States have tackled the virus differently, but they must learn from each other

On June 20, a month after 1,00,000 novel coronavirus cases were reported, India crossed a grim milestone of 4,00,000 cases. If it took 13 days to double to 2,00,000 cases, India added another one lakh cases in 10 days on June 12. From a test positivity rate of 4.6% in mid-May, it is 7.9% as on June 21, reflecting a wider spread in the community, particularly in the hotspots — Mumbai, Delhi, Chennai and Ahmedabad. Mortality, which was initially low, has been steadily increasing. The first death was reported on March 13 and the figure crossed 1,000 only on April 28. But it has taken just three days for each additional 1,000 deaths after the toll touched 4,000 to reach 13,703 deaths as on June 21. The lower mortality figures are a reflection of the low median age (nearly 27 years) of the Indian population, the stage of the pandemic in India, health-seeking behaviour and the health-care system. While the low median age has helped keep mortality low, high prevalence of high-risk factors even among younger people might put them at great risk if infected with the virus. The  health-care system in Mumbai, Delhi, Chennai and Ahmedabad, already strained, could witness more deaths if the virus spreads unabated. With India now in the unlock phase, this is the time to be most vigilant.

Kerala, Karnataka and Andhra Pradesh have done exceptionally well in containment. If Kerala was fully geared even before the first case was reported, the other two States utilised the early phase of the lockdown to track, test and isolate those infected and trace contacts. Nothing else can explain why Bengaluru has bucked the trend while Delhi, Mumbai and Chennai have become pandemic epicentres. Maharashtra has adopted the correct approach of enhanced testing unmindful of the large number of cases getting reported each day. Aggressive testing enabled Maharashtra to achieve the remarkable feat of containment in Dharavi. In stark contrast, till a few days ago, Delhi had used every trick in the textbook to keep cases and deaths low. That fewer cases are reported from Telangana, West Bengal, Uttar Pradesh and Bihar raises suspicion about their testing and counting. While many States have reported migrant workers testing positive on arrival, it is inconceivable that Uttar Pradesh, Bihar and West Bengal, which have recorded the most returnees, should not see a spike. Through fever clinics and testing of people with influenza-like illness in certain areas in Chennai that have high spread, Tamil Nadu is making up for lost time. But true containment will remain difficult and will depend on door-to-door surveillance and large-scale testing in these areas. Going by the cases reported, Gujarat seems to be the only place where the virus spreads to a definite number of people every fortnight even when tests are increased incrementally. The only way to contain numbers is by not hiding them.