Covid-19 and complacency

Variable reporting and testing standards obscure the big picture

Delhi is an outlier among India’s major cities with the number of Covid-19 infections surging daily to over 5,000 even as Mumbai and Kolkata record fewer than 1,000. Information technology capital Bengaluru peaked in mid-October and has been falling since to about 2,000 cases a day — about the same as the whole of Tamil Nadu. Remarkably, Uttar Pradesh appears to be at the same level. In fact, Delhi and Mizoram are the only two states where the number of Covid-19 cases has shown an increase over the past two weeks compared to the previous fortnight — though in terms of the highest number of fresh infections, Kerala remains India’s Covid-19 capital. However, it represented a decline over the previous 14 days.

The wide differentials in infection rates within states and between cities and the occasionally anomalous trends in the data are partly a reflection of the varied testing policy that states have been following, reporting standards, and the quality of their medical infrastructure. For instance, the government data shows that India’s national average of Covid-19 tests per million population per day is 844, significantly above the World Health Organization norm of 140 tests per million population per day. Overall, at least 12 states are performing more tests per million per day than the national average, with Kerala (3,258), Delhi (3,225), and Karnataka (1,550) leading the way. Another eight states and a Union Territory — Andhra Pradesh, Bihar, Odisha, Jharkhand, Telangana, J&K, Tamil Nadu, Haryana, and Goa are also performing more tests than the national average. Except for Goa, none of these states figured among the five states with the highest test positivity rate (TPR), however. The exponential expansion in the testing rate has mostly been via the controversial rapid antigen-based testing, which has an accuracy rate of below 50 per cent. Karnataka is one of the few states where the rate of RT-PCR tests outpaces that of antigen tests. Only a handful of states are following the Indian Council of Medical Research’s recommendations for the more reliable RT-PCR tests for symptomatic negative cases. Thus, clarity on the direction and spread of the infection remains elusive and there is as yet little scope for optimism in the steady net reductions in active Covid-19 cases from the September peak. The fact that net additions to the number of cases are about half that of the United States, therefore, should not be cause for complacency.

At less than 2 per cent, India also records one of the world’s lowest death rates from Covid-19, but here too the picture lacks clarity. For example, the number of deaths in Delhi and West Bengal, 6,356 and 6,640, respectively, roughly equals the far more populous Uttar Pradesh’s 6,940. Given UP’s appalling health infrastructure and its large complement of migrant labour returning from urban hotspots during the national lockdown, this low death rate can reliably be ascribed to faulty reporting and poor health care access. This appears to be the trend in most backward states with fewer hospital beds. Bihar and Jharkhand, again with high population densities, large migrant labour cohorts, and sub-optimal health care systems, have recorded just 1,065 and 876 deaths, respectively. These divergent and hard-to-explain statistics across the states point to the lack of a reliable health data-collecting mechanism at the national level. This deficiency could have serious consequences when the next pandemic strikes, especially if it involves a virus less benign than Covid-19.