#Corona in India: Has it entered Stage 3?

India’s number of cases has already crossed 1000 and is growing at an exponential rate. This is very worrying. There are fears that India has entered stage 3 i.e. community spread. Community spread is the most dangerous stage because it is here that the virus really explodes. Containment becomes near impossible.

Stage 1 means only foreign returned are infected, stage 2 means people who came in their contact are infected. Because the number of these people is generally small (relative to population) and they are easier to trace, so the virus can still be controlled at this stage. But once it moves beyond that, i.e. the general populace starts getting infected in stage 3, there is no stopping.

Although India has very small number of cases compared to other major countries, it was discredited saying India was not testing enough. It made sense – no testing, means no positive. Until 28 March, India’s testing was just about 20 per million – among the lowest in the world. Coupled with figures released 3 days ago that between January 23 to March 23, 15 lakh people entered India, (10 lakhs is 1 million) a real risk of  missing out on testing a lot of foreign returned people exists. So these fears were not totally unfounded.

So, in this article, to assess it, we do a cross country comparison of reported cases and tests done. Corona has started spreading in different countries from different dates. And also in the initial few cases, the spread is very variable and unpredictable. So for every country, we start from the day when the cumulative reported number of cases crossed 50. This happened in India on 10th March, Iran on 24th Feb, Italy on 22nd Feb, USA on 22nd Feb, Spain on 29th Feb, France on 28th Feb, UK on 3rd March and South Korea on 19th Feb. Then (because we have data until 28 March and focus of this study is on India) we look at how the number of reported cases has grown in 19 days since the day 1 i.e. when the total number crossed 50. The result can be seen in the left panel in the figure below. India is clearly the best i.e. shows least number of cases on day 19 at 987. All the countries are far worse except USA which is close at 1301 cases on day 19.

coronastage3

Does this mean that the virus’ spread has been least in India? Well, before answering in yes, we must consider two more facts. A) Our closest US went on to become the most infected country in the world with around 1.5 lakh (0.15 million) cases today i.e. 37th day since it crossed 50. B) Our testing rates are one of the lowest in the world, both in absolute numbers (only about 27,000 tests so far) and tests per million (approx 20). If we don’t test, we don’t report positive, simple.

To address this issue of under-testing, we take a snapshot of number of positive cases various countries reported when they did their 30,000th test. Why 30,000? Because a) this is where India stands today and remember this is an India centric study, and b) We can’t compare the ratio of positive cases reported to total tests done when total tests are very high. Because by the time countries began testing those huge numbers, virus had already entered stage III and a larger proportion of their population had become infected. In other words, as we test more and more, days also pass, and virus spreads more in population and proportion of positive cases in total tests done also increases.  So for an apples to apples comparison, we must compare when countries were around their 30,000th test. Around and not exact, because we don’t have daily data of tests conducted for any country except USA.

The right panel in the chart above clearly shows even here India fares much better here too. It has the lowest number of positive cases per hundred tests done (3.66%) around the 30,000th test level. And although by the end of 19th day, USA was closest to us in terms of total number of positives, they had done only around 7700 tests compared to our 27000. This means by day 19, they were already 3.5 times more virulent than us. Coming back to positive to total tests ratio around 30,000th test mark, USA’s figure was 13%, Spain was already at 49%(!) and France at 15%. This means at this stage, these countries had already entered community spread stage. Only UK was close to us at 5% however, their’s figure is for 64,000th test and because proportion of positives increases with more tests, around 30,000th test they too would have been closest to us. Now one way to hack this percentage is to test only low risk cases (to give less number of positives) but India’s testing policy has been to test highest risk patients first. I doubt any other country would be capturing any higher risk patients only.

So, this means if we want to estimate how our corona trajectory will look like, our best estimate would be UK, right? Well yes, but for one thing. UK initially had refused to take the utmost important decision of locking down. As a result, it let virus spread and only locked down on the 34th day i.e. on 23 March. But by then, the virus had already spread far and wide and it had 8961 cases or 175 cases per million population. Contrast this with India, where we imposed a total lockdown on 13th day itself i.e. 22nd March when our total cases reported were just 396 or 0.22 per million population.

I know there have been massive migrant labor movements after that and leakages in lockdown and home quarantines etc., and will estimate their impact in a later post, but we have clearly (at least it seems so at present stage) averted the disaster which the western countries find themselves in presently. And given our much inferior health infrastructure capacity than most of these countries, I think by acting early and decisively we have saved lots and lots of lives.

However, the battle is far from over. If anything, this highlights the paramount importance of lockdown. I know its painful, very very painful, but it is our only good enough chance at survival right now. Its going to be a long journey. Take care and stay indoors!

11 comments

  1. Well written
    I think corona is there for long term
    And hard to stop as long as there is agressive medical infusion either in terms of vaccines or infrastructure building and the other option (hypothetical) people will get immune .
    Otherwise it will keep on Going .

    Liked by 1 person

  2. Hello Sir, there is something critically wrong with India’s testing protocol. The protocol allows testing of:

    i. All symptomatic individuals who have undertaken international travel in the last 14 days:
    ii. All symptomatic contacts of laboratory confirmed cases.
    iii. All symptomatic health care workers.
    iv. All hospitalized patients with Severe Acute Respiratory Illness (fever AND cough and/or
    shortness of breath).
    v. Asymptomatic direct and high-risk contacts of a confirmed case should be tested once
    between day 5 and day 14 of coming in his/her contact.

    This does not include testing of symptomatic persons who do not have travel history/contact with lab confirmed cases or are healthcare workers. Dr. Gangakhedkar of ICMR has rightly said that we need a definite percentage (let’s assume somewhere between 10-20%) of cases for whom we can’t trace contact with confirmed case or travel history so as to conclude the occurrence of community transmission in India. The question is how do we get that percentage if we are never going to test them. The only random sample testing done by ICMR was 820 samples which were all negative. That was on 19th March. Further, ICMR has said that they will no more be doing random testing.

    Sir, clearly, ICMR is in a vicious cycle built through convoluted logic – No testing of symptomatic people who may have got it (from community) implies no community transmission and no community transmission implies no need to test symptomatic people without travel history/contact with confirmed case.

    It is understandable that India had shortage of testing kits and PPE which led to a restrictive testing protocol. We went for the lockdown to build capacities and prevent stage 3. But the crucial lockdown period is passing. 11 days are already gone! Also, Sir, note that PBNS (foolishly) has claimed that there will be no extension of lockdown (quoting the Cabinet Secretary). Meanwhile migrant labour and Tablighi Jamaat issues have cropped up and economic pressures are starting to pain the citizen. Now, we are in a catch 22 situation. We have not identified any hotspots (please listen to the vague statements made by JS LA on hotspots) and we don’t know if we are in stage 3.

    We have a high risk of stage 3 if we end the lockdown on the 14th. If we extend the lockdown, the words of the Cab Secy would go down the drain but more importantly, the economic pressures will mount. In both cases, our decision would not be an informed decision but based on a faulty data produced by a faulty testing protocol.

    One solution to avoid this is to change the testing protocol immediately and test as many symptomatic persons (not random…let the symptoms be checked by a govt doctor who would then recommend test) in the next 10 days as we can. We should have atleast some data from which we can identify areas where community transmission is occurring and keep them under strict lockdown while lifting the lockdown from other parts in a staggered way.

    Thanks for reading.

    PS- Sir, have a look at South Africa as well…their first case was detected on 5th march. Had 927 cases on 26th March when they entered lockdown… have 1585 cases as of 4th April. Number of tests at 53,937 is strikingly similar to India as well.

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  3. How a labourer helps us?
    Does everything around us has A TOUCH OF THEIR HANDS?
    Would migrant workers be needed after this pandemic lockdown?

    The labourers build the roads.
    They help build the houses.
    They help fix the water pipes.
    They help make and clean drains.
    They help cut the çrops.
    They help clean cook wash
    They help baby sit and care for the old too.
    They clean the cars and bikes too.
    In a restaurant they serve, clean and wash the dishes too.
    Cinema’s, parks and sports fields labourers help build, maintain and clean.

    The government and society are doing but 139 million internal migrant labourers from 10+ states and national capital need to reach their home sweet.

    A country which can send mission to 166.61 million km away to mars can certainly devise a way if some ppl in power PRIORITIZE TO SOLVE THIS CRISIS.

    #migrantlabours
    #helpthemigrantlabours
    #solveproblemsofmigrantlabours
    #migrantlaboursof7states
    Trend these hashtags on Twitter
    Share with intelligent ppl
    Jai hind

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  4. Hi sir

    WHAT ARE THE PROBLEMS, DANGERS, AND HARMS THESE INDUSTRIES FACE?
    WAYS TO TACKLE THESE PROBLEMS

    what harms these industries pose to all life forms on earth? Way to reducè the harms

    Industry

    AGRICULTURE AND ALLIED INDUSTRIES

    AUTOMOBILES

    AUTO COMPONENTS

    AVIATION

    BANKING

    CEMENT

    CONSUMER DURABLES

    ECOMMERCE

    EDUCATION AND TRAINING

    ENGINEERING AND CAPITAL GOODS

    FINANCIAL SERVICES

    FITNESS

    FMCG

    GEMS AND JEWELLERY

    HEALTHCARE

    INFRASTRUCTURE

    INSURANCE

    IT & ITES

    MANUFACTURING

    MEDIA AND ENTERTAINMENT

    METALS AND MINING

    OIL AND GAS

    PHARMACEUTICALS

    PORTS

    POWER

    RAILWAYS

    REAL ESTATE

    RENEWABLE ENERGY

    RETAIL

    ROADS

    SCIENCE AND TECHNOLOGY

    SERVICES

    SECURITY

    SPORTS

    STEEL

    TELECOMMUNICATIONS

    TEXTILES

    TOURISM AND HOSPITALITY

    (Crime mafia anti social activities and wars comes under SECURITY industry)
    All the industries are inter dependent.
    Obeserve analyse consider pros cons…think and try to achieve an end…

    https://www.statista.com/statistics/271320/distribution-of-the-workforce-across-economic-sectors-in-india/

    (Just sharing all information can be found online yet achieving an end that is beneficial to maximum ppl needs some intelligent constructive activity…)
    Regards
    Abhay

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