3rd February 2023

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COVID-19: Testing, Fatality & Lockdown

The testing data suggests that there is no strong link between test rates and death rates across countries. However, the analysis suggests that countries that have been able to test more have also been able to loosen the lockdown restrictions sooner or later. In other words they may be more aware and therefore more confident about the spread of COVID-19 in their countries.

At first glance, the test figures suggest that India is not testing enough. Despite accelerated testing, it still tests fewer people than many other affected countries. When the national blockade was imposed on March 25, India was performing 539 tests per million people and ranked 52nd among countries in terms of test rate. Since then, the number of tests has been multiplied by 47, even when the number of cases has been multiplied by a hundred, India performing 758 tests per million, making it the 24th country in terms of tests per million. However, as pointed out by officials of the Indian Council for Medical Research (ICMR), India also found fewer positive cases for each test it performed (return rate) and did not have to pay a high price in terms of death so far.

Evidence from around the world also seems to suggest that there is no simple linear relationship between evidence and death rates. Some countries that conducted aggressive tests very early (when there were fewer cases) such as Italy and Belgium ended up having very high death rates.

Currently, the death rate in India i.e. less than 4% seems relatively low compared to countries with high epidemics such as Italy and the United Kingdom, but the number of deaths in India is increasing rapidly. However, compared to countries like Indonesia and Mexico, which have low test rates, high performance rates (positive cases per test) and higher deaths, India so far seems better placed .

Within India, the states with the highest testing rates – Andhra Pradesh, Delhi, Tamil Nadu, and Rajasthan have so far had lower fatality rates.

States that have reported high case fatality — Maharashtra, Gujarat, Madhya Pradesh, West Bengal and Karnataka have either low or moderate testing rates.

Of these, West Bengal and Madhya Pradesh have high positivity levels as well. This suggests they may not be testing enough despite indications of higher prevalence.

It is true that this comparison has limits. Positivity or rate of return depends on the test strategy and its ability to capture the segment of the population most likely to be at risk. Furthermore, the number of deaths depends not only on the scope of early detection, which adequate tests can guarantee, but also on other factors such as access to medical care, the age of patients, diseases and even how they are reported the causes of death in all regions.

However, the data suggests that early detection through increased testing may help. For example, Delhi has increased the evidence from the start and has grown faster (49.5%) in cases up to the 500th case. However, growth in the cases slowed down later.

At the other extreme, the Punjab, which was slow to speed up testing at first, has seen a much larger increase in cases at later stages, and continues to see an increase in cases. This analysis is based on states with more than 500 cases as of May 3.

ICMR officials have so far denied community transmission, but due to the limited evidence to date and the lack of random sampling in the population, the true extent of the prevalence of covid-19 in the country remains unknown.

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