Coronavirus numbers, explained: Why is there a spike in cases in India?

After the first COVID-19 case was recorded on June 30 in Kerala, it took 110 days for the coronavirus tally to touch the 1 lakh mark; in contrast, it added four lakh infections in the next 39 days. With a record spike of nearly 20,000 cases in a day, India's COVID-19 tally mounted to 5,28,859 on Sunday and the death toll rose to 16,095, as the country registered almost a lakh cases in the past six days.

India is in the fourth place in the global COVID-19 tally after the US, Brazil and Russia. Sunday is also the fifth consecutive day that coronavirus infections have increased by more than 15,000.

However, on the bright side, the recovery rate has also steadily improved to reach 58.13 per cent. 

The mortality rate is 3 per cent and doubling time of coronavirus cases has marginally improved to 19 days.

How are states faring

Eight states—Maharashtra, Tamil Nadu, Delhi, Telangana, Gujarat, Uttar Pradesh, Andhra Pradesh and West Bengal—contribute 85.5 per cent of active caseload and 87 per cent of total deaths in India. 

Maharashtra: 5,493 cases in 24 hours till Sunday (Total of 1,64,626 cases)

Delhi: 2,889 cases in 24 hours (Total of 83,000 cases)

Tamil Nadu: 3,940 cases in 24 hours (Total of 82,275 cases)

Gujarat: 624 cases in 24 hours (Total of 31,397 cases)

Uttar Pradesh: 606 cases in 24 hours (Total of 22,147 cases)

West Bengal: 572 cases in 24 hours (Total of 17,283 cases)

Andhra Pradesh: 813 cases in 24 hours (Total of 13,098 cases)

How are the fatalities stacking up in the states?

Maharashtra: 7,273 deaths

Delhi: 2,558 deaths

Gujarat: 1,789 deaths

Tamil Nadu: 1,025 deaths

Uttar Pradesh: 649 deaths

West Bengal: 629 deaths

Madhya Pradesh: 550 deaths

Rajasthan: 391 deaths

The national death toll is currently at 16,000.

What actions are the states taking to combat the spike?

Tightening their containment strategy, Madhya Pradesh and Uttar Pradesh announced a door-to-door survey joining other states and Union territories, including Delhi, Goa and Odisha, while a 14-day lockdown began from Sunday evening in Guwahati in Assam.

Maharashtra: Maharashtra Chief Minister Uddhav Thackeray made it clear that the restrictions will continue even after June 30 as the crisis is not yet over. "Even if I am not using the term lockdown, do not misunderstand and lower your guard. In fact, we need to show more stringent discipline," he said. "We can't leave this war halfway in this final phase. I am sure that you will continue to cooperate with the government to ensure that lockdown is not reimposed," he said in a televised address. The unlock process, dubbed 'Mission Begin Again' by the state government, is being gradually implemented to put the economy back on track, Thackeray said.

In the financial capital Mumbai, police urged the city residents not to move beyond the two-km radius of their homes unless it is for attending office or medical emergencies. As part of the campaign, 15 close contacts of a COVID-19 patient will be compulsorily kept in institutional quarantine. It was launched on May 27.

Delhi: In Delhi, where authorities are implementing a revised strategy after a major surge in cases, the number of COVID-19 containment zones has risen from 218 to 417 after a re-mapping of such areas, while around 2.45 lakh people have been screened in a mammoth house-to-house survey to check the spread of COVID-19. The count of containment zones is expected to jump further as the screening process is well underway, set to be completed by July 6. 

A serological survey will cover 20,000 people. "The survey is being conducted door to door and it will reveal the extent of coronavirus spread in Delhi," Chief Minister Arvind Kejriwal said in an online briefing.

Uttar Pradesh: State Additional Chief Secretary (Medical and Health) Amit Mohan Prasad said the state will launch a large-scale campaign from Meerut division in July, where house-to-house survey will be undertaken similar to the pulse polio immunisation. "It will be carried out in containment and non-containment zones," he said.

Madhya Pradesh: The Madhya Pradesh government said it will launch a 'Kill Corona' campaign from July 1 to control the spread of COVID-19 in the state. Under the campaign, door-to-door survey will be conducted and tests would also be done on citizens for other diseases as well, Chief Minister Shivraj Singh Chouhan said during a virtual review meeting on the COVID-19 pandemic. Chouhan said during the 15-day campaign, 2.5 lakh tests will be carried out and 15,000 to 20,000 samples would be collected daily.

Karnataka: Bengaluru police said criminal cases will be filed against those flouting face mask and social distancing rules and public can call police in case someone refuses to follow the COVID-19 preventive norms in the city. 

What is causing the surge in cases?

There could be a multitude of factors involved. Medical experts have pointed out that the surge in COVID-19 testing, now available more extensively and at a reasonable price, could be a major factor. According to the Indian Council of Medical Research (ICMR), a cumulative total of 79,96,707 samples have been tested up to June 26, with 2,20,479 of them being analysed on Friday, the highest in a day since the beginning of the pandemic.

The government has ramped up its testing infrastructure across the country significantly with the ICMR validating around 1,007 diagnostic labs, of which 734 are in the government sector and 273 private sector. The per day testing capacity which was around 1.4 lakh on May 25 has been increased to three lakh per day now. Starting with one single laboratory, the National Institute of Virology (NIV) in Pune and having 100 laboratories in the beginning of the lockdown, the ICMR on June 23 validated the 1,000th testing laboratory.

The data also showed that there has been a surge of 3,18,418 infections from June 1 till 27; 'Unlock 1' came into effect from June 1 as part of the graded exit from the national lockdown that was imposed on March 25.

Dr Monica Mahajan, Director, Internal Medicine, Max Healthcare, told news agencies it is important to understand the reason for the exponential rise in cases. "The numbers are doubling at such a fast rate due to factors such as the high reproduction number of the virus [the number of cases, on average, an infected person will cause during their infectious period]," she said. "Also, with the lifting of lockdown norms people's behaviour has changed again as they are not acting as responsibly as before in terms of social distancing, and testing has become more liberal," Mahajan told PTI.

What is the Centre doing?

15 Central teams consisting of public health experts, epidemiologists, clinicians and a senior joint secretary-level officer have been deployed to provide technical support to the states.

India now has 1,026 diagnostic labs dedicated to COVID-19. This includes 741 in the government sector and 285 private labs. As of June 27, the COVID-related health infrastructure has been strengthened with the availability of 1,039 dedicated COVID Hospitals with 1,76,275 isolation beds, 22,940 ICU beds and 77,268 oxygen-supported beds, the ministry said. Also, 2,398 dedicated COVID Health Centres with 1,39,483 isolation beds, 11,539 ICU beds and 51,321 oxygen-supported beds have been operationalised.

Moreover, 8,958 COVID Care Centres with 8,10,621 beds are now available in the country. The Centre has provided 185.18 lakh N95 masks and 116.74 lakh Personal Protective Equipment to the states, UTs and Central institutions.

Noting that India's recovery rate is rising, Prime Minister Narendra Modi said India is much better placed than many other nations due to lockdown and many initiatives taken by the government as well as a people driven fight.  At the same time, he cautioned that people can't let their guard down yet.

"In fact, we have to be even more careful now. Wearing masks, following social distancing, avoiding crowded places remain important," he said addressing the 90th birthday celebrations of Rev Joseph Mar Thoma Metropolitan in Pathanamthitta in Kerala via video conference.

Congress leader Rahul Gandhi while targeting the government on the COVID-19 situation alleged it has no plan to defeat the pandemic and that Prime Minister Modi has surrendered as he refuses to fight coronavirus. "COVID-19 is spreading rapidly into new parts of the country. The government of India has no plan to defeat it," Gandhi tweeted. "PM is silent. He has surrendered and is refusing to fight the pandemic."

Expanded pharma options

An inexpensive, widely used steroid dexamethasone, meanwhile, was included in the treatment protocols for COVID-19 patients in moderate to severe stages of illness among other therapeutic measures by the Union health ministry. The updated protocol includes the advice to use dexamethasone as an alternative choice to methylprednisolone for managing moderate to severe cases of COVID-19. The change has been made after considering the latest available evidence and expert consultation, it said.

According to the revised 'Clinical Management Protocols for COVID-19',  dexamethasone, which is already used in treating lung infections besides in a wide range of conditions for its anti-inflammatory and immunosuppressant effects, can be used as an alternative to methylprednisolone which already existed in the treatment guidelines.

The health ministry on June 13 had also allowed the use of antiviral drug remdesivir for restricted emergency use and off-label application of tocilizumab, a drug that modifies the immune system or its functioning, and convalescent plasma for treating COVID-19 patients in moderate stage of the illness as an investigational therapy.

It also recommended hydroxychloroquine in patients during the early course of the disease and not on critically ill patients.

The use of these drugs continues to be included in the revised treatment protocols under the 'investigational therapy'. 

-Inputs from PTI