India and COVID- An Update: Part 1
Written on August 1st , 2020 by {"login"=>"jcbitshyd", "email"=>"journal@hyderabad.bits-pilani.ac.in", "display_name"=>"Journal Club, BPHC", "first_name"=>"", "last_name"=>""}Recently, India ranked third in the list of countries with the most COVID-19 cases. With over 1.5 million confirmed cases, the situation in India seems undoubtedly stark. Decoding the daily headline- “Another Record High Number of Cases”, one of the things to come to terms with is that record highs will increase until the peak is reached which may still be between 2-6 weeks in the future. Only after the peak can we see a constant and gradual reduction in the daily new cases. A positive takeaway, however, is that India’s Test Positivity rate, which is the percentage of COVID-19 tests that test positive has not surged like the cases and has found stability around the 9% zone, which is better than WHO’s 10% target rate. Though this is much higher than we saw during the initial days of the pandemic, with the surge in the number of tests conducted, an increase in the test positivity rate was only natural.
With a stable positivity rate, focusing on other factors can help us get through this situation. Another positive news is India’s continually declining case fatality rate which as of today is at about 2.25%, compared to the global average of about 4%. Further, this rate is quickly inching towards the 2% mark. One of the speculated reasons being the younger part of the country’s population. More than half (~56%) of India’s population is under the age of 30, contributing to just 4% of the total deaths by the virus. However, lifting the lockdown nation-wide has made way for community transmission. Week-long lockdowns are being enforced in states to control the spread.
Recently, India recorded the highest number of recovered people in a day, taking the recovered cases to almost 1.89 times the active cases as the recovery rate stands at around 63.92%. While the overall numbers may seem ambiguous, a look into the situation in different parts is more lucid. The floods lashing out in Assam, Maharashtra being the most affected state despite the measures taken are well in contrast to a tremendously high recovery rate in Delhi. With more than a hundred days since the first case, the country is battling with the pandemic alongside a multitude of dire situations - take a look at how these areas are faring in terms of tackling the virus.
Delhi: From pacing its way to being the city with the highest daily count of cases in the world to having an excellent recovery rate in the country, the Capital has come a long way. The positivity rate fell to 5.7%, the death curve flattened as the deaths fell by 44% with the recovery rate at a whopping 88%. WHO said that a positivity rate of less than 5% implies the spread is significantly controlled. Health Minister Satyender Jain said, “Experts say that herd immunity will be developed when 40-70% of the population has recovered.” The government has said it will conduct a serological survey every month in order to assess the overall situation by extrapolating the data. The survey conducted by taking samples in late June and early July showed that nearly one-fourth of Delhi’s population is affected by the virus. This data gives us a large picture of the scene and is something to be glad about. The Centre says it will advise other states to follow the Capital’s model in fighting the virus.
Assam and Bihar: The north-eastern parts of the country are facing disastrous floods since May 2020 owing to the overflow of the Brahmaputra, affecting over 25 lakh people in Assam, death toll touching a 100. The floodwaters had led to discharge of medical wastes from CoVID-19 hospitals which raised concerns in the state. The state crossed over 30k cases while around 25k recovered. The NDRF is actively working to rescue as many people as possible, as many as 44k people from Assam have reached rescue camps so far. Caritas India is helping setting up relief camps to curb the situation in Bihar and Assam while aiming to maintain social distancing norms. Assam stands at 33k positive cases. The recovery rate was almost 77% with the positivity rate down at 5% as the ministry claimed to have conducted 20k tests per day. The city of Guwahati remained under stringent lockdown for more than a week.
Bihar, on the other hand, has ramped up testing, it has also been asked to focus on the containment zones by the Centre. These instructions have also been given to the states of Assam, West Bengal, and Odisha to name a few. Currently having a recovery rate of around 67%, Bihar crossed the 41k mark as it recorded an all-time high in the daily number of cases. Certain states have also been advised to focus on the medical infrastructure along with proper treatments for the affected. Bihar has been shut down since the 16th of July up until the 16th of August. It is speculated that small lockdowns are going to be necessary for states like Bihar.
Odisha: The state had actively taken measures to curb the spread by enforcing a lockdown much before the Centre back in late March. Around 180 cases in Bhubaneshwar came into light in the first half of June causing worries. However, the government tied up with private hospitals to bring together standalone beds for CoVID-19 along with the implementation of plasma therapy in early July. The positivity rate during this period surpassed the national average to around 6%, the cause for which was a lower number of tests being done with just 4-5k per day compared to the promised 15k. Odisha showed a recovery rate of 66.68% in mid-July, which again fell to almost 64% as it recorded a continuous surge in daily cases with 1.5k in a day so far. Weekend lockdowns had been implemented across the state as one of the measures. The fatality rate was quite low compared to the national average. A serological survey conducted in Bhubaneshwar showed that only 1.42 of it had been exposed to the virus.
Maharashtra/Mumbai: Maharashtra stands at the top of the most affected states in India despite Mumbai showing a downward peak in daily cases. The state’s recovery rate was around 55% in the first week of July with the death rate at 4.22%. Mumbai’s recovery rate touched a 70 (up from a 50% last month) as the cases touched the 1 lakh mark. The financial capital showed a doubling rate of 51 days as the growth rate of cases fell to 1.36 from 1.68 percent. Meanwhile, Pune Metropolitan Region continues to record daily high with each passing week. The Pune Municipal Corporation is aiming to redefine the containment zones in order to reduce the positivity rate. The death rate fell from 2.7% to 2.3% in mid-July. Maharashtra’s positivity rate stands between 22-25% which seems like a good sign coming with huge amounts of testing although a large chunk of testing in Mumbai was done using the rapid antigen tests which might give a false negative.
Telangana/Hyderabad: Telangana crossed the 40k mark as it conducted the highest number of tests in a single day. The positivity rate stood at 18.85% with the recovery rate at 67%. Telangana topped the chart with the highest positivity rate of around 25% earlier this month, crossing Delhi and Maharashtra. The reason for this was it had ramped up testing from 1k to around 6.4k a day. However, experts said a high positivity rate like this signified the state was testing only the sickest of the population and sufficient tests weren’t being done. A study published in the ‘Lancet’ in mid-July ranked the state third in the list of most vulnerable states in the country. It comes third after the states of Madhya Pradesh and Bihar. Telangana had shown epidemiological vulnerability along with the non-availability of infrastructure. The state recently released an app called HITAM(Home Isolation Telemedicine and Monitoring) to help CoVID-19 patients get doctoral consultancy at home. This comes after the state’s inability to find enough doctors for the job. Repeated reminders from the High Court were made to ramp up testing while the state had launched an app to cover medical consultancy and explained that the testing had been increased to about 16k per day and the total number of tests done was around 3.8 lakhs. Lack of infrastructure posed a problem with the deaths in the state. Presently, the state showed a recovery rate of almost 76.8% with a daily increase in the number of cases.
“The coronavirus has entered into the community. It’s hard to tell where and how it comes from and there is no other way but to take precautions against this invisible virus,” said Dr. G. Srinivas Rao, director of public health. The state is battling with the start of local transmission and must be on high alert for the next four to six weeks in order to curb the spread. Owing to this, the state has decided to ramp up testing further.
Tamil Nadu/Chennai: Chennai recorded almost 50% of the total cases in Tamil Nadu with around 87k cases. The positivity rate was around 30-35% which fell to 10-12% officials say. Testing is being done vigorously, Chennai has done 5 lakh tests as of July 20, the highest in the country and the recovery rate stood at 81%. The city showed a lesser number of cases in the older containment zones and the daily count didn’t show a spurt in the whole of last week. Tamil Nadu crossed the 6,000 case mark in daily cases with an increase through the past week as it recorded near to 7,000 cases on July 27 with the state’s tally beyond 2 lakh. Almost 45% of the total deaths in the state were reported from Chennai during this period. Although it still remains the state’s hotspot, 77% of the total cases are accounted for by the rest of the state. The state mulls to extend lockdown until late August as the numbers continue to grow in some of the districts.
Karnataka/Bangalore: The state’s inability to trace the source of every 2 in 5 people testing positive raised concerns earlier this month when the death rate was still at 1.6%. Contact tracing in the state had fallen from 47 per patient in June to a mere 6 while in Bangalore it was just 2 per patient. Almost 75% of cases were active in Bangalore during this period, the highest in the state. Proper contact tracing helped keep the count low but a drastic drop in the tracing process has called for better measures. More than 1000 people had been deployed to work on contact tracing. Karnataka reported 5000+ cases for six consecutive days crossing 1.07 lakhs. A report given by Stanford showed Karnataka at the top of the list of states with CoVID-19 reporting in early June. However, it is speculated that it might slide off the list owing to a lack of tracing. While tracing was being done properly in several districts, the state couldn’t manage to keep up the same for Bangalore Urban which showed the highest number of cases. Meanwhile, the Karnataka High Court ruled in favor of conducting the KCET 2020 without further postponement on July 30,31. It has also advised the state to decline no student who wants to appear for the examination. Full details regarding the SOPs given by the Department of Education have been shared by the Government further information regarding which can be found in this link: https://www.timesnownews.com/education/article/kcet-2020-exam-begins-today-sops-shared-by-state-government-that-students-should-know-about/629255
Kerala: There was a rise in case count earlier this month in the Ernakulam District as authorities surged to take measures. The area also showed a positivity rate of 5.3% compared to the 2.5% of the state's capital which entered a triple lockdown that week. Ernakulam’s positivity rate was at 5.3% for a whole of nine days with the state’s average at around 2%. The state’s single-day tally crossed 1,000 earlier this week leading to the Govt. considering an option of another lockdown. Thiruvananthapuram recorded the highest number of cases in the state. The capital tested more in the first two weeks of July than it did in the past four months. A spurt in the cases calls for a cluster containment strategy as a possible model. “We are trying to break the chain of transmission from one cluster to another. We are thoroughly locking the clusters. We need to give more attention to the coastal areas”, said KK Shailaja, the Kerala Health Minister. The state said there were a large number of cases in the coastal areas which were due to community spread. “Today, there are 84 clusters in Kerala. Inside the clusters, local transmission is more than 50 percent, but outside it is below 10 percent”, Shailaja added.
West Bengal: The state portrayed a good positivity rate of 5.8% as it crossed the 40k mark as of July 18. The death rate at 2.7% was close to the national average of 2.5%. The state also argued that the recovery rate during this period had increased to around 55% which was a good sign. The daily count crossed 2,000 on July 19 as experts say the peak is yet to come. Upon noticing community spread in some parts, the Govt. had decided to declare two days of lockdown every week up until August 31 in order to break the chain of community spread. This comes in addition to the existing lockdown enforced in the broad-based containment zones.
Gujarat: The state had a triumphant moment mid-June with the doubling rate at 31.47 days compared to the national average of just 19.6 as the recovery rate was up at 69%. The fatality rate however was at 6.25% compared to almost 2-3% displayed by some of the other states. The state however saw a shift in the hotspots with Ahmedabad’s share coming down to 42.2% from 64% while that of Surat went up. Death rates at these places rose while Gandhinagar saw a dip. The government reduced the cost of COVID tests by private labs to 2.5k down from 4k for people visiting for one albeit that of home testing was up at 3.5k. In the next fifteen days, the cases went by 62% along with the recovery rate up at 70.2% and death rate down to 4.7% by when Gujarat had tested almost 4.87 lakh. It crossed the 50k mark earlier last week with a daily high of 1,000, taking its total death toll past 2,000. Surat surpassed the 10k mark second to Ahmedabad at a little short of 25k. The death and recovery rates were at 4.4% and 72.1% respectively. Earlier this week the state was at 57k with Surat portraying the highest number of daily cases. There was an increase in the recovery rate along with a small fall in the death rate. In the current week, Gujarat inched towards a 60k with another record-high. Statistical analysis revealed that cases had gone up by 57% from July 24 to July 29 while the daily number went up by 7% during the same period although there was an increase in the testing per million of the population.