Most discussions on India’s Covid-19 outbreak centres on the high number of cases, now third in the world after the United States and Brazil. The messaging from the government has been that things are getting better. However, a broader look at the month’s data shows that cases are growing fastest in India among the worst affected countries, and improvements in India have plateaued.
Not only that, but India is gradually inching towards registering the highest number of daily new cases. Since last week, it has consistently added over 40,000 new cases every day, and on Monday, July 27, it was just 5,000 cases away from reporting the highest daily rise in cases in the world. India reported nearly 50,000 new cases, just behind the US, which added a little less than 55,000 cases on the day. Incidentally, Brazil at the third spot added less than half the number of cases as India.
Despite having the world’s third-highest caseload, India’s cases are growing faster among the 10 worst-affected countries. In fact, India has one of the world’s highest growth rates in cases; just 18 countries out of nearly 200 are growing faster, but all of them (except Argentina with 1.5 lakh cases) have only a few hundred or few thousand cases. In the worst-affected US, cases are doubling in 40 days, while in Brazil, they are taking 36 days. In India, cases are doubling in 19 days.
The seven-day rolling average of India’s daily additions is also sloping upwards and competes with that of Brazil and the US. According to ‘Our World in Data’, as of July 26, India’s average daily additions were around 44,000; the same was 45,600 for Brazil. The US tops the chart with daily additions averaging 66,600.
Epidemiologist Giridhar R Babu believes this increase in cases should not worry us as increased detection helps in early isolation. “Starting with just a few labs, India has come a really long way in detecting these many cases by expanding testing throughout the country. However, there is still scope for more testing, especially in areas with low case detection. We should not worry about the absolute number of cases, as increased detection helps in saving more lives by early isolation and timely management,” said the professor and head of lifecourse epidemiology at Public Health Foundation of India.
Doubling time of cases
One widely used indicator to measure change over time is “doubling time of cases”. This is the daily increase in cumulative cases expressed in terms of the number of days taken for cases to double, usually as a seven-day average. This is one indicator in which a rising graph is a positive trend, as it shows cases are taking longer to double and growing more slowly.
Data shows that for the first time since the pandemic began, India has had a month of no improvement in doubling time of cases. On June 24, cases were taking 19 days to double, and by July 24, little had changed. In comparison, in every previous month, the doubling time of cases grew significantly. This despite cases now growing from a much higher base.
Compared to the other two worst-hit countries the United States and Brazil India’s month of no improvement is particularly worrying. Brazil has had a month of steady improvement, while India plateaued, and the US first rapidly worsened, and may now be stabilising.
Professor Vineeta Bal, immunologist and faculty at IISER Pune, however, believes that every additional case count is not necessarily a patient. Speaking to India Today, she said, “Though India is facing a high number of daily new cases, we should note that not all of them are patients. Suppose India tests 3 lakh people today, of which 50,000 test positive, most of them will not be patients since they aren’t unwell or need physician’s assistance. Hardly 500- 1,000 of them might need oxygen or ventilators. Thus, it will be incorrect to categorise all of them as patients.”
“The major reason why SARS-CoV 2 cases are growing rapidly is because we have increased daily testing tremendously. And the reason as to why so many people are catching the virus is because of its high degree of contagiousness as it can spread through coughing, sneezing or face-to-face contact. Even if the government denies it, there is no stopping community transmission”, said professor Bal.
Within India, as the current outbreak slows slightly in the worst-affected states of Maharashtra, Tamil Nadu and Delhi, cases are now growing fastest in the three southern states of Andhra Pradesh, Karnataka and Kerala, and four northeastern states of Sikkim, Arunachal Pradesh, Tripura and Meghalaya.
The worst, it would appear, is yet to come.