Maharashtra Epidemic Review: Mismanagement Alert Yet Again

A solitary question continues to haunt our minds a year and a half after the Wuhan virus started to devastate India: why does the epidemic refuse to abate in Maharashtra?

The state is India’s resolute economic heart, which needs to beat with the vigour of private enterprise, if we are to soar out of this crisis and regain our livelihoods.

Instead, Maharashtra lies ensnared in lockdowns, uncertainty, and severe financial trammel. A genuine fear is that it could trigger a pan-national third wave, like Kerala, where too, the contagion continues to fester just as portentously.

This is the prevailing situation in Maharashtra:

As can be seen, testing has plateaued around the 200,000 per day mark since early June (purple curve). That is no doubt high by any yardstick, but it is nevertheless still inadequate.

The point to be noted is that the moment the Maharashtra government took its feet off the testing pedal in late May, both the daily case counts (red curve), and the test positivity ratio (TPR; green curve), settled into unhealthy plateaus.

This erroneous decision was effected because the state administration maintained its focus on TPR, rather than cumulative positivity (CP; orange curve). So, a regrettable easing off of testing took place the moment the TPR declined to single digits, even while the CP continued to remain alarmingly high.

The state government didn’t understand that the trick to beating this virus is to pretend that the peak of a wave hasn’t passed; meaning, that if case counts and positivities are to be brought firmly down to acceptable levels (two digit cases per day, CP under 5 per cent, and TPR under one per cent), the administration has to maintain the same high level of testing they did during the peak, long after the crisis is in thankful decline.

This is because, as explained by Swarajya in detail here, administrators should actually use cumulative positivity, rather than TPR, as the primary monitoring parameter to determine the effectiveness of their epidemic management systems.

And the sole tool at their disposal for doing that is testing. If they don’t, then invariably, they would fail to trap the virus successfully, or, more disastrously, either lift lockdowns prematurely, or extend them indefinitely.

This is what has happened in Maharashtra, where, for reasons best known to the state government, it not only selected widespread, self-defeating lockdowns instead of micro-containments (as had been advised by the Prime Minister in early April), but then also compounded that misery by reducing testing levels at exactly the wrong time.

As a result, the state is in a pickle, with old clusters not being fully eradicated, even as new ones develop; and it all boils down to inadequate, inconsistent monitoring.

So, daily cases in Mumbai and Thane may be in some sort of decline (not satisfactorily, but in less of a mess than during the peak); Nagpur may be reporting cases in single digits this week, and Nasik in low double digits; but Pune continues in a debilitating plateau of over a thousand cases a day, while Solapur, Beed and Ahmednagar districts have reported increases.

Thus, the data shows that the state government has persistently demonstrated political cluelessness and administrative incompetence, in frankly slothful efforts to contain the contagion. Fresh clusters are forming and growing without being adequately contained, while old ones continue to fester.

This harsh assessment is substantiated by the next plot:

The chart above is a dimensionless one, meaning that there is no time scale. Instead, it plots cumulative positivity against tests per million. It is therefore, in effect, an index of administrative efficiency in combating the epidemic.

Simply put, it shows how quickly a state responded to the crisis, how quickly it brought matters under control, and the extent to which it was able to restrict virus transmission.

Tests per million is a cumulatively rising number. It integrates testing rates with geographical precision of monitoring (the tracing and isolation part), which is reflected by how the cumulative positivity curve behaves.

The faster the CP curve comes down below 5 per cent, the more efficient the state administration has been in tackling a wave.

For a sense of proportion, then, the data of Uttar Pradesh, Bihar and Gujarat have been plotted along with that of Maharashtra in Chart 2 above. We see that both Uttar Pradesh (black curve) and Bihar (green curve) performed magnificently during the second wave, by controlling transmissions within 10 per cent of state population (x-axis). Gujarat (blue curve) took longer, having to test out to 20 per cent of the population, but the plus side is that it maintained cumulative positivity at lower levels.

On the contrary, we see that the situation in Maharashtra is nowhere near under control. The state has tested 30 per cent of its population; yet, the cumulative positivity is still in double digits (red curve), and its rate of decline is pathetically meager.

It is as if testing is going on for testing’s sake, without the required results. The inference is that testing in Maharashtra has been both inadequate and unfocused; it is this inefficiency which has prevented the Wuhan virus from being rooted out of the state.

Therefore, it is incumbent upon the Maharashtra government to immediately conduct a review of where they are going wrong in testing and tracing, adopt cumulative positivity as the principal epidemic monitoring parameter, and enhance both levels and focus of monitoring.

The present CP has to come down to half before mid-August, case counts have to reduce to double digits by the end of next month, and testing has to go up to peak levels with immediate effect, in step with tracing and isolation.

In addition, the state will have to consider a policy shift from lockdowns to micro-containment within the next fortnight, if there is to be any hope of an economic turnaround in the third quarter. All of this is doable, as states like Bihar have shown, if political will is exercised adroitly.

If not, the currently-simmering situation will spill out of control, the risk of mutations will rise, and chances of Maharashtra triggering a pan-India third wave will heighten greatly. Either way, India cannot afford the perpetuation of such administrative inefficiency any longer.