What data tells about India’s COVID testing and fatalities?

by Prithish Nandi and Suvrajit Pal

It has been almost eleven weeks that India enforced a stringent countrywide lockdown. Ever since then there has been a fierce debate on the timing of lifting the lockdown and its effectiveness. The government claims that the lockdown significantly helped in checking the spread of the pandemic in India. The lockdown duration was utilized to increase the testing capabilities of the country. India is now conducting more than a lakh test each day and is slowly increasing its testing capacity even further. We are also third in the world, only after the USA and Russia as far as the daily testing count is concerned. Can we be complacent going ahead? What are the areas we need to work on as we prepare ourselves for the steady opening of our economy? What holds for us in the future? This article tries to answers questions like these with the help of data.   

Flattening the curve is a public health strategy to slow down the spread of the SARS-CoV-2 virus during the COVID-19 pandemic. But what exactly do we infer from the flattening of the curve? Is it just the number of reported cases reaching a constant value every day? 

We believe flattening of curve doesn’t always mean that number of cases have fallen back. The true picture will reveal only when we keep on increasing the number of tests each day and no significant changes in daily cases are observed. The following graph depicts the trend of India’s covid testing versus cases registered each day.

Fig 1

The above regression analysis states that there is a good correlation between the number of tests performed and new cases reported. We see a steady increasing trend line with high goodness of fit and a low p-value denoting a higher significance value. The high goodness of fit suggests the derived model explains the data very well. This model shows, that the more we test, more we are likely to register covid cases. This comes at a time when we have already ramped up testing to more than a lakh test per day. India’s initial increase in pattern represents that of Italy in its initial stage (mid-March) as shown in Fig 2 below. We can also infer, that we are far from reaching the maximum amount of cases reported each day.  

Fig 2

At this critical juncture, Italy ramped up its testing even more. This resulted in the detection of newly infected cases at their early stages, before they can transmit to others. The positive patients were quarantined. This stage also saw the implementation of a nationwide lockdown. Early detection helped in stopping further spread of the virus. However, experts still believe that Italy was late in implementing the lockdown. It took a huge toll of life before it started showing the signs of receding. In other words, it is registering lesser cases each day with the increasing number of test.

Fig 3

What we can learn from Italy that It is not just the individual actions of lockdown but a combination of effects that will bring the count down. This includes ramping up the testing even further. And use of lockdown to build infrastructure for health facilities. People may argue that India has already done more tests per thousand than Italy. Well, this depends upon the nature of the demographics, testing strategy and how people are following the social distancing rules. Every country has its own characteristics.

Going by the trend India is estimated to report 11000 new cases everyday by 13th of June. These estimations are based on the present scenarios. However, with the wheels starting to run in factories and people returning to work, the estimates may double up.

Fig 4

Ceteris paribus, the new case value, 11208 would be reported on 13th of June. This would make 0.0081 case per thousands of populations being reported. To obtain the total test to be done, we will take the equation from the regression analysis in Fig 1. 

We put the value 0.0081 in place of new case per thousand

We find that approximately 4 people in every 1000 to be tested by 13th June.In total 52 lakhs tests will have to be done. This requires us to conduct 15 lakhs more test within the span of next 10 days, considering the current total test count to be approximately 37 lakhs. The average per day test count comes out to be 1.5 lakhs.

Now the question that arises is whether this number of testing done by India, enough? Can India be complacent with the current testing numbers of around 1.5 lakh per day?

Well, no! 

• Regression analysis shows that we are yet to identify the true total cases in any given day. Since, cases registered are increasing as the number of test are increased.
• We can also learn from Russia which has been doing 2 lakhs tests per day. It is able to flatten the curve (Fig 4) faster than India. It is also to be noted that Russia has less population density. From a high of 11000 cases registered per day in the early weeks of May they are down to 8000’s now and is expected to be near about this number by 13th June.
•  Similarly, for USA we see that between 21st May and 29th May there has been a decrease of about 6.26% in the new case per thousand reported. Although, there is an increase of about 18.2% in the new test per thousand rate. This shows how increase in testing has actually helped USA in detecting and acting rapidly on the cases and bring the new infection rate down.

Fig 5

Fig 6

Forecast indicators shows Brazil is going to be the next epicenter of this outbreak. Tableau forecasting indicates Brazil will be reporting close to 40k cases by the mid of June. This comes at a time when the worst seems to be over for US and Europe.

Why should we be worried?

India and Brazil, two BRICS nations, rank high in the global Covid-19 count. Both are middle-income growing economies, having densely populated cities dotted with large slums, and battling a rising Covid-19 burden. And both countries have seen a spike in cases from mid-March, especially in its congested regions.

Let’s compare between the two countries -the main factors for the spread of this pandemic

• We can clearly see that the curve of covid19 patients India, is on the rise more or less similar to that of Brazil but at lesser magnitude.

The situation could become worse in India, considering the fact India has started to open up its economy now. The estimates presented above are based mostly on when India was under complete lockdown, Airports were closed and passenger train were not running. With people travelling in the upcoming days, new cases are bound to increase with higher trajectory than expected. The only silver lining is that the death rate in India is not as high as compared to that of Brazil, yet.

Fig 7

Also, the two countries differ on one very key consideration - Brazilian President Jair Bolsonaro is strictly anti-lockdown, even joining protests against governors who've imposed lockdowns, such as the governor of Sao Paulo. India, on the other hand, has been under central lockdown since March 25. Also, the effects are shown in the following:

Fig 8