The Indian health establishment is sparing no effort to convince everyone that the government’s strategy to control the spread of COVID-19 infections has been a success, but the reality on the ground proves otherwise.
In the first week of August, almost a week after the third phase of a gradual unlocking was announced, Chief Ministers of at least two States reporting fairly large COVID-19 numbers tested positive.
While Shivraj Singh Chauhan in Madhya Pradesh and B.S. Yeddyurappa in Karnataka were the high-profile COVID-19 cases, at the Centre, Home Minister Amit Shah too was diagnosed with COVID-19. On August 2, Kamal Rani Varun, a 62- year-old Cabinet Minister in the Uttar Pradesh government, succumbed to the disease.
India today has the third highest number of COVID-19 infections after the United States and Brazil and the fifth highest number of deaths after the U.S., Brazil, Mexico and the United Kingdom.
During the period from July 5 to August 5, the daily number of confirmed cases more than doubled from 23,942 to 56,626. On July 25, the daily number of cases touched 50,000 for the first time and has been on the rise since then. A record 57,486 confirmed cases were reported on July 31, the highest in the month. By August 6, this figure had gone up to 62,000.
On two consecutive days, India even surpassed the U.S. and Brazil in the largest single-day spike of cases and deaths. With around 40,000 deaths so far, India can hardly boast of having controlled the spread of the virus.
On August 4, a day when 51,282 cases were reported, senior Health Ministry officials urged the media to look at the “biggest news”, which was that nearly two crore tests had been done till date and that more than six lakh tests had been conducted in the previous 24 hours.
The other “big news”, of daily infections crossing 50,000, was not mentioned at all. At a briefing on that day, Rajesh Bhushan, the newly appointed Health Secretary, told mediapersons that the total number of recovered cases was double that of active cases.
This line of presentation was nothing new; each time a briefing was held, media officials always talked about the high recovery rates. It was not mentioned that the total number of recoveries was the cumulative figure, that is from March onwards, while the number of active cases indicated those currently active, that is, in the past 14 days.
The two were not comparable metrics from any standpoint, yet in each press conference health officials were self-congratulatory about the recovery figures. The number of active cases was by no means small: it was over six lakh.
At the briefing on August 4, there was no reference to the two days when India recorded the largest number of cases and deaths in the world.
Testing methods
Of the 1,370 laboratories in the country, 698 were conducting tests using the gold standard Reverse Transcription Polymerase Chain Reaction (RTPCR) method. Of the 1,370 laboratories, 921 are run by the government and 449 are in the private sector.
Apart from these laboratory tests, the Rapid Antigen Tests (RAT) method was also used but considered less reliable than the RTPCR, which is known to have higher sensitivity and specificity.
Although some mediapersons had repeatedly made inquiries about the proportion of antibody tests to the total number of tests, the government issued a reply only on August 4. The Director General of the Indian Council of Medical Research (ICMR), who was present at the Health Ministry briefing, said that 30-40 per cent of the total tests were done using the RAT method.
This was interesting as the ICMR had, in guidelines issued in May, stated that rapid antibody or antigen tests should not be used for diagnostic purposes. This was also in line with the guidelines of the World Health Organisation (WHO).
The problem with this method is that a positive test would indicate exposure to COVID-19 but a negative test would not overrule the presence of the infection.
If there were false positives, then these tests would have to be followed up with the RTPCR method. Given that there are only 698 laboratories using the RTPCR method for a population of 1.3 billion, it is impossible for every false negative case to get tested again using the gold standard method.
Besides, if 30-40 per cent of the total of two crore tests were done using the RAT method, many possible carriers of the infection were going untested and undetected.
The government and the Health Ministry have been sensitive to the criticism regarding the low rates of testing. They have been at pains to convince critics that India was testing far beyond the WHO standard on the optimum number of tests that need to be done a day per million, which is 140, according to the Health Ministry.
However, the cases per million in most countries are well over 140, often running into thousands, so it was unrealistic that a mere 140 tests a day per million would suffice.
Rise in cases and deaths
On August 6, the Health Ministry announced that a new record had been set with 6,64,949 tests in the previous 24 hours and that it was the third consecutive day that the number of tests a day had crossed six lakh. The tests per million had also crossed 16,000, the Ministry said in a release. However, it did not mention that in the previous 24 hours, India had taken the top spot in the highest single-day spike of confirmed cases, touching almost 62,000 and surpassing even the U.S. and Brazil in daily numbers.
August 6 was a milestone as the 60,000 mark had been breached. It was apparent that as more tests were being conducted, the number of confirmed cases were also going up. Also, India topped in the number of COVID-related new deaths. A day before, it was in the second place. On August 6, as many as 888 people in India succumbed to the virus, compared with 829 in Mexico, 416 in the U.S. and 274 in Brazil.
According to Health Ministry officials, the case fatality rate—the number of deaths as a percentage of the number of people who have tested positive—was at its lowest since March. But they did not offer any explanation on why the number of fresh daily cases (61,000 plus) was far higher than those reported in the U.S. (22,858) and Brazil (10,543).
The positivity rate over the weekly seven-day average was close to 11 per cent, which was high, although the cumulative positivity rate was around 8.89 per cent. The positivity rate indicates the percentage of positive samples out of the total number of samples tested.
According to the WHO, a positivity ratio of less than five was desirable and an indication that testing was adequate. A high positivity rate showed that testing was not adequate and that the infection was being chased, which was the case in India. According to the government, the positivity rate was high because of some States.
The Health Ministry said that some 28 States and Union Territories were testing more than the WHO’s guideline of 140 tests a day per million. The all-India average was 479, which the government considers robust. However, several countries are testing far greater numbers on an average.
Goa, Delhi, Tripura, Jammu & Kashmir and Tamil Nadu had increased their testing capacity and were testing more than the nation’s average.
Although the daily testing numbers had gone up, it was clear that India had woken up rather late to the ‘test, treat and track’ approach, as a result of which infections were far ahead of testing capacities.
Maharashtra, Tamil Nadu, Andhra Pradesh, Karnataka, Delhi, Uttar Pradesh, West Bengal, Telangana, Bihar and Gujarat accounted for the bulk of the caseload, but there is hardly any State left where no fresh cases are being reported.
Uttar Pradesh, for instance, was at the bottom of the list of States contributing to the caseload for many months. With over one lakh confirmed cases, it is now in the sixth place.
Export of ventilators
On August 4, even as the Health Secretary declared that there had been a progressive decline in the case fatality rate since June, he also announced that the government had decided to lift the ban on the export of ventilators.
The formal decision came in the form of a notification from the Directorate General of Foreign Trade in the Department of Commerce, which stated that “all ventilators, including any artificial respiratory apparatus or oxygen therapy apparatus or any other breathing appliance or device” whose export was prohibited under the existing policy could now be exported.
The lifting of the ban defied logic given the rising number of cases and daily deaths.
The Health Secretary also gave a presentation on “Make in India” ventilators in which he said that India was now self-sufficient in the production and supply of ventilators.
The Indian ventilator market had grown from 8,510 units to 18,000, all of them domestically produced. They had been supplied to States and were being installed in more than 700 hospitals. The government had placed orders for the domestic production of a total of 60,000 ventilators, which was the projected demand during the pandemic, he said.
Two public sector units had been given the charge to produce 43,500 ventilators and Maruti Suzuki was to supply another 10,000.
The government has been in denial mode for a long time now. Its recent discovery of the merits of aggressive testing and contact tracing should be complemented with adequate health infrastructure and life-saving equipment.
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