Delhi moving into a red zone: Every third person tested is COVID-19 positive

Trends suggest that soon every second person who would be tested would be positive for COVID-19. Further, mortality rate in Delhi is quite high at 3.3%, higher than national average, which is 2.9%

Representative Image (Photo Courtesy: social media)
Representative Image (Photo Courtesy: social media)

Ashlin Mathew

Delhi is moving into a red zone where soon every second test could result in a COVID-19 positive case. On June 13, it took only 2.71 tests to find one Coronavirus positive case. This means there is at least 37% positivity in Delhi, i.e. more than one-third of the people who are being tested are COVID-19 positive.

Let’s consider data for a week. From June 7 to June 13, a COVID-19 positive case was being discovered every 3.13 tests. This increase in positivity is a worrying trend. When we compute the positivity for a month (May 14 to June 13), we see that it took 5.36 tests to find one positive case. The cumulative figure from when the cases began in Delhi is 7.3. An increase in positivity means that fewer number of tests are required to find one COVID-19 positive case. It is inversely proportional.

As of May 14, there were 8,470 COVID-19 cases in the capital and 1,19,736 tests had been done. This meant that one COVID-19 positive case was being found after every 14.1 tests. From May 14 to June 13, 1,63,550 tests were done, and 30,488 cases were COVID-19 positive. Within a month, it took only 5.36 tests to find one COVID-19 positive case in Delhi.

For the last one week, the number of tests required to identify a positive case has decreased further. From June 7 to June 13, 31,324 tests were done, of which 10,022 were COVID-19 positive. This means last week, it took only 3.13 tests to find one positive case.

If we were to look at the numbers for the last three days (June 11, 12, 13), it is quite perturbing. On June 11, it took 2.86 tests to find one COVID-19 positive case, on June 12, it became 2.78 tests and on June 13, 2.71 tests. Trends suggest that soon every second person who would be tested would be positive for coronavirus.

The worrying trend began to show from as far as April. On April 2, it took 10.4 COVID-19 tests to find a positive case. Delhi’s case positivity was already higher than the national average even in April. On April 2, a COVID-19 positive case came up after every 27.2 tests nationally. Delhi should have been worried back then too.

By then Delhi was already in the stage of community transmission, according to Dr Jayaprakash Muliyil, an epidemiologist and former principal of the Vellore-based Christian Medical College.

“What is worrisome is that Delhi’s COVID-19 trajectory is only rising. By the end of June, Delhi is expected to touch 90,000 COVID-19 cases. The present trend shows that the day when every second person tested will be COVID-19 positive is not far away,” underscored James Wilson, who has been analysing COVID-19 data from around the country. As of June 13, there are 38,958 COVID-19 positive cases in the national capital.

We need to remember here that Delhi is only testing symptomatic patients. According to the new guidelines passed on June 5, only ‘symptomatic’ contacts of coronavirus patients are allowed to be tested for the virus. Additionally, all patients of severe acute respiratory infection (SARI) are to be tested too. These testing criteria were more stringent than those released by the Indian Council of Medical Research on May 18, where all contacts of a COVID-19 positive patient had to be tested.

On June 13, Delhi conducted 5,776 tests; on an average, the state has been testing only 5,195 cases this week. ICMR has stated that 41 labs (18 government labs and 23 private labs) in Delhi can test for the novel Coronavirus. That would mean an average of only 128 tests per lab.

“We can conduct up to 2,200 COVID-19 tests per day in Delhi, and we are running to full capacity. We get swabs from Delhi and nearby states. We have already informed the Delhi government than we can ramp up the testing numbers,” said Dr Arvind Lal of Dr Lal Path Labs. Dr Lal Path Labs in north-west Delhi’s Rohini is one of private labs which have been approved by ICMR.

Dr Dang’s Lab in south Delhi’s Safdarjung Development Area tests around 150-200 COVID-19 tests a day. “The testing capacity varies according to the RT-PCR machines and manpower available,” said Dr Arjun Dang, CEO, Dr Dangs Lab.

The testing labs at government hospitals cannot conduct as many tests. According to sources at Maulana Azad Medical College, under which Delhi’s designated COVID-19 facility Lok Nayak Hospital comes, they can test a maximum of 250 samples every day. It is closer to 200 than 250, said sources. The director of Lady Hardinge Medical College NN Mathur said they have the capability to conduct 250 COVID-19 tests and “we test as much everyday”.

Even by conservative standards, if we were to consider both government and private labs were able to test only 200 COVID-19 samples a day, Delhi has the capability to conduct at least 8,200 tests a day. The reality will be a much higher number.

The situation in Delhi needn’t have reached this bad. We only have to look towards Chhattisgarh, a Hindi heartland state. It was expected to do poorly in this pandemic, but has done extremely well. In fact, if we consider certain parameters, it has done better than Kerala.

While Chhattisgarh has a population of 2.9 crore, Delhi has a population of 2.02 crore. On April 2, Chhattisgarh had conducted only 930 tests, of which nine people tested positive. On the same date, Delhi had conducted 3,038 cases and there were 293 COVID-19 positive cases.

As of June 12, Chhattisgarh has conducted 1,03,740 tests of which 1,429 turned out to be positive cases. Here it takes 72.6 tests to find one COVID-19 positive case. Commendably, there have been only 6 COVID-19 deaths so far in the state, which makes the mortality rate of the state 0.4%. The total number of tests in Chhattisgarh does not include the 52,485 rapid anti body tests conducted by the state to find out instances of community transmission.

The World Health Organisation calculates mortality rate by dividing the number of deaths by the number of officially confirmed cases.

Meanwhile in Delhi, 2,83,239 COVID-19 tests have been conducted as of June 13. Of these, 38,958 are the confirmed COVID-19 positive cases. In the national capital, 1,271 people have died so far. The mortality rate in Delhi is quite high at 3.3%. This is higher than national average, which is at 2.9%. Delhi’s mortality rate is 8.25 times higher than that of Chhattisgarh.

What did Chhattisgarh do differently? The government stepped in, built make-shift quarantine centres and took over private hospitals. And that has made all the difference.

“Initially, when the numbers were low, people were quarantined at home. When the movement of people to our state had started, we had more than one lakh people in public COVID-19 Care Centres. We had four waves of people to take care of – those who came from abroad, those who came after a religious meeting, students who came from Kota and migrant workers,” explained TS Singh Deo, Chhattisgarh health minister.

The number of migrant workers estimated to reach Chhattisgarh was 2.5 to 3 lakh in May. “But, we made quarantine arrangements (schools, ashrams and other such places) for about 5.5 lakh people. So far, about 3.25 lakh people have come back until now and currently 1.30 lakh people are in public quarantine. We expect another lakh more to come in. Again, these are identifiable people, so we have been able to contain the spread,” added Deo. The main thing is to separate people coming from outside before they meet others and spread it, underlined Deo.

Chhattisgarh has been able to identify most of those who came in. “The more you are not able to identify the people, the more you will not be able to contain it. So, of the 1,400 cases reported so far, we have not been able to identify the origin of the virus in only 50 people. But, it is a cause of worry because they have no travel history. Though these people are there, community transmission isn’t there yet in Chhattisgarh. But, we are worried,” said Deo.

Chhattisgarh was the first state to take over private hospitals. The state has already identified 922 ventilators (public and private) – 300 for babies and 622 for adults. “We had to stay ahead of the requirements. We have identified 22,000 beds in government hospitals and institutions for isolation and treatment. There are more ventilators in the state; some of which have been left for other treatments,” added Deo.

Chhattisgarh has tried to err on the side of caution. “We may be seen to do more than what is required at that point in time, but that is the way one should do it. Containment is the solution. Today there are more cases in Chhattisgarh, because they came from urban areas. Urban areas should look at containing the virus as we cannot stay locked down forever. The strategy has to be to live with the virus, just like how Hong Kong has been doing,” underscored Deo.

Delhi can be compared to Kerala too. On April 2, Kerala, which has a population of 3.5 crore, had done 8,421 tests and 295 had tested positive. On the same date, Delhi had conducted 3,038 tests and there were 293 COVID-19 positive cases. Even with fewer tests, an equal number of people had tested positive in Delhi on the same date.

By June 12, Kerala had done 1,40,457 tests, of which 2,322 tested positive. Even with the influx of people from outside the state, it takes 60.5 tests to find one COVID-19 positive case. Nineteen people have died of COVID-19 in the southernmost state and the mortality rate of Kerala is 0.8%. The national capital has registered 1,271 deaths, and this makes the capital’s mortality rate almost four times that of Kerala’s.

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