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Hope or illusion? Covid numbers dip in India but dark clouds still loom


(This story originally appeared in on May 17, 2021)

NEW DELHI: A faint glimmer of hope is visible on the horizon as India’s burgeoning Covid caseload is on a decline, finally.

For the first time during the course of the second wave, India registered a fall in cases in the week ended Sunday.

Also, India’s daily new cases fell below the 3 lakh mark for the first time since April 21 with the country reporting 2.81 lakh new infections on Monday.

The fatalities, however, continue to stay high.

Several hard-hit states like Maharashtra and Delhi appear to have crossed their peaks and are reporting lower numbers compared to couple of weeks ago.

Long road to recovery

Fresh Covid cases may be falling steadily but experts warn that it is still too early to say that things are improving.

AP quoted experts as saying that the drop in national caseload largely reflects falling infections in a handful of states with big populations and/or high rates of testing.

Thus, the nationwide trends represent an incomplete and misleading picture of how things are faring across India as a whole.

“There will always be smaller states or cities where things are getting worse, but this won’t be as clear in the national caseload numbers,” Murad Banaji, a mathematician modeling India’s cases, told AP.

Experts are also of the view that it is important to note that cities are hitting peaks at different times.

“It seems like we are getting desensitized by the numbers, having gotten used to such high ones,” said Bhramar Mukherjee, a University of Michigan biostatistician tracking the virus in India.

“But a relative change or drop in overall cases does not diminish the magnitude of the crisis by any means.”

‘Drop in cases an illusion’

Another reason for an apparent peak or plateau in cases could be that the virus has outrun India’s testing capabilities, experts warn.

The second wave that erupted in February is rampaging through rural towns and villages, where about two-thirds of the country’s 1.35 billion people live, and testing in those places is sorely lacking.

“This drop in confirmed Covid cases in India is an illusion,” S Vincent Rajkumar, a professor of medicine at the Mayo Clinic in the United States, said on Twitter.

“First, due to limited testing, the total number of cases is a huge underestimate. Second, confirmed cases can only occur where you can confirm: the urban areas. Rural areas are not getting counted.”

Combating the spread in the countryside, where health infrastructure is scarce and where most Indians live, will be the biggest challenge.

“The transmission will be slower and lower, but it can still exact a big toll,” said K Srinath Reddy, president of the Public Health Foundation of India.

Even in big cities, testing has become increasingly harder to access.

Labs are inundated and results are taking days, leading many to start treating symptoms before confirming a coronavirus infection.

In the last month, cases have more than tripled and reported deaths have gone up six times — but testing has only increased by 1.6 times, said Mukherjee.

Meanwhile, vaccinations have plummeted by 40%.

‘Positive tests ominously high’

The World Health Organization has also flagged concerns over the high positivity rate in India.

While the country has witnessed a slight dip in positivity rate – from 22.6% on May 10 to 18.1% on May 17 — the overall figures are still too high.

World Health Organization chief scientist Soumya Swaminathan said the “worryingly high” national positivity rate, at about 20% of tests conducted, is a sign that there could be worse to come.

“Testing is still inadequate in a large number of states. And when you see high test positivity rates, clearly we are not testing enough. And so the absolute numbers actually don’t mean anything when they are taken just by themselves; they have to be taken in the context of how much testing is done, and test positivity rate.”

The WHO has recommended 5% positivity rate as the maximum threshold for easing restrictions. Anything beyond that is considered too high.

Challenges galore

The reports of crippling shortage of oxygen and ventilators dominated the headlines a few days ago. Now, the focus has shifted to mucormycosis, also known as black fungus.

AIIMS director Randeep Guleria had recently warned that secondary infections like mucormycosis were adding to India’s mortality rate with states reporting hundreds of cases recently.

The disease, which can lead to blackening or discolouration over the nose, blurred or double vision, chest pain, breathing difficulties and coughing blood, is strongly linked to diabetes.

And diabetes can in turn be exacerbated by steroids such as dexamethasone, used to treat severe Covid-19.

Special wards are being planned in hospitals for those suffering from black fungus.

However, the low availability of injections that are used to treat the infection has only added to the challenge.

(With inputs from AP, Reuters)

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