India looks set to cross the 100,000 mark, in terms of number of Covid-19 infections, as this column is being written on Monday afternoon. The country touched 95,656 cases on Sunday night, adding 5,084 cases to Saturday’s total. The number of deaths was 2,951 on Sunday night, so that number looks set to cross 3,000. The number of tests per million of its population, according to worldometers.info, was 1,671. The fatality rate (number of dead expressed as a percentage of number of cases) in India is 3.08%, which would put the country between Turkey (149,435 cases; 4,140 deaths; fatality rate of 2.77%) and Germany (176,651 cases; 8,049 deaths; fatality rate of 4.56%). The Turkey and Germany data is also from worldometers.info. But there is one big difference.
India’s 1,671 tests per million of its population is dwarfed by the number of tests done by Turkey and Germany. The comparable number for Turkey is 19,293; for Germany, 37,584. India is 11th on the list of countries in terms of number of cases – and not one country in the top 10 has tested fewer people per million of the population than India has. Indeed, only two countries have tested fewer than 10,000 per million – Iran (No.10 with 120,198 cases and 6,988 deaths), which has tested 8,191 per million; and Brazil (No. 5 with 241080 cases and 16,122 deaths), which has tested 3,462.
As India enters the next phase of its exit from a complete lockdown – that’s what the next two weeks to May 31 are, more than an extension – testing becomes even more significant. Only widespread testing can show the real extent of the spread of the viral pandemic. Apart from continuing to use the gold standard RT-PCR (reverse transcriptase, polymerase chain reaction) test, India should also use antibody blood tests because these are a good measure of who is immune, who isn’t, and how prevalent the disease is. Sure, there are problems (not just in India, but everywhere else; even in the US) with most antibody tests, but some are better than others – and the new generation ones will be even better because that’s how such tests evolve.
This writer’s hypothesis is that roughly 10% of the Indian population is already infected with the Sars-CoV-2 virus that causes the coronavirus disease. Many people who get infected by the virus, we know, are asymptomatic; and many of the infections are mild. The beauty of the 10% number is that it would immediately take down India’s fatality rate by a tenth (which is more like viruses we know). To be sure, this wouldn’t apply just to India. The US, for instance, probably has far more cases than the 1,527,664 it has recorded (90,978 deaths). That would bring down its fatality rate from the current 5.9%. Limited antibody tests in parts of the US have shown 10-20% of the sample tested being infected (or having been infected), although these studies have been too small.
India can open up fully by testing enough people; if it doesn’t want to do that, it can still open up by treating anyone with even the mildest symptom as a Covid-19 patient and assuming that a certain proportion of the population (say 5%, though 10% would be better) already has Covid-19. If it tests more it will find more cases – which is what is happening in Tamil Nadu (639 cases on Sunday; 11,224 cases in all; and 4,590 tests per million); Delhi (422 cases on Sunday; 9,755 cases in all; and 7,147 tests per million); and perhaps even in Maharashtra (2,347 cases on Sunday; 33,053 cases in all; and 2,393 tests per million), Gujarat (391 cases on Sunday; 11,380 in all; and 2,291 tests per million), and Rajasthan (278 cases on Sunday; 5,202 cases in all; and 3,366 tests per million). These five states accounted for 80% of the new cases on Sunday.
If this is true – this writer’s opinion is that it is – then the low number of cases on Sunday in West Bengal (101), Uttar Pradesh (206), and Madhya Pradesh (187) are likely misleading. The number of tests per million in these states are only 952, 843, and 1,418 respectively. Interestingly, it is only 1,293 in Kerala. While there is a lot to be said for the state’s aggressive contact tracing and quarantining protocols, and also for its quality of health care, Kerala too, I believe, will discover more cases of Covid-19 if it tests more.