On Tuesday, the number of cases in Delhi, Maharashtra, and Tamil Nadu, which drove up the number of India’s coronavirus disease infections for much of April, May, and June, accounted for just 26.5% of the total 50,777 cases in the country, according to the HT dashboard. On Monday, the corresponding proportion was 31% of 49,401 cases. On Sunday, it was 30.7% of 53,112 cases. And on Saturday, it was 30% of 55,617 cases.
This writer has been saying it for some time, but the epicentre of the pandemic in India is moving further into the hinterland and to parts of the peninsula where it did not previously seem to be very prevalent. To be sure, while Delhi has seen a sharp fall in cases, Maharashtra and Tamil Nadu have not – so the new wave is being driven largely by states such as Andhra Pradesh, Bihar, Karnataka, Uttar Pradesh, and West Bengal. On Saturday, these five states accounted for 43.4% of all cases in India; on Sunday, this proportion was 44.17%; on Monday, it was 44.6%; and on Tuesday, 47.6%.
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Some final numbers to close the argument: while these five states account for 29.7% of all cases, they account for 40.7% of active ones currently; and while they account for just about a fifth of all deaths, over the past four days, they have accounted for a third of the deaths (which are continuing to rise). There are other states whose numbers are also a cause for concern (Telangana, for instance, where the testing is also low), but these five are the states where immediate intervention is required.
{{/usCountry}}Some final numbers to close the argument: while these five states account for 29.7% of all cases, they account for 40.7% of active ones currently; and while they account for just about a fifth of all deaths, over the past four days, they have accounted for a third of the deaths (which are continuing to rise). There are other states whose numbers are also a cause for concern (Telangana, for instance, where the testing is also low), but these five are the states where immediate intervention is required.
{{/usCountry}}New Delhi, we have a problem – and it is not in New Delhi.
The trajectories – of the two states and the Capital ravaged by the virus through April, May, and much of June, and of the five states that are now seeing a spike in cases – are telling.
Of the five states, three have already crossed the 100,000 mark in terms of number of cases. The others will, especially as they increase testing (indeed, the efforts to fight the pandemic, of at least three of these five states, have been hobbled by inadequate testing). Some of these states are looking at antigen testing as a quick fix. Uttar Pradesh, for instance, has conducted large-scale testing camps using these testing kits that give results within the hour. Many of them are simply following the Delhi model, one element of which was a sharp increase in testing using rapid antigen tests. These tests respond to the protein on the surface of viruses (unlike molecular tests, which respond to viral RNA, or antibody tests, which respond to antibodies generated by the body to fight the virus), and their biggest advantage is that they are quick. As this column has suggested previously, it makes sense to use them when a large number of people have to be tested in a very short time – for instance, in a containment zone where cases are peaking, but it definitely does not make sense to use them as a substitute for gold-standard molecular tests such as the Reverse Transcription Polymerase Chain Reaction (RT-PCR) one.
Indeed, given that other parameters (such as the occupancy of hospital beds) clearly establishes that the Capital is on the mend, Delhi should probably stop using antigen tests altogether and use only RT-PCR ones. Neither time nor capacity is a constraint (the first is reason enough to use antigen tests; the second, not so – the only way to deal with inadequate testing capacity is to rapidly acquire it).
If antigen tests have to be used – they have to be used the way they were meant to be.
Scientists recommend that negative antigen tests be followed up by molecular tests. The Indian Council of Medical Research also suggests that this be done. That’s because these tests are very accurate in identifying positive cases, but some of the cases they identify as negative are positive.