testing, shows data

Other big states see an uptick in cases as vaccination gathers pace at the other end

Crowds of people aged 60 and above are gathering at designated vaccination centres in most urban localities in India, as the second phase of inoculation begins in the country with website-based registration. Prime Minister Narendra Modi kicked off this phase by getting himself vaccinated.

But as we make progress here, we might be going back to square one. The much-feared second wave of Covid-19 seems to be on its way, as the growth in daily confirmed cases is not limited just toMaharashtra. Punjab, Gujarat, Madhya Pradesh, and to some extent, Karnataka, are having new surges in cases in both, urban and rural areas. In fact, Delhi too has been seeing a slight uptick in cases since the last week of February.

The pandemic spread was on the decline in the country, with active cases falling from 400,000 in the first week of December, to about 130,000 in the third week of February. Tests undertaken daily reduced from 1.1 million a day to 0.66 million a day in these two months, with a view to save resources when the need arises.

 

But active cases have risen to 165,000 now.

The anatomy of subsequent waves is hard to comprehend. National and state-level groups of scientists, municipal officials, doctors and hospitals are struggling to ascertain the reasons for this rise, apart from the obvious reasons of mask-complacency and neglect towards hygiene.

A simple analysis, by plotting the daily rate of testing per million population against the rate of positivity in tests conducted gives a hint as to what might have gone wrong.

Weaknesses in testing capacity, absence of institutions who chipped in their resources during the last year’s surge and peak, resulted in delay in testing even as positivity rose in Maharashtra, data shows.

In the first place, testing levels had been low in Maharashtra in comparison to other states even in and during the 2020 peak (chart 2). Here, the daily testing rate used is the sum of RT-PCR and antigen tests performed in a day per million population in the state.

But what is visible in the most recent surge is more baffling. While the most-affected states did not give up on testing after their 2020 peaks, Maharashtra, on the other hand, slid below its already low level of testing.

Why Maharashtra’s testing delay is worrisome compared to other states

In fact, even when the test positivity rate began rising in the first week of February, testing prevalence dipped in Maharashtra. It began rising only two weeks later, data analysed from the independent data repository covid19india shows. It is the only agency that publishes structured data on the disease spread in India.

Kerala, Karnataka and Delhi handled the pandemic differently, the same chart shows. In Delhi, testing was raised after each peak, and the level was maintained thereafter. In Kerala, it did not reduce as the state kept finding new cases daily for a long time. In Karnataka, testing level was reduced only after a prolonged stable decline in test positivity.

Saurabh Rao, who is the divisional commissioner for Pune division in Maharashtra—the region that leads in cumulative cases to date—told Business Standard that the machinery needed some time to gear up for increased testing.

“In the 2020 peak, the National Institute of Virology, National AIDS Research Institute, Indian Institute of Science Education and Research contributed a lot towards testing,” he said. Currently, the NIV is fully focused on the genome sequencing work.

If we look at the two major cities in Maharashtra, we find similar evidence in Pune, the second-most affected city in the country. Chart 3 underlines the lag between rise in positivity and the focus of testing in the city.

Testing declined in Pune from 1299 tests per million to 762 tests per million from February 3 to February 15, when the test positivity rate increased from 4.9 per cent to 11.8 per cent. It was only in the second week of February that Pune increased testing.

Existing guidelines dictate that tests should be at a level that the test positivity rate should not be more than 5 per cent, an official said. This means that testing in Pune, and in Maharashtra as a whole, should have been pushed up when the positivity rate crossed this threshold, which did not happen.

Mumbai, on the other hand, did not see that big a surge in test positivity rate. Nonetheless, testing was increased—if not commensurately, at least to some extent—as cases rose in the financial capital.

Testing is certainly not the only way to control the spread of the disease. However, it does provide an early alarm to take immediate action.

Experts, however, said that existing data is insufficient to make any claim about the right level of testing, and the correct way of testing.

Gagandeep Kang, a vaccine specialist who teaches microbiology at the Christian Medical College, Vellore, said that nuances of testing strategy are very important to make any conclusive .

“What proportion of tests are the Rapid Diagnostic Tests as against the RT-PCR is important in this case, as a low positivity rate with a higher prevalence of RDTs might not present the accurate picture. Further, if an agency is limiting testing only at hotspots, and testing only symptomatic people, the positivity could rise disproportionately,” she told Business Standard.

Unfortunately, state wise data on type of tests undertaken daily is not available, making a detailed analysis difficult. But it has been reported that the share of RDTs was high in Delhi, and one of the lowest in Tamil Nadu.

Pune divisional commissioner Rao said that the administration intends to double their testing effort in March, compared to February. But he also said that the case fatality rate (CFR) is lower this year, compared to the 2020 peak. CFR is less than 1 per cent in Pune district, data shared to Business Standard shows.

The real surge, however, lies in the predominantly rural districts in Maharashtra, namely Amravati, Akola and some others in the Vidarbha region. A strong wave hitting Maharashtra could be of severe economic hardship, as the state is the biggest contributor to India’s economy.

But economic commentators have said that everyone in the world has become more capable of handling new surges. “Second waves in other countries have proven less economically disruptive,” Nomura said in a recent note.