For close to a month after April 15, Telangana had one of the slowest growth rates of novel coronavirus infections in the country. During this time, its caseload increased by just two times, from 766 on April 17 to 1,551 on Sunday. In the same period, India’s case has increased by almost seven times, Uttar Pradesh’s numbers rose by more than five times from a similar baseline, while neighbouring Andhra Pradesh, which had a lower baseline, saw its numbers grow by more than four times.
It now emerges that Telangana’s impressive numbers could have a lot to do with its woeful record on testing. As of May 14, the state had conducted just 22,842 tests, which was among the lowest in the country. It was even lower than the tests conducted by Chhattisgarh and Assam, both of which had less than 100 cases on May 14.
Neighbouring Andhra Pradesh had, by that date, conducted 2.1 lakh tests, almost ten times more than Telangana. Tamil Nadu had conducted more than 2.9 lakh tests by then.
Telangana is the only major state that does not reveal its testing numbers in the daily bulletin. Scientists say there is a direct correlation between the number of tests carried out and the caseload. That is because a large share of the infected people do not show any symptoms, and can be detected only when they are tested. But these infected people without symptoms are as likely to infect others as those with symptoms.
Scientists and experts stress on more and more testing as it usually results in finding more positive cases. Maharashtra, Tamil Nadu, Gujarat, Rajasthan and Delhi, the states with maximum caseloads in the country, also happen to be the ones that have carried out the largest number of tests. As of now, Telangana is not testing people without symptoms at all.
And that is making officials in the central government a little uneasy. “Telangana numbers don’t inspire confidence at all. They may be sitting on a crisis, you never know,” a senior Health Ministry official in New Delhi told The Indian Express.
But Telangana’s Health Minister Etela Rajender said the state was only following the guidelines of the Indian Council of Medical Research (ICMR).
“We are conducting tests on those who show symptoms of Covid-19 as per the guidelines issued by ICMR. We are on a par with the US and the UK in doing accurate testing. If a person has no symptoms, swab samples cannot be taken,’’ he said, asserting that the state was doing adequate testing.
However, experts and activists are now questioning the state’s strategy on testing. Doctors for Sewa, a collective of public health specialists and doctors, said such limited testing would lead to an explosion of cases.
“Asymptomatic persons even in zones where Covid-19 positive cases have been reported are not being tested. We will not know if the virus is spreading if there is no testing. The state is also not testing dead bodies, so we won’t know if they died of coronavirus. Now that the High Court has given directions, so we hope that they will start doing it,’’ Dr G Veda Prakash, a member of Doctors for Sewa, said.
The Telangana High Court on May 14 directed the state government to conduct tests on dead bodies. The direction came on two PILs filed by activists against a circular issued by the Director of Medical Education not to conduct tests on dead bodies.
“When you don’t do enough testing even in zones where Covid-19 cases have been reported, those zones will become epicentres. This is what is probably happening in Greater Hyderabad Municipal Corporation (GHMC) area now. The number of cases came down for a few days but are now increasing daily,’’ Dr M Karuna, a paediatrician, said.
After several days of just single-digit daily increase, the numbers have started to rise in Telangana. More than 275 new cases have been detected in the last six days.
The majority of new cases since May 8 are from areas under Greater Hyderabad Municipal Corporation (GHMC). Officials said that violation of lockdown restrictions and not maintaining social distancing were the main reasons for the spike in cases in GHMC areas. At least 45 new cases were reported from two apartments where people held birthday parties. Out of the 42 cases reported on Sunday, 37 were from GHMC areas. Similarly, 44 of 55 cases on May 16, 33 of 40 on May 15, 40 of 47 on May 14 and 31 of 41 on May 13, were from that one area.
Three of the 31 districts in the state — Warangal (Rural), Yadadri, and Wanaparthy — have not reported a single case of coronavirus infection till now, while 25 districts have not reported any new cases in the last 14 days.
The Doctors of Sewa group has submitted a representation, highlighting the low testing being done in the state, to the central government’s Inter-Ministerial Team that had visited Telangana from April 27 to 30.
“Mere lockdown is not enough to win the war over COVID 19. Accurate assessment of the caseload before lifting lockdown is very important to plan further post lockdown actions. Fewer tests are happening in the state. This will project falsely low total number of cases. Only when more tests are done, we get more positive reports – which in turn necessitates further testing of their contacts and the chain goes on. If we continue to under-test, then we will miss many un-tested positive patients in the community. We have information from multiple sources that doctors and healthcare officials in all hospitals need permission from higher authorities before they can test a patient suspected to have COVID19 – especially in the district hospitals – some districts have as much population as small countries of Europe (eg GHMC area) – This will escalate the spread of disease. There are many instances where even patients with bilateral pneumonia are not being tested for COVID19 as the higher authorities do not allow. ICMR Guidelines clearly suggest that all ICU patients need to be tested for COVID19. This is not being done in Telangana now,’’ the statement from Doctors for Sewa said.
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