Even as discussions about the continuation of the national lockdown continues, India has seen a record number of new COVID-19 patients in the last 24 hours.
According to various crowd-sourced data sources, a total of 809 new cases of Coronavirus infections were reported in the last 24 hours (official confirmation expected today afternoon).
This is about 50% higher than the regular number of around 500-550 daily new cases that India has been recording in the last one week or so, and is especially worrying given that the country has already spend nearly 16 days under lockdown.
Under a ‘perfect’ lock-down, the number of new cases should keep increasing till about Day 10, and remain elevated till about Day 16, and start to come down from then on.
The exact shape of the curve will, however, depend on whether everyone in the household of a COVID-19 patient is tested immediately, or whether they are simply put under observation and tested only if they show symptoms later on.
If they are tested immediately after someone in the household tests positive, the number of COVID-19 cases should shoot up around Day 6, and remain elevated till Day 15, and show a sharp decline from Day 17 onwards.
If they are not tested, but are only quarantined, the number of new cases would show a gradual increase till day 12, remain somewhat stable, but elevated at those levels till about Day 18, and then start a steady decline.
The problem with India is that different states are following different protocols as far as testing is concerned.
While states like Kerala are testing the immediate family members of anyone who reports an infection without waiting for symptoms to appear in them, some of the other states have not been aggressive with testing.
However, as the availability of testing kits have improved, more and more states are starting to test household members and immediate contacts of new, positive cases immediately.
What this means is that the secondary infections — which happens within the household during the lock-down — are also being detected within 1 or 2 days of the primary infection coming to notice, thus leading to a sudden increase in the number of reported cases from Day 4 to Day 11.
This is because of the incubation period of the SARS-CoV-2 virus, which causes COVID-19. In most cases, symptoms appear on the 3rd to 6th day of exposure, but they can appear as late as the 14th day.
What this means is that there should be high number of reported cases between Day 4 and Day 15, as both primary cases as well as the members of the infected households are brought on to the charts after testing for COVID-19.
This also means that the number of new cases shoud start showing signs of a decline from Day 16, which was yesterday.
In case the number of new cases do not start showing a decline as expected, it could indicate one of two things:
- It can be because the lockdown was not implemented in a foolproof fashion, and infected persons are communicating the virus to people outside the households, and these cases slip out of the net, leading to community transmission.
- It can also mean a shortcoming in the detection and reporting infrastructure. This means that, many of the infections were not detected at the stage of the primary infection within the household, but only when the entire household is sick. This leads to a ‘bunching up’ of new cases towards the later stages of the lock-down.
Going by the empirical data so far, only a few states are conforming to the ideal pattern of a plateauing towards the middle of the 21-day lock-down period.
These states are Kerala (which started its Coronavirus lock-down on March 10), Haryana, Karnataka and West Bengal. Jammu and Kashmir and Andhra Pradesh too have shown some signs of moderation in their growth (see chart below).
On the other hand, there are several states that show no signs of moderation even as the lock-down enters the 17th day.
These include Maharashtra (see chart above), Tamil Nadu, Delhi, Rajasthan, Telangana, Madhya Pradesh, Gujarat, Punjab and Uttar Pradesh.
The reason for the continued increase in the number of new cases in these states even at this stage of the lock-down is likely to be a mix of both point 1 and point 2.
There were leakages in the way the lock-down was implemented in some of these states — particularly Delhi and Uttar Pradesh, while in others like Telangana and Tamil Nadu, initial cases were not detected, which led to a bunching up of new cases towards the end of the lock-down period.
What remains to be seen is if these states can put in place a thorough detection and reporting mechanism in coming days, so that cases of infection can be isolated and contained.