While most of the attention in the ongoing second wave of the coronavirus epidemic is centred on Maharashtra, which has been contributing more than 60 per cent of all cases in India, Punjab seems to be facing a more serious problem.
It is the only major state where the death rate in the second round of infections is higher than in the first. In most other states, including Maharashtra, death rates have so far been showing a declining trend despite the surge in infections, although this may well change in the coming days.
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For the last two days, Punjab has been reporting the second highest number of deaths in the country, after much bigger Maharashtra. The state reported 38 deaths on Tuesday and 35 on Wednesday.
High case fatality ration
Punjab has always had a high case fatality ratio, much more than the national average. At the end of last year, for example, the state had recorded 1.66 lakh cases and 5,341 deaths, giving it a case fatality ratio, or CFR, of 3.21 per cent.
Ideally, the death number from two weeks later should be taken to make a better estimate of CFR, to account for the fact that deaths usually occur two to three weeks after infection. That would push the CFR of Punjab even higher.
But for the sake of comparison, India’s CFR, calculated similarly, at the end of last year was 1.45 per cent. In Maharashtra, the death rate at that time was 2.62 per cent.
For the first two months of this year, Punjab’s CFR seemed to be declining, in line with the trend elsewhere in the country. As on Tuesday, the cumulative CFR in the state, since the start of the epidemic, was 3.05 per cent, while the national figure had come down to 1.39 per cent.
However, it is the number since the start of the second wave, in the first week of February, that is a cause for concern — especially if the actual CFR, accounting for the two-week lag, is taken into consideration.
Punjab recorded 8,706 cases in the month of February. It is only in March that it has started reporting more than 1,000 cases a day. The state reported 392 deaths between February 15 and March 15, giving it a CFR of almost 4.5 per cent.
As this paper has reported earlier, the comparative figures for India, as well as Maharashtra, using the infection numbers for February, and death numbers between February 15 and March 15, yield much lower death rates compared to their overall CFRs.
That has led many to conclude that the second wave is leading to milder infections compared to the earlier one that hit India last year. This conclusion is also supported by the fact that on any given day, between 15 and 20 states have been reporting no deaths at all. Also, on most days, all states barring Maharashtra, Punjab, and Kerala, have been reporting deaths in single digits.
If the CFR for Punjab is calculated using the total number of cases and deaths after February until now, it presents a vastly different picture. It gives a death rate of only 1.88 per cent. But that is only because the number of infections have risen very sharply in March. Already, more than 20,000 cases have been recorded in the state in the first 17 days, compared to 8,706 in all of February. But it is unlikely that many people from this group, who got infected in March, have died.
In fact, the impact of the surge in March is just beginning to become evident. The death numbers in the last one week has been substantially higher than earlier. The state has reported 194 deaths in the last one week, while 217 deaths were recorded in all of February.
Dr Rajesh Bhaskar, nodal officer for Covid-19 in Punjab, said the high fatality rate in the state could be because of the fact that a large proportion of the population had lifestyle diseases such has diabetes, hypertension, or obesity, which lead to complications following the infection.
Also, he claimed that Punjab was counting even those deaths in which the coronavirus infection was completely incidental.
“For instance, if an accident happens and the patient dies due to trauma, but tests positive, during treatment, or any time before autopsy, it is getting counted as a coronavirus death. No other state is doing that. Punjab is not concealing even a single death,” Dr Bhaskar said.
The extraordinary rise in the number of infections is not very well explained. For the last 12 days, Punjab has consistently reported more than 1,000 cases. On Wednesday, this number crossed 2,000. The last time the state had reported more than 2,000 cases was on September 23.
What is even more curious about Punjab’s surge is that it has come well after the farmers’ protest which, at its peak, had seen very large crowds assembling in several parts of the state. In fact, between October 15 and January 31, when the farmers’ protest was the most active, Punjab never touched 1,000 cases a day. The highest single-day figure during this period was 843 on November 26. Through most of January, when the agitation was still going strong, the numbers had remained well below 300.
Dr Amandeep Kang, director of health services in Chandigarh, suggested that the low numbers in January could have led to complacency among people.
“When the cases came down significantly in January and February, there was a feeling that the Covid-19 epidemic was over. People became casual about wearing masks and following Covid-appropriate behaviour. There were large social and family gatherings. And that was a mistake,” she said.
Dr Bhaskar said the increased testing in the last few weeks could also have led to higher detection of cases. Punjab has been testing over 30,000 samples for the last few days, compared to less than 20,000 on an average for most of January and February.
After Maharashtra and Punjab, the surge in Gujarat appears to be getting serious. On Wednesday, Gujarat reported more than 1,000 cases for the first time in over three months. Karnataka crossed the 1,000 mark a day earlier, after a gap of over two months, but it has a much higher threshold than Gujarat.
Karnataka has a total caseload of more than 9.6 lakh, compared to about 2.8 lakh for Gujarat, and has, in the past, reported more than 10,000 cases in a day. Tamil Nadu, another state with a high caseload, more than 8.6 lakh, is also nearing the 1,000 cases a day mark, for the first time this year.
Gujarat too has a CFR higher than the national average — 1.58 per cent now — mainly because of very large numbers of deaths in Ahmedabad in July and August. But the death numbers have been under control in the last two months. The state hasn’t reported more than 10 deaths in a day since December 16.
The reasons being cited for the surge in Gujarat are very similar to those that were offered for Maharashtra — local body elections, complacency on part of the people, and the recent round of cricket matches. Surat is the worst affected city in the current wave.
—With inputs from ENS, Chandigarh & Ahmedabad