India completed its 100 millionth test for Covid sometime on Friday, according to the HT panel. According to the Indian Council of Medical Research tally, the number was slightly lower, 92.25 million tests (ICMR has a tally protocol that not all states follow), which means that the 100 million mark will be crossed. in a week, maybe sooner.
Still, I’ll stick with the 100 million mark on Friday because the test numbers on HT’s dashboard are what we use to measure the positivity rate.
Only the United States (about 122 million) and China (160 million) have conducted more tests than India. Even in terms of tests per million, at 100 million tests, India has performed around 77,000 tests per million population. That translates to 7.7% of the population, which is adequate according to most experts if the screening, isolation, and treatment protocol that follows the tests is strict enough. Unfortunately, it rarely is, not just in India, but in most of the world.
Read also | Covid: Daily RT-PCR tests hit record 15,000 marks, cases over 3,000 in Delhi
The 100 million number also includes new tests. And it includes not only molecular tests like reverse transcription polymerase chain reaction tests (RT-PCR), but also rapid antigen tests (RAT). I have written extensively about the indiscriminate use of the latter, in contexts where it does not make sense for them to be used, and in large numbers (especially in Bihar and Uttar Pradesh where they account for the majority of the tests performed; even Delhi uses too many rapid tests for his own good, and for the good of his people). Still, 100 million is 100 million, and for a country that started with the capacity of a few labs and a few thousand tests in late February and March, the figure marks a tremendous achievement.
India, as Dispatch 176 of October 7 pointed out in the first place, has overcome the first wave and is in the pause between that and the second wave that will surely come. Given this, and the testing milestone, how are the Indian states doing?
The table accompanying this piece lists 11 states that together account for 79% of India’s cases, 82% of its testing, and 70% of its testing as of Thursday night. Sure, 10 is a better number, but I chose 11 because Bihar is 11th on the list in terms of number of cases and its numbers are interesting.
Of the 11, Bihar and Uttar Pradesh have the lowest positivity rates: the number of people who tested positive, 2.3% and 3.6%, respectively. The average for these 11 states is 8.3%, a number biased upward by Maharashtra’s high number of cases and positivity rate. The national average is 7.4% (according to the HT panel).
Interestingly, if the case fatality rate is an indicator of the quality of a state’s healthcare system, it should be, then Bihar, Kerala, Odisha and Telangana are more similar than most people would expect. Kerala has the lowest fatality rate of 0.34%; Odisha’s is 0.43%; Bihar’s is 0.48%; and 0.57% from Telangana. The only other state among the 11 with a fatality rate below 1% is Telangana. The fatality rate for these 11 states is 1.56%, slightly higher than the 1.52% for India. Uttar Pradesh’s fatality rate of 1.46% is actually lower than the national figure.
Uttar Pradesh and Bihar’s low positivity rate is hard to explain (and we won’t try). There could be a possible explanation for the low fatality rates in Kerala because the state has an excellent public health system. And there could be a possible explanation for the low case fatality rates in Bihar because infections started showing up in the state much later than in many others, and both nationally and internationally, healthcare systems have improved to save lives as that the pandemic has progressed. Does that explain rates as low as 0.34% and 0.48%? Uttar Pradesh’s numbers are at least internally consistent: it has few cases, but the proportion of deaths is about the same as the national figure.
Like the mystery surrounding the African figures, I wrote about this in Dispatch 154 on September 10, that it is necessary to study the extremely low positivity rate of Uttar Pradesh and Bihar and the low fatality rate of Bihar, already that could contain answers on how to handle the pandemic.
.
