NEW DELHI: The weekly growth rate of coronavirus testing during the second wave of pandemic reveals how grossly underprepared were the states to handle the crisis.
The unprecedented growth rate of cases dwarfed any attempt by states to increase their testing capacity and check the transmission of the virus.
States across India fumbled as the second wave gripped the country. Though the number of tests conducted per day was increasing, there was a wide gap between growth rate of cases and growth rate of testing.
Why measure growth rateTesting, as we all know, provides a window into the pandemic. Without testing, it is impossible to get a clear picture of the extent of the transmission on the ground.
For a rapidly spreading virus such as Covid-19, speed is the essence. Ideally, testing should be one-step ahead of transmission so that infected people can be traced, quarantined and the chain of transmission broken.
Hence, the weekly growth rate of testing and not just the daily increase in the number of tests conducted becomes a more credible unit to measure the pandemic.
The plot of the weekly growth rate of testing against the weekly growth rate of rise in the number of cases revealed that though testing capacities were being increased on almost daily basis, the rate of this increase was not substantial. States either didn't have the required resources to expand or failed to take necessary action to check the spread of the virus.
States that didn’t actThere were several states that -- either due to paucity of resources or lack of initiative -- didn’t increase the pace of testing when hit by the second wave.
“When the second wave started, we should have had excess capacity to test much more, and using test positivity increased testing, anticipated and made policy changes. But either we didn’t have the capacity or were not doing much contact tracing and testing of household contacts,” says Vincent Rajkumar, professor of medicines at
Mayo Clinic
in Minnesota, United States.
Delhi was in the midst of a severe second wave in the first week of April. However, the rate of testing remained around 3%; in fact when cases were exponentially rising in Delhi in mid-April, there was a dip in the growth rate of testing.
In Delhi, as the growth rate of cases increased by an unprecedented 19%, the rate of increase in testing, ironically, came down to 2.67%.
The dip in testing could be due to healthcare systems getting overwhelmed. For example, in Delhi, it took 3-4 days for people to receive a test report, instead of 24 hours.
In Jammu and Kashmir, Bihar, Uttar Pradesh and Odisha, the maximum growth rate of testing during the second wave increased by not more than two per cent, even as the cases increased by as much as 23%.
However, experts believe that though a lack of growth in testing rate was an important factor for the second wave, it would not have been sufficient to control the raging growth in cases.
“The fact that Delhi which has close to the US level of testing has done so badly tells you that more testing may not have solved the problem because the exposures that occurred in January/February were so massive on a nationwide scale that short of strict lockdowns in mid-March nothing could have stopped this,” says Rajkumar.
The exceptional case of NagalandBarring the exception of Nagaland, none of the state's testing growth rate, or the speed at which tests were conducted, came anywhere close to the growth rate at which cases were increasing during the second wave, the data revealed.
In Nagaland, the second wave of coronavirus started in the first week of April. The cases peaked by the end of the second week of May when the cases were growing at a weekly rate of over 12 per cent. The state's Covid-19 testing capacity was accordingly ramped up.
Before the start of the pandemic, Nagaland was increasing its testing capacity by 0.6%. As the weekly growth rate of cases increased to over 11%, the testing capacity was hiked by twenty times to over 12 per cent.
The states that actedGujarat witnessed the highest growth rate in Covid-19 cases during the second wave — from 0.6% to 18.6%. During this period, the state increased the weekly growth rate of testing by over 5 percentage points — next only to Nagaland and Tripura.
The coronavirus testing capacity in Tripura was increased by nearly 6 percentage points during the course of the second wave. Assam responded with urgency and increased the weekly growth rate of testing by four percentage points in two weeks. As the growth rate of cases in the state increased to a high of 11%, the weekly growth rate of testing has hovered around 4-5%.
Maharashtra was more consistent in increasing its testing rate. The testing rates in the state were on top of virus transmission until mid-March. It is also the state where the weekly growth rate in cases during the second wave was among the lowest in the country. Nevertheless, the testing capacity in the state increased by nearly five percentage points -- one of the highest in the country.
Early rise in positivity rate should have alerted statesThe test positivity rate, i.e.the share of total Covid-19 tests that are positive, increased to nearly 10-15% in several states, even before the onset of the second wave.
"With test positivity rates of 10-15%, more testing could not have averted the crisis. The prudent course would have been to anticipate the crisis based on change in test positivity and rise in case numbers and basically have a policy that everyone is considered as having Covid-19 and has to act accordingly, with masks, social distancing, and avoiding crowds and crowded gatherings. Unfortunately this should have occurred quite early. Once cases visibly started climbing rapidly, the problem was already set in and too late to reverse," Rajkumar says.
Testing numbers not enough India has conducted the second highest number of cumulative tests after the US. However, considering its massive population, the numbers pale.
When compared in terms of population, India has been testing far less than other countries throughout. India is on par with Brazil at ~220 tests per million population. Whereas the US, France, Spain and Germany are at 1000-1300/million. The UK has done better with 2500.
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