Indias coronavirus cases cross inevitable 5 million

एनसीएटी ने अपनी रिपोर्ट में कहा है कि 31 अगस्त तक देश के 25 राज्यों और केंद्र शासित प्रदेशों की 1,350 जेलों में से 351 जेलों में Covid-19 के मामले दर्ज किए गए हैं. #NationalCampaignAgainstTorture | #coronavirus

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While we have officially announced a rise of 95,000-100,000 Covid cases every day - by far the highest in the world, of course - the unreleased data suggests that it could in fact be much higher: at 200,000 to 250,000 new cases every day (Table 1).

Earlier we reported that Indias numbers were likely to be an underestimation because of the increasing reliance on the less accurate Rapid Antigen Tests (Chart A). It has already been established that Rapid Antigen tests miss a large percentage of Covid positive people and declare them as Covid negative.

According to the literature, PCR tests, when conducted properly (and this is important), detect a much higher number of Covid cases - in fact two to three times higher, than Rapid Antigen tests. This is clear from official data of Delhi and Maharashtra (Table 2) which are known to have the best practices, methodology and techniques of PCR testing. This differential between the two tests is similar to global standards.

However, the new data indicates a disturbing development. Rapid Antigen tests are easy to administer and require a simple procedure without amplification. PCR tests, on the other hand, to be accurate require a much higher degree of skill and training. If PCR tests are not carried out with the requisite checks and balances, the level of false-negativity rises rapidly. The new data (Table 3) suggests that this is exactly what may be happening in India.

Based again on this recently accessed official data from all the other states (Table 4) - it is disturbing that the positivity rates of both types of tests should be almost the same.

Consequently, it is clear that if the positivity rate of the Rapid Antigen test in India is around 7%, the positivity rate of PCR tests should be twice to three times that rate - suggesting that the PCR positivity rate in India is likely to be around 15% -20% or thereabouts. This means that instead of the daily reported 100,000 new cases - the truth is that India probably has 200,000-250,000 new cases every day (see Table 5).

With at least 200,000 daily new cases, we need, as a nation to recognise that the reality on the ground is much worse than we acknowledge. It is a reality that requires vastly different medical and social policies than if the numbers were much lower as earlier believed.

Footnote: The data base of this article is for the period 1st -31st August 2020 for every state of the country and extended to 10th September 2020 for the All India data.

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