Why Bihar should be conducting more Covid-19 tests than Delhi is
An HT analysis based on the latest Sample Registration System (SRS), National Sample Survey and Covid-19 testing statistics suggest otherwise. It tells us why a state like Bihar is more likely to fail to detect Covid-19 infections and deaths than a place like Delhi or Kerala.Updated: Jul 16, 2020 08:11 IST
Earlier this month, a wedding in Patna district became the biggest Covid-19 hotspot in Bihar. The groom, who had come from Gurugram had been feeling unwell a few days before the wedding and wanted it to be postponed. However, his family did not agree and forced him to go ahead. Even on the day of wedding, he was made to take paracetamol tablets and go through the rituals. The groom died two days after the wedding. His family cremated him without informing the administration. However, the administration came to know about it. Close relatives of the groom were tested. Fifteen of them were found positive for Covid-19 infection. Of the 364 people who were traced to have participated in the wedding, 86 were found Covid-19 positive.
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The entire episode seems to be a result of recklessness on part of the groom’s family. An HT analysis based on the latest Sample Registration System (SRS), National Sample Survey and Covid-19 testing statistics suggest otherwise. It tells us why a state like Bihar is more likely to fail to detect Covid-19 infections and deaths than a place like Delhi or Kerala. Here’s why.
The latest SRS data gives a state-wise breakup of type of medical treatment received before death. There are four categories under this head: government hospital, private hospital, qualified professional and untrained functionary and others. Bihar had the lowest share of deaths (32.1%) where the medical treatment was in a government or private hospital.
Data on tests per million people compiled by HT shows that Bihar also had the lowest testing per capita among the 22 large states for which data on the treatment received before death is available in the SRS data. To be sure, Bihar is not the only state facing this challenge. Chart 1 shows a scatter plot of Covid-19 tests per million and share of deaths where medical attention before death was at a hospital. States such as Bihar, Jharkhand, Chhattisgarh, Gujarat, West Bengal are in the worst quadrant. They have lower hospital attention before deaths and are also testing fewer people. Delhi is in the best quadrant. It has the highest per capita testing as well as the highest proportion of deaths where treatment was in a hospital. Kerala, scores badly on per capita testing, but does well on hospitalisation attention before deaths. Assam has a poor score on hospitalisation attention before death, but it has done well in per capita tests.
States that have low per capita testing and low hospitalisation rates even in the event of life threatening illnesses will find it difficult to deduct Covid-19 infections, fatalities, and therefore, possible hotspots in time.
To be sure, Bihar fares relatively better when it comes to share of deaths where medical attention was received from an untrained professional. It was ranked sixth among 22 states for which data is available. Also, 40% of deaths received attention from a qualified medical professional before death in the state, which is the fourth highest among states.
However, the collapse of the health system after the pandemic could have made access to doctors more difficult in the state.
In an analysis in April this year, Rukmini S used National Health Mission data to highlight a massive disruption to health service provisioning because of the pandemic.
Bihar has been facing absenteeism from doctors after the pandemic. States with poorly functioning health sector could be facing similar problems.
There is another reason why a more pro-active approach is needed for detecting Covid-19 infections among the poor. A 2017-18 NSS survey on consumption of health services shows that the poor are less likely to report illnesses. Proportion of persons that responded as ailing (PPRA) in the 15 days prior to the survey among the top 20% (by household expenditure) was 2.2 times in rural areas and 1.7 times in urban areas compared to the bottom 20%.
A state-wise comparison of PPRA figures from the NSS and life expectancy statistics from the latest SRS suggests under-reporting of illnesses in states such as Bihar. Bihar has the lowest PPRA figures among the 22 states for which life expectancy statistics are available in the SRS. However, this does not mean that Biharis are the healthiest people. This can be seen from the average life expectancy levels. In contrast, a state like Kerala has the highest level of both PPRA and life expectancy.
People not reporting themselves as sick when they are unwell, not visiting a hospital when they might be dying, and the state not testing enough to compensate for these institutional oversights is a dangerous combination during a pandemic.