Could India have averted the crisis? And why more districts need a lockdown

More than half of the india's districts have a higher growth rate in covid-19 infection cases than the national average. Growth rate has doubled in three-fourth of India's districts in last fortnight.

Last year in May, the government came out with a strategy to classify districts into three categories. The classification was to decide the level of activity allowed in each zone. The red districts, with rising cases, were to observe lockdown-like conditions with the administration allowing only a few services to operate. The orange districts were to be more liberal in strategy, and the green districts—reporting no infections in 21 days—were allowed to open up subject to capacity restrictions on public transport.

The idea was that a colour-coded classification would allow authorities to track and trace infections swiftly and allow economic activity to restart. Despite the plan, most districts opened up gradually, and infections spread faster. By September 2020, India was near its peak of 100,000 cases. Our analysis shows that even though the government had classified 130 red zones across the country in May, there were 351 districts by June 18, 2020, growing faster than the national average.

As restrictions were eased, this number climbed to 518 districts between July 2020 and August 2020 and only slightly decreased to 480 between August and September.

The decline in districts led to a decline in cases post-September 19, 2020, and by October 2020, there were only 370 districts where cases were growing at a faster rate than the national average.

During this entire period, the national average daily growth rate also declined, leading to an accelerated fall in daily infections. By February 2021, there were only 126 districts in the country where cases were rising faster than the national average.

So, what did we miss?

While the rise in cases may seem unexpected, a Business Standard analysis shows that there were enough warning signs for the governments between February and now to act. Still, the central and the state governments missed the growing infections.

Between January and February, of the 126 districts that were witnessing a growth in cases higher than the national average, three-fourths or 92 belonged to just six states (Chhattisgarh, Gujarat, Kerala, Maharashtra, Madhya Pradesh and Punjab). These were also the states that later witnessed a rise in infections and were the first to show signs of a second wave.

While the number of districts experiencing a rise in infection declined marginally between February and April, the growth rate of cases nearly doubled across the country. Most of the cases were still concentrated in the six states, but more districts in these states were infected by April 1. Additionally, adjoining states also started witnessing a rise in infections. Some districts in Haryana and Himachal Pradesh had a faster rate of growth than the national average.

Further analysis shows that in 297 districts across the country between February 15 and April 1, the growth rate more than doubled. So, the doubling time of cases—the period in which the infections double in an area—had increased drastically.

There is no doubt then, that between April 1 and April 15, the situation deteriorated further. The number of districts with a growth rate of infections above the national average doubled from 117 to 236; there was a fourfold rise in national average growth. Cases were growing 0.25 per cent daily between February 15 and April 1, and the daily growth rate of infections went shooting up to 1.05 per cent in the first fortnight of April.

Given that 297 districts had witnessed a doubling of infection growth rates between February 15 and April 1—this illustrates Covid-19 becoming widespread—there were 646 districts on April 15, where growth rates had doubled.

Today, there are 380 districts across the country where the growth rate is higher than the national average; besides, there are still 522 such districts where the growth rates have nearly doubled.

Besides, now the national growth rate is two per cent daily. A two per cent daily growth indicates that India will have nearly twice as many infected people in another month.

Why consider daily growth rate as a parameter?

Although the government is preparing a proposal for state governments to impose a lockdown in 146 districts with more than 15 per cent positivity, it needs to bring back the colour-coded system again. Some states already have colour-coded districts, but they do not follow strict norms or restrictions. The government can urge states to impose a lockdown in 380 districts with a daily growth rate more than the national average and closely watch another 142 districts where the growth rate of infections has been doubling every 15 days. There are only eight districts across the country which have not recorded a case in the last 21 days—a precondition to be defined as a green area.

The reason positivity rates may disrupt the government plans is that testing strategy can differ from region to region. It is difficult to determine positivity if the ratio of rapid antigen tests to RT-PCR tests, which are more reliable, is high.

A reliance on growth rates and doubling time of these may prove to be a better strategy. Take the case of Delhi; while the daily growth rate of cases between January 15 and February 15 was just 0.03%, this nearly tripled to 0.09% between February 15 and April 1. However, given that testing was lower during this period and RAT share higher it would have been impossible to determine positivity. For the first fortnight in April, the growth rate went up 15-times to 1.1%. Delhi imposed a lockdown on April 19, but by that instance, it had missed the bus. This is one reason that the daily growth rate of deaths in the capital has jumped six times between April 15 and May 1.

Although the national Covid taskforce has suggested that the government impose a total lockdown, the reopening strategy needs to be well calibrated. This time the government needs to ensure that green doesn’t become orange and the orange doesn’t turn into red.

Of the 130 red zones classified last year, only 23 today have a caseload lower than 10,000. There are 49 of the 284 orange districts where cases are below 5,000 and 75 of the 322 green districts where total infections have been less than 1,000.