A municipal worker sanitizes a Roman Catholic Church graveyard after the burial of Covid-19 coronavirus infected people in Ranchi on September 6, 2020. Photo: AFP

With 90,000 plus daily Covid-19 cases over the past two days, India gained yet another dubious distinction as it moved into second place in the world after overtaking Brazil.

The growing number of virus cases comes on top of the economy contracting by a whopping 23.9% during the quarter of the lockdown to June, the biggest drop among the top economies, and incursions into its territory by China.

The huge number of coronavirus cases – almost three times that of the United States – catapulted India ahead of Brazil as the second-worst country hit by the invisible killer. The US remains the worst affected with 6.5 million cases, with India at 4.2 million and Brazil at 4.14 million.

Experts caution that the number of daily cases could multiply several times, and that some areas of the country were already in the midst of a second wave.

“Daily infections are already likely several fold,” said Dr Swapneil Parikh, who lead-authored a book on the coronavirus with two other doctors in March. “The numbers will increase when we start looking for them better. Testing more will allow us to accurately see the uncontrolled spread of the virus that is already occurring.”

The 49 million tests India has conducted may look impressive, but not when seen in the context of its 1.38 billion people. India has ramped up tests mainly from one month ago to more than one million per day. Doctors see that also as a cause for the spurt in the number of cases.

More testing needed

However, the current level of testing is not even remotely near what the country needs. In tests per million, India is the third-lowest among the 10 worst affected countries, ahead of Mexico and Argentina.

India’s tests per million are about half those done by Brazil and one-eighth of the US total.

“India needs to massively up testing and get the positivity rate to around 1% and keep a turnaround time below 24 hours, or lower,’’ recommends Dr Parikh.

The positivity rate, defined as the percentage of people who test positive for the virus with the total number of people tested, in India at present is 7%.

Dr Parikh favors antigen tests as it has a higher limit of detection, meaning a person needs to have more viruses to be detected as positive, unlike a RT-PCR test which, according to the doctor, is so sensitive that even someone who has some fragments of the viral RNA but is not infectious can also test positive.

The government for its part says the recovery rate is a healthy 77.3% and the fatality rate a low of 1.8%.

The number of deaths in India at 71,739 is still low compared with 193,020 in the US and 126,266 in Brazil.

Five states worst hit

Dr Randeep Guleria, a member of the central government’s special task force on Covid-19, said in a television interview that the number of Covid-19 cases in India will continue to rise for some more months before they begin to flatten. He expects Covid-19 to spill over into 2021.

Of the 29 states, five account for 60% of the active cases and 70% of the total deaths. Maharashtra leads with 25% of the active cases and 37% of the deaths, limiting the state’s ability to fully open India’s commercial capital Mumbai.

The worst five states are Maharashtra, Uttar Pradesh, Karnataka, Tamil Nadu and Andhra Pradesh.

The past two days also saw a record rise in cases in Maharashtra, Punjab, Gujarat, Kerala, Odisha and Jammu & Kashmir. In Maharashtra, 92% of the cases are asymptomatic and despite the higher number of cases, only 44% of hospital beds are occupied.

Even as India ramps up the number of tests, India faces challenges on more than one front.

More challenges ahead

Stealthy incursions by China in several locations in the mountainous Ladakh border region have diverted national resources and pushed up defense expenditure. Top defense officials describe the situation as tense, as China remains unrelenting in vacating the areas it intruded into.

India also faces a slowing economy, which makes it tougher for it to avoid lifting lockdown restrictions in a significant way, which is critical for helping open up the economy and for people to make an income.

From September 7, the Delhi Metro will start working, carrying less than half the usual number of passengers to ensure social distancing. This is happening as part of the central government permitting metro trains to run all over the country.

Metros in Lucknow, Chennai and a few other towns are resuming on Monday after a five-month break.

Most bazaars, playgrounds and public places are opening, but many safety-conscious people remain at home. However, a large percentage of people are ignoring social distancing and not wearing masks after the two-month lockdown.

The coming Hindu festivals also pose a big danger of pushing up case numbers as devotees tend to throng to markets and religious places for their annual festival purchases.