Behind Bihar’s Covid success rate is less testing

PATNA: Bihar’s Covid positivity rate, death rate and total cases per million population is lower than most states in the country. And, the state’s recovery rate is also better than the most.

How does Bihar measure up to this achievement when its doctor-population ratio is the lowest in the country, with one allopathic doctor for a population of 28,391 (source: National Health Profile, 2018); and having just one hospital bed per 8,645 people.

The answer to this puzzle lies in the Bihar’s low testing rate (1,767 per million population), which is the lowest among eastern India states such as Uttar Pradesh (2,841), Jharkhand (3,566), West Bengal (4,645), Odisha (5,449). Bihar’s testing rate per million is even less than that of Madhya Pradesh (4,019) and Chhatisgarh (4,995).

Infact, Bihar’s testing per million is lowest in the country and is less than one-third of the national average of 6,622 tests per million.

Delhi (29,750), Jammu & Kashmir (28,039), Kerala (23,967), Andhra Pradesh (16,981) and Tamil Nadu (15,393) are much better-off so far as testing is concerned, shows the data compiled by Hindustan Times through

daily health bulletins of the state governments.

The Bihar government has claimed to have ramped its testing capacity from about 2,352 tests per day on June 1 to about 8,500 on Friday last. Chief minister Nitish Kumar on Tuesday set a target of testing 15,000 samples per day.

Bihar’s total testing capacity includes Covid tests done on real-time polymerase chain reaction (RT-PCR), Truenat and cartridge based nucleic acid amplification (CB-NAAT). Bihar has nine labs for conducting RT-PCR tests, including three in the private sector, and has

mobile units to conduct Truenat test in all the districts.

“We are increasing our testing capacity and the increase in cases is because we are testing more. We have already expanded our testing facility to cover all the 38 districts. We are also relentlessly striving to increase our testing capacity so that there are no missing cases,” said Bihar chief secretary Deepak Kumar.

On Monday, Bihar recorded 389 cases — the highest reported in a day since it reported the first three cases of the fast-spreading contagion on March 22. On Fri

day, Bihar recorded 88 new cases taking the total infections to 10,076, from 3,692 cases on May 31. According to Bihar government data, around 70% of the total reported Covid cases during May and June were linked to in-migration of around 2.1 million migrants who returned to the state during lockdown.

Despite high daily growth of Covid cases, Bihar health secretary Lokesh Kumar Singh said there was no reason any alarm as infection rate (positive cases of the total tested) was still very low. In fact, Bihar’s infection or case positivity rate has declined from 7.47% on May 24 (when there was high in-migration and the state was testing about 2,000 samples every day) to 3.20% in the week ending June 28 (when in-migration is almost nil though testing has touched 8,000 perday) and is less than the national average of about 8%.

As on June 28, Bihar’s positivity rate was lower than Delhi (18.38%), Maharashtra (22.01%), Gujarat (9.75%) and Haryana (9.35%) and Uttar Pradesh (3.75%).

The reason for this is again less number of tests than in these states, the data from HT Covid data dashboard shows.

On the same day, however, the eastern state’s positivity rate was higher than that of Madhya Pradesh (2.73%), Andhra Pradesh (2.61%), Jammu & Kashmir (2.56), Punjab (2.45%), Himachal Pradesh (2.41%), Rajasthan (2.35%), Assam (2.27%), Chhattisgarh (2.03%) and Mizoram (0.53%). Except Rajasthan, all of states have low testing rates.

“To me, the Bihar situation is a mixed bag as testing is low and therefore, the infection rate. We will have to see what happens when the states increases per day testing to 15,000,” said Dr K K Aggarwal, former president of Indian Medical Association.

Health experts in Bihar, however, link the decline in Bihar’s infection rate to multiple factors — the lessening of in-migrant after June 1 being one of them.

“Bihar imported the epidemic largely through inter-state travel, whereas states like Maharashtra, Delhi, Kerala, Tamil Nadu and West Bengal did it through international travel too,” said Dr Tanmay Mahapatra, an epidemiologist working in Bihar with previous experience of research in US on infectious diseases.

“The influx of migrants has reduced, which must have reduced the positivity rate. Bihar’s infection growth rate is slow because its epidemic surge was late (first Covid case in Bihar was reported on March 22 vis-à-vis the first case in India on January 30), and the state got time to prepare itself,” he said.

“The trend in the epidemic curve in Bihar is on expected lines and is following the same trend as other states, being slow in the earlier phase, and now rising. So, Bihar can ill-afford to breathe easy about the pandemic response,” added Dr Mahapatra.

The Indian Medical Association (IMA) has also been dwelling on increased testing, but believes that it cannot be the only reason for increase in the number of Covid cases.

“Bihar needs to test the vulnerable section, including doctors, pregnant women and the senior citizens. Its infection rate is also not the lowest in India. Increased testing cannot be the sole reason for spike in cases,” said Dr Ajay Kumar, senior vice-president of the Indian Medical Association, Bihar.

A silver lining for Bihar were its low case mortality rate of 0.72% as compared to the national average of 2.97% as also its 77.52% case recovery rate, against a national average of 59.43%.

A SILVER LINING FOR BIHAR WAS ITS LOW CASE MORTALITY RATE OF 0.72% AS COMPARED TO THE NATIONAL AVERAGE OF 2.97%. .