Is India flattening the coronavirus curve? That of course, is the 1.3 billion dollar question that everyone wants to know the answer to. Let us look at the data so far. India had performed around 47,951 tests as of April 1, out of which around 1,637 were declared positive. This gives us a positivity rate of around 3.41%. The deaths reported till then were around 40, which gives us a death rate of around 2.44%. None of the numbers here are as alarming in comparison to those we are seeing in other parts of the world like Italy, Spain or the US. So India must be flattening the curve, right? The answer is we don’t know yet.
We aren’t testing enough cases, something that almost every scientist and doctor worth their salt accepts. Except the ICMR and the health ministry who feel that this level of testing is fine and who seem to believe if there were so many cases, hospitals should be overflowing with cases of respiratory distress. But take a look at this data: Iran on the 4th of March had 2,336 cases in all and only 77 deaths; 14th March: France had 3,640 cases and just 79 deaths; 13th March: Spain 4,209 cases and 120 deaths; 17th March: the US had 6,349 cases and only 98 deaths; 5th March: even Italy that has had a 10% plus mortality rate had only 197 deaths for 4,636 cases.
Clearly the surge in fatalities and the exponential increase in numbers appears to come within a week after they reach the 5,000 number. In India’s case we are still around the 2,200 mark (April 2). So it is way too early to say that we have flattened the curve. One obvious reason that the case count is going up slowly here in comparison to other countries is that many of them drastically upped their testing soon after the case numbers got beyond a few hundred. In our case, even as late as April 1, we are testing less than 5,000 cases a day.
The US is doing 1,00,000 a day, Germany 5,00,000 a week, Korea has tested 4,00,000 and even the UK is ramping up despite a significant and costly lag to test 10,000-20,000 patients a day. Remember that barring the US, the others have the population of a mid-sized Indian state. So passing any judgment on the numbers we have so far is relatively meaningless. Also, at present, the case doubling time for India is around five days as is the death doubling time. These are not too different from the doubling times of other countries, barring China and those who have done well to control the spread like South Korea, Singapore, etc.
The argument that the case numbers must be low because our hospitals haven’t been flooded with cases is a facetious one. Already we have doctors and nurses in Mumbai starting to say they are seeing more SARI (severe acute respiratory illness) cases and while it is true that most parts of the country haven’t seen hospitals flooded with cases, the terrifying speed with which the illness seems to surge leaves us with no room at all for complacency. The most perplexing stand of the government has to do with its apparent reluctance to test. Everyone who has a dry cough or a fever must be tested and isolated until they are proven negative.
In a country of 1.3 billion people, many more than 3,500 patients a day are likely to have such symptoms. So, it does seem that all patients with symptoms are not being tested. Even if we assume that 0.0001% of our population has a cough or a fever at any given time, this alone would mean 1,30,000 people. So far we have done around 50,000 tests and most of them are on foreign-returned people or their contacts and those from the Tablighi Jamaat meeting at Delhi. Large-scale testing has simply not started, whatever be the reason.
There are many arguments being espoused for not testing on a large scale. Quite apart from the cost and limited availability of kits, there are reasons being espoused such as: Even if someone is positive, there is no treatment anyway. And why not just ask people to remain in isolation if they have symptoms? Further, someone who is negative today may test positive tomorrow, so what is the point in testing? Also, widespread testing may take away testing kits from those who need it the most. None of these are valid arguments.
If strict isolation is not done to anyone who may be positive, then he or she could end up infecting dozens of people. Just telling people to stay at home if they have symptoms by no means diminishes risk of spread to family and close contacts, who then go into the community to spread the infection. During a lockdown period, if a family tests negative it is very unlikely they will test positive during the rest of the lockdown period as they are homebound. That is why testing and isolating as many positive cases as possible is needed during the lockdown.
The fewer the positive cases there are in the community at the end of the lockdown, the better we will be able to contain the spread once the country gets back to work, even if that happens in a phased manner. Also there is increasing evidence that countries like South Korea, Singapore and even China that have indeed flattened the curve have used mass testing as a vital part of their strategy together with tracing, isolation, quarantining and lockdowns. For India the next three weeks will be vitally important. If we test at the same rate that we are doing now without ramping up over the next two weeks, then the days and weeks after the lockdown may become even more important— hopefully not in a tragic manner.
Dr SUMANTH C RAMAN
Political Analyst, Doctor and Healthcare IT Professional
Tweets @sumanthraman