Expert view: Covid-19 resurgence... Why Pune, again?

For the last two-three weeks we are observing a rising trend of Covid-19 cases in Maharashtra

For the last two-three weeks we are observing a rising trend of Covid-19 cases in Maharashtra.

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Pune is showing this rise more prominently. As of March 13, Pune has the highest number of cases in the country. Why Pune again?

As if Covid-19 is just proving the local proverbial saying about the city, Pune tithe kay une? (Everything in abundance in Pune.)

Take a look at the statistics. On September 10, 2020, when the state was reporting its almost highest daily tally of 23,446 cases, Pune reported 5,939 cases in a day, approximately 25% of the state tally.

Pune’s proportion of Pune of the state’s Covid-19 morbidity figures ranges between 20%-25%, even if you consider the cumulative tally, or the tally of January 31, when Pune reported one of its lowest daily figures of Covid-19.

There is nearly a 10-times-rise in the daily reported cases in Pune on March 14, 2021, as compared to its January 31 figures.

At any given time, every fourth or fifth Covid-19 case in the state is from Pune district.

In the last week of January, when the weekly positivity rate of the state was 4.65%, Pune’s positivity was 7.40%; and in the current week of March 2021 when the state’s positivity rate is 14.66%, Pune’s positivity rate is higher than 20%.

It categorically explains that Pune district never achieved the desired positivity rate indicative of effective covid-19 containment. We are also doing genomic surveillance as per the Government of India (GOI) guidelines. But, any variant of such concern has not been detected so far. One important observation is case fatality, which is on the decline, indicative of low virulence of the circulating virus at present.

Current figures show that Pune district is witnessing a second surge of Covid-19. What are the reasons for this rise, especially after a declining trend since October last year?

The first one is related to the weather. In February the state observed a fall in minimum temperature by 5-7 degrees Celsius, due to a cold wave in north India. This fall in temperature is more pronounced in the Pune and Vidarbha regions. Obviously, this is a conducive environment for Covid-19 transmission.

In January there were gram panchayat elections in almost 14,000 villages across the state. Voting turnout was more than 80 per cent. This election facilitated state-wide social intermingling. We have observed an increase in cases in blocks like Shirur of Pune district, where these elections were fought vehemently.

Family celebrations like marriages were on the rise after unlocking, and started in a phased manner with pre-Covid fervour.

The reluctance of the public to observe Covid-appropriate behaviour is an important root cause of the surge. It’s true that many of these factors have been observed all over the state; however, interplay of different variables and local conditions displayed different epidemiological pictures in different areas of the state.

Even after discussing these common factors, the question still remains unanswered about Pune’s curious situation.

Why is this particular district the most affected in the entire country? Why Pune?

A cursory look at the Influenza A H1N1 pandemic will reveal a similar situation. During the 2009 pandemic also, Maharashtra and Pune had topped the influenza morbidity numbers. In the entire last decade, Pune always reported the highest number of Swine flu cases. In their study regarding “Dynamics of Influenza Seasonality at Sub-Regional Levels in India and Implications for Vaccination Timing”, Mandeep Chaddha, et al, emphasised the role of climatic factors and topography in disease transmission. It appears that Pune’s hot semi-arid or steppe climate, with an average temperature of between 20 to 28 degrees Celsius is one of the most important reasons for higher transmission rate of diseases like Swine flu and Covid-19.

This difference is more evident when we compare the Mumbai situation with Pune. This factor needs further exploration with inputs from experts in climatology. Approximately 70% of the Pune population is urbanised with nearly 40% residing in slums. The population density of Pune city is 9,400 per square kilometre, which is way ahead of the state average of 603. The decadal growth rate of Pune is 36, which is almost more than double the state’s decadal growth rate of 16. It must be kept in mind that the decadal growth rate of Mumbai is -5.75.

As an educational hub and industrial hinterland, Pune is the most preferred migration destination for job seekers from various states. The World Economic Forum’s report of 2017 mentioned that Pune has now emerged as a counter magnet of Mumbai.

All these factors have raised huge challenges for urban local bodies in providing essential services adequately to its populace, including public health when there’s a manpower crunch.

Surveillance is the soul of outbreak containment. Though Pune managed surveillance activities well in the initial phase of the pandemic with the help of manpower pulled from various other departments, it’s difficult to sustain the tempo once this manpower is withdrawn during the declining phase of the disease. In cities like Pune, it is breath-taking to keep pace with a rapidly growing population in terms of building health infrastructure. Sassoon hospital is the only government tertiary care centre for its four-million population. Even for Covid-19, only 23 per cent of dedicated beds are available in government institutions. Covid-19 pandemic laid open these inadequacies substantially.

Though with proactive administration and effective resource management Pune is doing every necessary thing to contain the Covid-19 menace, long-term planning, and action plans to develop urban public health infrastructure are need of the hour. With expanding its hospital and laboratory network and ensuring surveillance activities, Pune managed the August-September surge well. Its surveillance-centric approach will help to curb this second surge too. But, lessons learnt during these phases should not be forgotten. These lessons must be translated into action.

The author is state surveillance officer, Integrated Disease Surveillance Programme, Maharashtra