COVID-19 Data: Different States, Different Trajectories

Analysis of the state-wise COVID-19 numbers indicates that the trends in states are varied. Different states seem to be going in different trajectories compared to where they were a month ago. Here is a look at numbers from six states that contribute to more than 70% of India’s case load.

The prevalence of COVID-19 & the corresponding case numbers are varied across the country. As observed in an earlier story, while India’s Case Fatality Rate (CFR) is comparatively lower than most of the other countries which have a high prevalence of COVID-19 cases, it is not uniform across the country.

In this story, we dig deeper into the numbers reported by few select states that have either reported a high number of cases or displayed extreme trends over the past few weeks. We also correlate these numbers with the number of tests conducted and the number of positive cases.

The source of information is the data released by Ministry of Health & Family Welfare (MoHFW) as well as respective State governments. In order to minimize the impact of any extremities, 7-day moving average (up to 05 July 2020) is considered for analysis of all the parameters.

Maharashtra – CFR on the decline though the number of daily deaths increase

Maharashtra has reported the highest number of COVID-19 positive cases and accounts for nearly 30% of the total cases recorded in India. The total reported deaths due to COVID-19 in Maharashtra are around 9 thousand which is around 45% of the total COVID-19 related deaths in India.

After the first death was recorded in mid-March, the number of deaths per day increased gradually on a day-to-day basis though the average number of deaths per day remained below 100 until the first week of June. The subsequent gradual increase in the number of daily fatalities had an unusual spike post 17 June, due to the reconciliation done by adding on 2000 + COVID-19 fatalities. During the latter half of June, the average daily fatalities gradually increased from over 150 to 200.
Meanwhile, the Case Fatality Rate (CFR) has witnessed a different trajectory. After an initial high of over 6%, when the number of positive cases and the deaths were low, the CFR has gradually decreased in the ensuing days. Early June saw a shift in the trend with a slight increase, contributed in part by the increasing number of daily deaths. It peaked in the last week of June, thanks to reconciliation on 17 June.
However, in contrast to the increasing number of daily deaths from the last week of June, the CFR is again on a decreasing trajectory. This trend can be attributed to the increase in the number of positive cases which increased from around 1.2 lakh cases on 20 June to more than 2 lakh cases by 05 July. During the same period, the number of tests conducted has also increased from 7.5 lakh to over 11 lakh tests. The number of daily tests is more than 25 thousand for the past few days, more than double the number of tests that were being carried out in the beginning of June 2020.

Gujarat – Despite fewer daily deaths, CFR is the highest in the country

As on 05 July 2020, Gujarat has recorded 1925 COVID-19 related deaths out of the 35 thousand plus positive cases recorded as on that date.

On 19 April, Gujarat recorded its first double digit number of deaths in a day. Since then, there has been a gradual increase in the number of daily deaths until mid-June (with the exception of few days in between). However, this increase in fatality numbers has not been steep and the maximum average number of deaths was around 30 during mid-June.
Although the number of daily deaths being reported is comparably lower than States like Maharashtra and Delhi, CFR is higher because of fewer positive cases. Compared to the rest of country, Gujarat has the highest CFR of all the states.
The least CFR in Gujarat was around the end of April, where in it was slightly more than 3.5%. Since then, irrespective of the trends in the number of deaths, the average CFR is seen to be on a rise, with the highest hovering around more than 6% during most of May and June.
Over the last two weeks, the CFR has gradually come down with the 7-day average CFR being at 5.61% on 05 July.
While there is an increase in the number of new cases recorded daily in recent days, it is nominal. The 7-day average at the beginning of last week of June was 540 per day which subsequently increased to 658 new cases per day. This increase can be attributed to the corresponding marginal increase in the number of tests conducted.
Although the trend is uneven, around 5 thousand tests per day were conducted around the last week of June, which has since increased to around 6-7 thousand tests in recent days. The daily number of tests being conducted are much lower than in Maharashtra which is conducting anywhere between 25-30 thousand tests per day.

Delhi – No Major increase in the number of New Cases despite significant increase in the number of tests

As per the information provided by Delhi State government, more than 20 thousand tests per day are being conducted since the beginning of July 2020. This is in line with the increasing trend of number of daily tests being conducted from the beginning of June.

A significant increase in the number of tests being conducted is observed since 19 June, when the number of tests conducted increased from around 8 thousand per day to 13 thousand per day. The daily tests continued to increase after this single day ramp up. Bulk of this increase in testing capacity can be attributed to the rapid antigen tests being conducted now alongside RT-PCR tests.
However, the same increasing trend is not observed in the number of new COVID-19 positive cases, where in the number of positive cases are around 2.5 thousand per day (with few exceptions). There is actually a decreasing trend from the beginning of July.
The average number of daily deaths in Delhi has also largely remained consistent with around 60 deaths. Meanwhile, the average CFR has also shown a decreasing trend from around 3.8% during the last week of June to 3.12% on 05 July 2020.

Tamil Nadu – Though CFR is still low, it is slowly increasing

The number of new positive cases reported in Tamil Nadu on a daily basis is witnessing an increasing trend. On 01 June, Tamil Nadu reported more than 1 thousand new cases in a day, with the daily number increasing in the ensuing days.

The increase in the number of new cases can be attributed to the increase in the number of tests being conducted. Until 05 July 2020, Tamil Nadu has conducted over 13.4 lakh cases with more than 30 thousand tests per day being conducted for more than a fortnight. Around mid-May, Tamil Nadu conducted around 10 thousand tests per day, with this number doubling in the next one month.
The 7-day average number of deaths recorded in Tamil Nadu has seen an increase from around 10 in the beginning of June to nearly 70 deaths per day by the beginning of July 2020.
This increase in the number of deaths in a day has impacted the CFR. In early June, the 7-day average CFR for Tamil Nadu was only 0.75% which has subsequently increased to 1.34% by 05 July 2020.
In spite of this near doubling of CFR, the value is still less than half the national CFR. However, the increasing trend is a cause for concern.

Telangana – Significant increase in the number of new cases as CFR shows a downward trend

As on 05 July 2020, Telangana has conducted over 1.15 lakh tests which resulted in more than 22 thousand COVID-19 positive cases i.e. nearly 20% of the tested cases are positive. The number of tests being conducted have remained at around 3-4 thousand tests from mid-June to end of June. It has increased to more than 5-6 thousand tests per day from the beginning of July.

The number of new cases being recorded daily has increased more than 6- fold during this period i.e. mid-June to 05 July. On 15 June 2020, the 7-day moving average of daily number of new cases was 199 which increased to 1,268 cases by 05 July 2020. There is a marked increase in the number of cases compared to mid-June.
However, there is not much of a change in the fatalities being reported with the average number of deaths remaining in single digits per day.
The increasing number of cases and the near-constant number of deaths in a day has resulted in a downward trend of CFR.
Around mid-June, the CFR of Telangana was 3.8% and has drastically fallen down to less than 1.5% by 05 July 2020.

Karnataka- Increase in both the number of daily new cases and deaths

Similar to Telangana, Karnataka has also witnessed a surge in the number of new cases being reported in the past 15-20 days.

On 15June, Karnataka had around 7 thousand COVID-19 positive cases, which increased three times i.e. more than 21 thousand cases by 05 July 2020.
During this period, the number of new cases per day has increased from around 200 per day during mid-June to more than 1.5 thousand cases per day during the first week of July. More than 1.8 thousand cases were reported on 05 July 2020.
However, unlike Telangana wherein the number of deaths has been near constant despite the increase in the number of cases, Karnataka is witnessing an increase in the number of deaths as well. Double-digit death figures are being reported from end of June. There were 42 deaths recorded on 05 July 2020, which is more than double the previous day’s 20 death cases.
Because of the increase in the number of deaths, CFR has increased from around 1.2% in mid-June to 1.5% by 05 July.
The increase in the number of new COVID-19 cases can be attributed to the increase in the number tests. Around 5 thousand tests per day were being conducted on average during mid-June which has been ramped up to around 17 thousand tests per day.

Varied trends across the states

The trend in new cases & daily deaths among the states with a large number of COVID-19 cases has shown wide variations. The only uniform trend across the states is that all of them have ramped up their testing numbers.

The variance in the trend is quite evident in certain states. While increase in the number of tests has resulted in increase in number of cases for states like Telangana, Karnataka and Tamil Nadu, it does not have a similar effect on Delhi which is reporting fewer new cases as well as fewer deaths despite increased testing numbers.

In terms of the CFR, both Karnataka & Tamil Nadu are witnessing an increasing CFR while Telangana which is also witnessing a surge in new cases managed to significantly decrease CFR. Tamil Nadu appears to be at the cusp of increasing fatality rates despite one of the lowest CFR in the country in the earlier months.

These varying trends indicate that a one-size-fits-all uniform strategy may not work in a large country like India. State-specific strategies are the need of hour with special focus on the areas that the respective states lack in. There could be also be sharing of best practices where one state could learn from what others are doing well.

Featured Image: COVID-19 Data