REALITY CHECK

Pathogen load

highest spike of 3,900 new cases and 200 COVID-19 deaths. It, in fact, broke the previous record spike of 2,293 new cases, documented just two days ago. On March 24, the day the nationwide lockdown was announced, India had only 571 cases. By May 13, the country had 78,003 cases, or 136 times hike in cases.

Government officials, however, claim that significant achievements have been made. One of the most significant gains, they say, is cutting the chain of transmission by achieving a long doubling rate—this rate denotes the number of days in which cases double, indicating a slow spread of infection. On the face of it, this is a prologue to the still elusive objective of “flattened curve”. Agarwal, who holds daily pressers, has claimed several times over the past month that doubling rate, which was three days when lockdown began, has increased beyond 12 days; on May 10, he lowered the figure to 10.

But several experts do not think that it is a valid indicator. “You have to look at the baseline figure,” T Sundararaman, former head of the Union health ministry’s National Health Systems Resource Centre, tells

(DTE). Cases, when in hundreds, would take fewer days to double as compared to cases that are in thousands. Now, saying that the 45,000 cases have taken more than three days to reach the 90,000-mark and calling it an achievement is nothing but a farce, he says, adding that counting the number of days it takes for every 5,000 or 6,000 new cases to appear would offer a more realistic scenario.

Using 5,000 new cases as the base, DTE did an analysis to understand how the pandemic has progressed in the country and found that 5,000 new cases are being reported every two days since April 30 (see 'Reality check'). This indicates that the spread is far from slowing down.

Another tool that epidemiologists often employ for assessing progression of a pandemic involves comparing three-day rolling average, or the average number of new cases reported every three days. Worldometer, a private COVID-19 tracker, shows that the three-day average was 76 for India at the beginning of the lockdown; as on May 5, it was 3,060. Worse, when compared with 10 countries that ranked just above India in terms of higher COVID-19 cases that day, all of them had fewer three-day averages, with the exception of Brazil and Russia.

Explains T Jacob John, senior clinical virologist and emeritus professor at Christian Medical College, Vellore: there were 571 total COVID-19 cases in the country when the lockdown was announced. Forty days later, on May 5, the number of cases increased by 80 times to 45,000. If the government says the situation is better compared to its fear of a 200-time rise, then this is a manufactured good news, he says. India incidentally remains the only country, as per daily situation updates given by the World Health Organization, which does not report community transmission despite more than 60,000 cases. All countries that have reached this threshold or have fewer cases have accepted that the infection is spreading in new communities with no clear source of origin.

Another indicator of the progression of a pandemic is recovery rate, which according to the Union health ministry’s official briefing on May

5, stood at 27.41 per cent. The global average is 32 per cent. Peru, a close cousin of India in terms of cases, has a recovery rate of 30 per cent.

By now, it is a cliché to say that lockdowns only help buy time so that there is no sudden pressure on the limited health infrastructure while preparing for the post-lockdown situation when the infection could spiral out of control. Ramping up testing was one of the most important fronts in which preparation was needed. The Union government did increase it to more than 60,000 samples a day in the first few days of May from a few thousands in the beginning of the lockdown. And with 1.27 tests per 1,000 populations, India now stands at the base of the testing spectrum in the world, above only to Bolivia, Kenya, Ethiopia, Nigeria, Nepal, Myanmar, Indonesia and Mexico (see 'Test score'. Even countries like Senegal, Uganda, Zimbabwe and neighbouring Pakistan fare better than India, according to Our World In Data, an online publication based at the University of Oxford that tracks the number of covid-19 tests among others.

Government officials, however, refuse to accept that they were testing inadequately. Only 5.7 per cent people tested were found positive to SARS-CoV-2 before the lockdown, says C K Mishra, who chairs one of the 11 COVID-19 groups empowered by the Prime Minister’s Office, in a presentation on April 23. On April 22, the proportion was nearly the same, at 4.5 per cent, despite an increase in testing. This, he claimed, indicated that the government was not missing out on cases.

Testing has increased significantly in India. While the government still needs to increase its scope, the strategy needs to change, says epidemiologist and economist Ramanan Laxminarayan, who heads the Center for Disease Dynamics, Economics & Policy (CDDEP) at the University of Washington, US. India has so far tested to identify individual cases for containment and to observe growth of the outbreak. Going forward, the purpose would be to identify the elderly population who are at risk and to bring them in for treatment. India will probably need about half a million tests a day at that point,” he tells DTE. India has so far picked up only about 10 per cent of all infections and half of all symptomatic infections, says Laxminarayan, citing CDDEP’s estimates.

All public health experts DTE spoke to agreed that it was inappropriate to test only those with travel or contact histories and symptoms of influenza-like illnesses. Tests should be offered to anybody with fever and cough, especially once the lockdown is phased out.

The fact is, the pandemic is yet to reach its peak in India. A group of researchers who studied the landscape of the epidemic in India, write in medRxiv, a preprint server for research papers, that the country’s COVID-19 curve is likely to peak around mid-July and early August. India, thus, still has around two months to prepare for its worst phase. It must not let its guard down in the rush to return to normalcy.

IF VIRUSES were capable of emotion, they would commemorate the day the World Health Organization (WHO) declared coronavirus 2019 (COVID-19) a pandemic, and celebrated each time a country announced a lockdown to contain the spread of the respiratory illness. For what SARS-CoV-2, or severe acute respiratory syndrome coronavirus 2, has achieved is no mean feat for its family.

Yes, there exist hundreds of coronaviruses out there. Till the early 21st century, they were mostly known to circulate among pigs, camels, bats and cats and caused mild forms of common cold in humans. They caught the attention of virologists in 2002, when one member jumped from a horseshoe bat to a human, possibly via a civet cat, and went on to cause severe acute respiratoy syndrome (SARS) among 8,500 people and killed 900. Just like COVID-19, symptoms included fever, sore throat, shortness of breath and pneumonia. A decade later, another coronavirus, believed to have originated from bats but transmitted to humans via camels, caused a similar outbreak in Saudi Arabia. It was named the Middle

Viruses form just 14% of the total human pathogens. But among new and emerging pathogens, they account for 44%

reservoir in an animal and infect humans when they get a chance. For instance, avian influenza virus (H5N1) caused the bird flu outbreaks in humans when people came in direct contact with infected poultry or surfaces and objects contaminated by droppings or during slaughter, de-feathering and butchering. While the World Health Organization (WHO) maintains that the virus does not transmit efficiently from person-to-person, experts worry. “Animal-human interfaces where humans frequently get in contact with wild animals allow viruses to evolve and jump into humans leading to the emergence of a new virus,” says Pranav Pandit, a veterinary epidemiologist at the University of California, USA. H5N1 is considered endemic in poultry in six countries and at least 15 countries have reported human infections since 2003. It might not be long before the virus mutates to establish a life cycle reservoir in humans and spreads from person to person, infecting even those who have

AVIAN INFLUENZA