Southern States where COVID positive cases continue to remain high like Karnataka, Tamil Nadu and Andhra Pradesh, along with low caseloads of Telangana, have been following an ‘uniform formula’ of reduced testing, contact tracing and surveillance, compared to the first wave of the pandemic, say top epidemiologists.
“The higher tests per million are showing high cases per million along with test positivity. As the rate of tests goes down, the cases are going down and test positivity too, goes down. This has been the nature of the COVID second wave,” said Indian Institute of Public Health-Public Health Foundation of India’s Giridhara R. Babu.
Participating in a recent virtual webinar hosted by the Indian Institute of Public Health-Hyderabad chapter, he said that the Telangana case has been mystifying.
“Telangana State has been an honourable exception. When all other States, including Kerala, show high number of cases, it has been showing low number of cases and even deaths. No statistic can explain the status in the current scenario. It can’t be explained by any epidemiological knowledge as it has lower tests, cases and deaths per million,” said the public health expert in Karnataka COVID advisory panel.
“An extreme observation is either the burden of the disease is really low, with no impact on lives, livelihoods or mortality but that would be an exception or definitely, the public health surveillance needs to be strengthened,” he asserts. Mortalities per million in TS has been just 81.7 when it has been 342.7 in Karnataka, 251.6 in TN, 194.1 in Kerala and 186.7 in AP.
While Kerala has been maintaining the testing rate along with increase in cases, AP, TN and Karnataka have decreased the number of tests. Even if it has been for the operational feasibility or any other reason, it was imperative to ramp up testing considering the high COVID incidence in these States.
Dr. Babu called for a “syndromic approach to find the right cases and testing them along with contact tracing as an important element of learning” since lower tests per million with higher test positivity was a “matter of concern”.
“Last year, States had an effective contact tracing, testing and community participation strategy along with isolated quarantine centres with Karnataka even tracing up to 42 contacts, but this has been dispensed with now,” he claimed.
One reason being the Indian Council of Medical Research (ICMR) issuing a directive prioritising tests for those with influenza like illness and the primary contacts, leaving the asymptomatic and the secondary contacts. “AP and Karnataka have therefore, changed the testing policy,” he explained.
While urban burden is ‘reasonably’ known despite under reporting, virus spread was not being adequately captured in the rural population because testing is confined to cities and district headquarters.
The way out to “decrease the test positivity and bring the cases down is to have strict containment measures, isolate positive cases and increase the tests,” affirmed Dr. Babu.
The future wave or pandemic could be tackled only by strengthening public health workforce, primary healthcare and pooling in community resources in slums and residential welfare associations for an effective field surveillance to capture the first signs of disease and containment, the epidemiologist added.
