There are reports of a new swine flu in China, and some news outlets claim it could be the next potential pandemic, but I’m going to ignore it for two reasons. One, we are still dealing with one pandemic which originated in China and is currently raging through the world (10.4 million cases and 510,000 deaths, and still counting). Two, China remains a black box when it comes to information — we still do not know a lot about the origin and the early growth of the coronavirus disease in that country, nor do we know enough about its current status in remote provinces.
Which is why the US is a good country for India’s health policy mandarins, researchers, and epidemiologists to study. Sure, India’s population is much larger (1.3 billion compared to the US’s 330 million) but the US is larger by geographical area (7.7 million sq km to India’s 3.3 million sq km). And like India, the US is also divided into many states, and has many large cities (although its population density is lower than India’s). There’s more and better information coming out of the US too.
As this column pointed out last week, things have taken a turn for the worse in that country. On Tuesday, at least 48,000 Covid-19 cases were registered in the US, the highest single-day tally thus far, and driven almost entirely by a rising number of cases in previously relatively unaffected states such as Arizona and Texas.
That is an important learning for India.
Maharashtra, Delhi and Tamil Nadu accounted for 61% of the new cases on June 30, continuing a trend that has been in play for almost two months, maybe even longer, but there are signs (and I’ve discussed them in detail in recent instalments of this column) that things could get better in Delhi and Tamil Nadu, barring a sudden spike caused by what can only be described as moments of collective madness (for instance, the curious instance of the crowd in the vegetable market in Chennai). By the third week of July, if not the middle of the month, these states (fine, one city-state and a state) could see a sustained decline in new cases. Delhi has also been seeing the number of daily deaths stabilise in the mid-60s (for the past two weeks).
I won’t discuss Maharashtra because (again, as I have said before in this column) the state is most likely paying for decades of neglect of health-, civic-, urban-, and transport-infrastructure and simple overcrowding. But, if the US trend is any indication, then, as cases come down in Delhi and Tamil Nadu, and as India continues to open up, allowing more movement and activities, new hot spots will emerge in other states.
Sure, Delhi and Tamil Nadu are still hot spots (the first saw 2,199 new cases on Tuesday and the second 3,943), but if they seem to have gotten their hands and heads around managing the pandemic, it is on the basis of extensive testing. Delhi has tested close to 28,000 per million of its population, and Tamil Nadu 17,200. The rest of India isn’t testing as much as Delhi, Tamil Nadu, and Maharashtra. These three states account for 2.67 million of the 8.82 million tests carried out in the country. When the tests and the populations of these three states are included, India has tested around 7,000 people per million of its population; when they are excluded, it has tested 5,780 per million. And some states have tested far fewer, perhaps in an attempt to show that they are managing the pandemic well.
They should increase testing now, instead of leaving it till too late. As China has shown (in Wuhan where there was a potential flare-up of infections, and now Beijing), and, closer home, as Delhi and Tamil Nadu have, it is possible to rapidly increase testing. Sure, the price of doing this will be an initial increase in number of new cases as testing increases, but, over time, this will come down; such testing will also provide the state with information it currently doesn’t possess — the prevalence of the disease in the region.
Testing, tracing, and isolation remain the best way to manage the spread of the viral disease. Just as masks remain the best way to prevent being infected.