What Explains the Sudden Surge of COVID-19 Cases in Gujarat?

Gujarat has the second highest cases of the novel coronavirus in India.

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Coronavirus
5 min read
Gujarat has the second highest cases of the novel coronavirus in India.
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During the first half of March, when the novel coronavirus was simmering its way across the country, Gujarat had zero COVID-19 cases. The state recorded its first two cases only on 19 March (both patients with travel histories) when India stood at a total of nearly 200.

On 22 April, barely a month after, Gujarat became the second-hardest hit state in India, surpassing Delhi and following Maharashtra. By the morning of 29 April, the state had 3744 confirmed cases, 434 recoveries and 181 mortalities, according to the health ministry figures.

What Explains the Sudden Surge of COVID-19 Cases in Gujarat?
(Graph: Arnica Kala/FIT)

The recovery rate in Gujarat is around 11.5 percent for the same date (one of the lowest in the country) compared to India’s 24.5 percent. To put this in perspective, Maharashtra’s recovery rate is 14.8 percent and Delhi, with the third-highest cases, stands at almost 32.5 percent.

What Explains the Sudden Surge of COVID-19 Cases in Gujarat?
(Graph: Arnica Kala/FIT)

A similar trend follows for the mortality rate as on 29 April, with Gujarat at 4.8 percent as opposed to the national average of 3.2 percent.

What are the possible explanations for Gujarat’s rapid progression of COVID-19 cases? FIT explains.

Cases Concentrated in Few Cities

Before going into the reasons, mapping the spread of the virus in the state is important. As on 29 April, Ahmedabad, Surat and Vadodara have the highest number of cases within Gujarat, at 1298, 338 and 188 respectively. According to a PTI report, the death rate in Ahmedabad alone (4.71 then) is above the national average (around 3.1).

Speaking to FIT, Dr Dileep Mavalankar, Director, Indian Institute of Public Health (IIPH), Gandhinagar, says that the rural parts of the state hardly have any cases.

“While there is no clear answer as to why the cities have these numbers, the high population density may explain the trend. The congested areas within the city are densely populated, even though they are not slums. The central city also has small spaces and small houses, where social distancing may not be a 100 percent possible and transmission may be higher.”
Dr Dileep Mavalankar, Director IIPH

In the ministry briefing on 27 April, Lav Agarwal had a similar response to a query on the incidence of rising cases in Maharashtra and Gujarat, and attributed it to the population densities of their cities.

In fact, the pattern is not unique to India and has been observed world over, where most cases have been concentrated in ‘dense urban centres’ like Wuhan, Milan, Seattle, Madrid and New York, Fortune reported. Crowds, huge venues, public transport and events can become a breeding ground of a virus and may allow its easy spread.

Dr Mukesh Maheshwari a Pathologist from Ahmedabad, however, tells FIT that the low cases in the rural areas may also be because of a lower rate of testing there. “Diagnostic facilities are mostly in urban areas. All 15 testing laboratories in Gujarat, for instance, are in the larger cities.”

A Lot of People Travel to and From Gujarat: Experts

Another reason Dr Maheshwari points out which may be especially applicable to Gujarat, is that people from the state travel a lot. Since the virus was first encountered in China before it spread across the world to other countries, travellers coming from abroad are understood to be the initial carriers, starting a chain of transmission from their own contacts.

Gujarat is also known for its robust business community which makes international as well as domestic visits all through the year.

This fact is substantiated by data by the tourism ministry, according to which, over 30 percent Indian tourists are Gujaratis.

Another article by Travel News Digest stated that Gujaratis continue to be the most avid Indian travellers. “Gujaratis top the chart as the community that travels the most, whether within their country or abroad,” it said.

Dr Mavalankar also stressed that the initial hypothesis for the rising cases in Gujarat was, in fact, the habitual foreign connections that people from Gujarat seem to have and maintain.

In a similar analysis FIT had done for COVID-19 in Maharashtra, Dr Sumit Ray, critical care specialist in Delhi, had highlighted that this impact on ‘big cities’ was seen even during the time of Spanish flu. “We should look at it as Mumbai and Delhi, not Maharashtra and the rest of India. There is much more international travel and much more intermingling in tighter urban spaces overall. Mumbai was the place with the maximum Spanish flu and plague cases- at that time it was Calcutta and Mumbai - the ports."

Cases Likely to Increase Once the Lockdown Is Lifted: Dr Maheshwari

“Since many people are asymptomatic and can remain undiagnosed, lockdown is an efficient way to contain the virus. In Gujarat, we can estimate that it is being implemented well, with over 95 percent of the population staying inside. This is why we haven’t entered the stage of community transmission yet,” Dr Maheshwari told FIT.

The municipal corporation has been proactive in contact tracing, door-to-door surveillance, random testing, sending teams to various areas and slums for screening and sample collection, he says.

“Instead of the coronavirus chasing Gujarat, we are chasing the virus; that’s why our cases have jumped,” Jayanti Ravi, principal secretary (health and family welfare), Gujarat, has been quoted as saying.

According to estimates, the number of tests conducted in Ahmedabad alone is 2,700 tests per million people. A data analysis by The Hindu for 28 April found that in all of Delhi, a total of 2147 tests are being conducted per million, in Maharashtra, the number is 993.6 and in Gujarat, 865.7 per million. The percentage of positive cases among the samples collected is, however, lowest in Gujarat among the three.

What Explains the Sudden Surge of COVID-19 Cases in Gujarat?
(Table: Arnica Kala/FIT)

“The proactive measures taken by us might have increased the number of cases for the moment, but this will bring down our numbers very soon and finally make us feel safe,” Ahmedabad municipal commissioner Vijay Nehra had said.

But while the Gujarat government has maintained that contact-tracing and screening in hotspots is being diligently conducted, an article in The Print reported that people in Ahmedabad’s more ghettoised areas had not been following social distancing, and the police had made no visit to check them even after receiving complaints. In fact, the officials had ‘missed out’ on screening some families in the area, risking the lives of all others living in the extremely crowded space, the report stated.

As the numbers rise rapidly, Dr Maheshwari feels there will be a need for the state to adopt alternative ways of containment, as adopted by other countries such as the US.

“The cases may increase once the lockdown is lifted and that may overwhelm our hospitals. We will have to think of other policies by allowing people with mild symptoms to stay at home.”
Dr Mukesh Maheshwari

On these lines, the central government on 28 April, released its guidelines for home quarantine for those with very mild symptoms or those who are pre-symptomatic.

As lockdowns ease - social distancing and robust testing seem to be the only way forward.

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