Truth & tests

India should be holding its breath. So far, the pandemic has claimed — according to the Union Ministry of Health and Family Welfare — just over 15,000 lives. This puts it at eighth slot in terms of the number of fatalities. In terms of deaths per million people, this comes to about 11 — far lower indeed from the figures for European countries such as Britain, Spain and Italy, which had about 600 deaths per million.

There are two ways to read these figures. You might call them the optimistic and pessimistic view; but they are, perhaps more accurately, the naïve and the realistic view. By the optimistic reading, India or Indians possess something special that prevents Covid-19 from truly taking hold. Some have speculated about environmentally-built up resistance; others claim that early inoculations might have something to do with it. Of course, there is no question that India is a much younger country on average than the European nations that have suffered the most per capita. But that itself may not be sufficient to explain the low fatality rate per capita.

The realistic view, however, takes a somewhat more questioning approach to the data itself. As the data reporter Rukmini S, who has been tracking this issue, has pointed out India’s mortality data was problematic even before the stresses of the pandemic. For example, official data suggested that there were only 200 or so deaths from malaria in 2017; the true number might have been as much as 250 times higher. It is possible that, during a pandemic, even greater undercounting will happen. We have all heard reports of possible Covid-19 patients being turned away from hospitals, or people dying with severe respiratory symptoms being denied tests.

In short, we cannot rely on the mortality numbers for large parts of the country. 

Some have however pointed out that, whatever the official numbers say, you cannot ignore large numbers of deaths or a health infrastructure that has run out of capacity. To that, I can only say: Have these people lived in India? Of course we can, depending on who and where. In Wuhan, the only reliable guide to the 
eventual number of deaths was crowdsourced estimates of crematorium usage. Let us hope we never get to that position here.

For those who are truly interested, there are multiple stories from the interior of India of people being buried or burned without intervention or in some cases even a priest, because of fear of infection. Never have I been so firmly reminded of how far we still have to go in building an effective state.

And, of course, there is one obvious point that those making this argument forget: If we reach the point where the health infrastructure is visibly running out of capacity, it is already too late! It is absurd to suggest that policy can be made on the assumption that we should only prepare for the worst when the worst has already occurred.

Thus we are perforce thrown back on what we knew from the beginning: a testing strategy that is open, transparent, and widespread. We should test not just suspected contacts, but all suspected cases and indeed make antibody tests widely available so we can track the course of the virus across our communities.

 
The worst that the government, Union or state, can do is to try and conceal the extent of the danger from us. Information, not fear, is what Indians need — and incidentally, what investors and the economy need as well.

Many state governments have faltered in the past on testing. Some have partly corrected their attitude, such as West Bengal, where even the governor has now had to admit testing rates are improving. Others have gotten worse. Telangana is testing only 2,000 or so per million for example — compare that to almost 15,000 per million in Andhra Pradesh!

Overconfidence is never warranted. Karnataka, which a few weeks ago was being so publicly smug that the chief minister had his justly controversial Bengaluru MP photograph the two of them having a masala dosa at MTR, may have to lock down Bengaluru again after a spike in cases.

And then, of course, there is Uttar Pradesh, a special case in every way. The prime minister, no less, has singled it out for commendation, and the Union health secretary has, no doubt under instruction from his political masters, prepared a presentation on the “Agra Model”. I would like to say this flies in the face of the evidence, except there is no evidence. The Hindu data team has noted that UP is the  worst state in terms of transparency; news agencies have reported that the chief minister has complained he is not getting “accurate” data when the Health Department’s numbers seemed high in comparison to other trackers; and, despite a very low testing rate, the number of positive cases identified per test is puzzlingly few. Uttar Pradesh’s leaders may think that this is just another crisis, in which headlines are what need to be managed. But it isn’t.

The answer, for every state government, remains the same as it ever was: test, test, test. Identify, trace, target lockdowns and containment zones. Repeat until vaccine. There is no pay-off to concealing the facts or overconfidence. The virus doesn’t care.


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