COVID-19 Update

Gujarat: Not a model to follow

Print edition : July 31, 2020

Outside a health care centre in Ahmedabad, waiting to test for COVID-19 on July 8. Photo: Vijay Soneji

Surat Municipal Corporation officials and the police stand guard outside Surat Textile Market, which has been sealed following a spike in COVID-19 cases, in Surat on July 6. Photo: PTI

With the total positivity rate and the case fatality rate almost double the national average, Gujarat appears to have completely lost the grip on managing the pandemic.

Gujarat’s inability to contain the spread of COVID-19 has made it to the top five States in the country that have emerged as regions of grave concern. It is not just the number of positive cases and deaths that makes the situation worrisome but the State’s total positivity rate too, which is well above the national average. Additionally, the case fatality rate is also rising. In spite of the Central government’s pressure on severely affected States to adopt stringent measures, which includes ramping up testing, Gujarat appears to have completely lost the grip on managing the pandemic.

Among the main reasons for the surge is the opening up of industrial zones such as those in the southern city of Surat. Until then, it was only Ahmedabad that had a high concentration of positive COVID-19 cases and deaths. While Ahmedabad still remains the epicentre, there are ample signs that the virus has made its way across the State.

On July 7, Gujarat recorded 34,812 positive cases and 1,920 deaths. Gujarat, after Maharashtra, Delhi, Telangana and Tamil Nadu, accounts for a large number of cases in the country. July 4 recorded a daily high of 712 cases.

Total positivity rate

It is the State’s total positivity rate (TPR) and case fatality rate (CFR) that are of utmost concern. Currently, the TPR is 13.47 percent, well above the national average of 6.73 per cent. The TPR is the rate of percentage of tests that turn out to be COVID positive. In short, a large percentage of the people being tested are turning out positive. According to an epidemiologist, if the rate is high it usually indicates that only the sickest persons are being tested. According to him, it is critical to ramp up testing to include a larger number of people. Only then will a true picture emerge, said the doctor who works at a private laboratory in Ahmedabad.

Delhi’s TPR was around 37 per cent towards the end of June. The State was told to increase testing, which it did not do. Once it goes over 10 per cent, the number of people being tested needs to go up substantially, said the epidemiologist.

A spokesperson for a private testing kit manufacturer said there were enough testing kits available. It is the Indian Council for Medical Research (ICMR) that allots kits according to a State’s requisition. Gujarat hopefully would have asked for adequate numbers, he said.

Case fatality rate

The CFR is the number of people who die from COVID-19 for every 100 people who test positive. Figures say that Gujarat’s case fatality rate is 5.56 per cent. Ahmedabad’s is far higher at 7.2 per cent. India has reported a 2.95 per cent CFR.

Some sources say the State has tried to hide the number of deaths and even the number of positive cases. Local people too fear that the number of positive cases and deaths could be much higher than what is given by the government now. “No purpose is served when you hide the numbers,” said the Ahmedabad doctor. “This is why testing is crucial. If cases are detected early, it will immediately reduce the fatalities as treatment can be given in time.”

In order to address these concerns, the ICMR sanctioned 33 hospitals and 19 private laboratories in Gujarat to conduct tests and advised the State government to make the optimal use of the testing capacity. Adhering to the ICMR’s advice and to encourage more testing, the State reduced the fee for tests from Rs.4,000 to Rs.2,500. According to the State Ministry of Health and Family Welfare, Gujarat tested approximately 5,300 cases a day in June, while it has the capacity to test up to 8,000 per day. Until July 7, a total of 4,18,044 people had been tested. A doctor treating COVID patients in Ahmedabad said there was an urgent need to ramp up testing.

Until the ICMR and the Central government stepped in, the State government had been reluctant to allow private laboratories to conduct COVID-19 tests saying that government facilities were not being used to their full capacity. Under pressure from the top, in June, private laboratories were permitted to test, but with a caveat that only those holding a Doctor of Medicine (MD) degree could prescribe the test and not those with bachelor degrees (MBBS). This led to a petition being filed in the Gujarat High Court. “It is an indicator of how they work. Clueless and without a long-term plan. What is the point in ruling out MBBS doctors? Prescribing a COVID test does not require you to be a specialist,” said the Ahmedabad doctor.

Interestingly, the State, which keeps harping on its progressive development schemes, has been significantly silent these past few weeks on the COVID situation and the “stringent measures” that will be put in place.

Surat, the second hotspot

The only major announcement made by Chief Minister Vijay Rupani in the recent weeks was that Surat, with a surge in the number of COVID-19 cases and deaths, would be declared the second largest hotspot in the State. Surat had reported 2,014 active cases and 188 deaths as of July 7.

The opening of the diamond polishing units and textile markets is perhaps a reason for the spike in cases. Although diamond units say they have maintained physical distancing norms, there have still been positive cases in factories, leading to several units being shut down.

However, the bigger culprit would be the textile markets where thousands of shops are housed in massive towers. Moreover, the manpower required is sizeably large, increasing the risk of virus transmission. “It was bound to happen in Surat and in the markets,” said Hasmukh Shah, a textile trader. “But we have to start work. If they keep shutting us down people will start closing businesses.”

The districts of Aravalli, Banaskantha, Kheda and Gandhinagar have also witnessed a spike in cases.