India’s COVID-19 hot spots on recovery road

The punishing second wave of the coronavirus disease is receding in 19 Indian states and Union territories, some of which were its early epicentres, although some new hot spots have emerged in the south and the North-East where infections continue to surge, HT’s analysis of nationwide positivity rates shows.

Seven out of every 10 Indians live in the regions seeing an improvement. Among the 19 are Delhi, Chhattisgarh, Madhya Pradesh, Maharashtra, Bihar and Uttar Pradesh, some of which were ravaged by the second wave with the health care systems of most being overwhelmed by a rush of hospitalisations.

This trend comes as a glimmer of hope even as the Covid-19 toll continue to rise to grim new records. Daily deaths from the disease have remained above the 4,000 mark in the last four days despite a drop in new cases over the past week. To be sure, any drop in case trajectory generally take 14 days to reflect on daily deaths as studies have shown that the median time between someone testing positive for Covid-19 and dying from it is around 13.8 days.

The average weekly positivity rate – proportion of samples tested that return positive for Covid-19 – has gone down in states and UTs that are home to 69% of the country’s population, while 15 states and UTs, home to the remaining 31%, have seen an increase between May 7 and May 17, data shows.

Experts said that this drop in positivity rate is largely due to the application of non-pharmaceutical interventions like lockdowns, and that while cases are declining in most regions, actions taken to control the spread of the disease cannot be weakened just yet.

Areas in the country’s south and North-East, which fared relatively better than the rest of the country during the worst of the second wave though April, are now seeing positivity rate climb the most. Andhra Pradesh, Tamil Nadu and Karnataka, along with north-eastern states such as Meghalaya, Manipur, Sikkim, Tripura and Arunachal Pradesh, feature among the regions that have seen positivity rate rise the most between May 7 and 17.

The analysis took the positivity rate data from the first week of May (week ending May 7) as the base for comparison as it was perhaps India’s worst week in terms of cases – the seven-day averages of positivity rate and daily infections both peaked around this time in the country. At the government’s Covid briefing on Tuesday, health ministry joint secretary Lav Agarwal said that daily cases have been declining since May 7.

All positivity rate figures mentioned here are seven-day averages as it evens out inaccuracies in testing over weekends.

A rising positivity rate in a region indicates that the virus is spreading fast within the community. As a rule of thumb, tracking a region’s positivity rate serves as a good barometer for whether cases are going to increase or decrease in the coming days: a rising positivity rate generally means cases will rise in the immediate future, while a dropping positivity rate tends to precede a drop in new infections.

Importantly, this trend has sustained without daily tests going down in the majority of the country. In fact, the number of daily tests in the country have increased 5% between May 7 and May 17 – on average, a total of 1,813,242 samples were tested every day in the country in the past week, against 1,724,665 on May 7.

Regions with best improvement
Delhi saw India’s biggest change in average positivity rate in the past 10 days – there was a 14.3 percentage point drop between May 7 and May 17 (from 27.4% to 13.1%). It was followed by Chhattisgarh, where the positivity rate dropped 13.2 percentage points, from 25.4% to 12.2% in the same time period, and Haryana, where it dropped 10.4 percentage points.

Goa features in the fourth spot in terms of most improved positivity rate (drop of 9.8 percentage points), but despite the drop, the state still has the highest positivity rate in the country. In the past week, more than a third (36.5%) of all samples tested in the state have returned positive for Covid-19. The coastal state has been in the news over the past two weeks due to severe shortage of hospital beds and medical oxygen resulting in dozens of deaths. But a drop in positivity rate offers the region some much-needed light at the end of the tunnel.

Other regions that have seen significant improvements in positivity rate are Jharkhand (a fall of 8 percentage points, from 15% to 7.0%), Bihar (down 7.5 percentage points, from 14.8% to 7.2%), Madhya Pradesh ( 19.3% to 12%), Maharashtra (down 6 percentage points from 21.7% to 15.6%) and Uttar Pradesh (down 6 points, from 11.9% to 5.9%). Uttar Pradesh, Maharashtra, Bihar and Madhya Pradesh are four of India’s five most populous states – together housing more than 40% of the country’s population.

This phenomenon is clearly reflected in the drastic reduction on the load on India’s health care system in these regions. Pleas for help on social media for life-saving resources like hospital beds, medicines, oxygen, even ambulances had become commonplace towards the peak of the outbreak in regions such as Delhi, Maharashtra and UP. Over the past 10 days, the shortage of supply in these regions have dropped.

Nagaland, meanwhile, is the only north-eastern state where positivity rate is dropping (down 0.9 percentage points, from 21.7% on May 7 to 20.8% on May 17).

States and UTs with rising transmission
A majority of India’s south and the northeast, meanwhile, is at the other end of the spectrum. In Meghalaya, the positivity rate rose from 11.1% to 17.7% between May 7 and May 17 – a rise of 6.7 percentage points, the highest in India. It was followed by Andhra Pradesh, where positivity rate jumped from 18.7% to 24.4% (up 5.8 percentage points), and Tamil Nadu (from 15.2% to 19.8%, up 4.7 percentage points). Manipur (14.2% to 18.3%) and Karnataka (28.4% to 32.4%) both saw positivity rate go up 4.1 percentage points. Sikkim and Karnataka registered the second and third highest positivity rate in the past week – 32.6% and 32.4% respectively. Sikkim has seen the sixth highest rise in positivity rate in the past 10 days – of 3.4 percentage points.

Other states with high positivity rate (and rising) are Kerala (up 0.4 percentage points to 26.9%) and Odisha (up 0.4% to 20.9%).

One state and two UTs – Mizoram, Lakshadweep and Daman and Diu, Dadra and Nagar Haveli – were excluded from the analysis due to unavailability of consistent testing data.

During health ministry’s weekly Covid-19 briefing on Tuesday, Niti Aayog member (health) VK Paul said, “We have to be very mindful that when we are achieving declining positivity rate it is because of the results of what we are doing and that cannot be slackened. We cannot again let this go out of hand again.”

“In many states the pandemic curve is stabilising, as a result of comprehensive efforts at containment, at testing, restrictions, and all the other efforts that people of those states are carrying out — the states such as Maharashtra, Kerala, Karnataka, Telangana, Uttar Pradesh, Delhi, Rajasthan, Bihar, Chhattisgarh, Madhya Pradesh and so on,” he said. He added that there were still a few states where there continues to be concern such as Tamil Nadu, Andhra Pradesh and West Bengal, among others. “It is a mixed picture but there is overall stabilisation, and what we know from scientific analysis that the reproduction number (R0) is overall below 1 now,” said Paul.

Experts, however, say it is too early to let the guard down. “While most governments were reluctant to enforce lockdowns, it appears those measures are now starting to yield results… It is not a good time to celebrate decrease in numbers as we are dealing with an infectious disease and it is way too early to say which direction the spread is going to take, especially since the disease has reached rural and tribal areas where health infrastructure is weak and it won’t be able to test each and every individual there,” said Dr Lalit Kant, former head of epidemiology at the Indian Council of Medical Research. Hindustan Times