New Delhi: Massive crowds coupled with lax compliance with norms may have prompted the Election Commission to issue an advisory, calling on parties to ensure Covid-appropriate behaviour, but Bihar’s numbers present a remarkable picture.
The state is testing close to 1.5 lakh samples almost on a daily basis. Its test positivity rate for the 18-24 October week was 0.9 per cent — second only to Ladakh — against the national average of 4.71 per cent.
Bihar also has one of the lowest fatality rates in the country — at 0.52 per cent, it is way lower than the national average of 1.51 per cent. This, despite the fact that the health infrastructure availability in the state is among the worst in the country.
According to data with the National Health Profile 2018, Bihar has a total of 40,649 allopathic doctors — one doctor for every 2,435 people in the state as against a national average of one doctor for every 1,169 people.
As of Monday, the state had reported 2,12,192 cases, of which only 10,223 are currently active. The state also reported 749 cases and seven deaths Monday and conducted 1,39,218 tests, which means just 0.5 per cent of the samples tested were positive. Nationally, the number was 4.8 per cent for Monday. The death toll currently stands at 1,049.
Speaking to ThePrint on the condition of anonymity, a senior health researcher who has been tracking micro-level Covid data for some time now, said: “Bihar data looks so good on paper, to the point of being unbelievable for one of India’s poorest states. We need more information to make out anything.
“For example, testing by test types, areas where the tests are actually done etc. would help. If the cases don’t spike there in about two weeks or so from now, it will either be a miracle sort of or systematic under reporting.”
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‘Very difficult to explain’
Bihar’s Covid numbers have left experts flummoxed.
“It is very difficult to explain. It is the same kind of difficulty we face when we compare India to the world and then when we compare Bihar to the rest of India,” Dr P.K. Singh, director, AIIMS Patna, told ThePrint. “I know people here do not wear masks, do not practise social distancing, their behaviour is such that it supports infectivity. Yet the numbers are very low.”
He added that even testing has been adequate. “You cannot say not enough testing because the positivity rate is very low — in just one district it is around three per cent, everywhere else it is in the 0.7-0.9 per cent range,” he said. “There is no reason to increase testing. You cannot even explain this by immunity because even in people with very good immunity, the infection will show, the test will come positive.”
He is also not willing to link this to the infectivity of the virus or to admit the possibility of the state having got a different strain. “That is subject to studies,” he said. “Even UP numbers are more than this and the strain is unlikely to be different in UP and Bihar.”
Principal Secretary (Health) Pratyay Amrit too does not hazard a guess about whether the state has a less infectious strain. “I do not know anything about the strain. Ask the doctors.” But asked about compliance with Covid norms and whether he is happy about it, he says: “How can we be happy? It is a huge challenge.”
But state BJP president Dr Sanjay Jaiswal, who is also a practising doctor, has a theory about the numbers. He said the fact that Bihar does not have that many industries may actually have been an advantage for the state.
“If you look at the data you will see the lower strata is not affected at all. Tests, we are doing sufficient. But it is also a fact that in Bihar we do not use public transport or trains,” he said. “People go to the market or the farm and come back home. They either walk or travel by bikes. Hardly anybody uses public transport. That may be the reason why the numbers are like this. It is less crowded, markets are also in segregated areas.”
‘Declining trend’ across districts
The state Covid data shows a sharp spike some time in August and has been flattening since then.
In a series of tweets on Bihar, health economist Rijo John wrote: “#Bihar alone has done >1 crore #COVID19 tests so far (10% of India’s total tests) & kept its test +ve rate <5% for over 2 months. Its 2% now. Decline in cases seems to be sustaining.”
#Bihar alone has done >1 crore #COVID19 tests so far (10% of India's total tests) & kept its test +ve rate <5% for over 2 months. Its 2% now.
Decline in cases seems to be sustaining.
It's remarkable indeed for a resource poor state!
But, is this for real? One can only wonder!
1/ pic.twitter.com/nhrgXkccDD
— Rijo M John, PhD (@RijoMJohn) October 26, 2020
John also tweeted that the “declining trend” has been seen across districts.
“Not a single exception! State avg. TPR (cum) is at 2%. Varies from 10% in Patna to 1% in many dists. Dists with TPR<3% have done 92% of total tests so far Patna, Samastipur & East Champaran with TPR>5% did only 7% of all tests. Aggregated dist. wise test data shows 8.2L tests while state data show 1cr,” he added.
“Patna contributes to 16% of total cases so far and yet contributes to only 4.4% tests in Bihar. Whereas, Gaya which contributes only 3% cases has done more than 5% of tests with a TPR 1%,” he further tweeted. “All google mobility indices for Bihar are where they were in early Feb (https://bit.ly/31ZVcBN) Huge election rallies defying all physical distancing & mask wearing norms were witnessed across the state recently. Its expected results in terms of case counts are yet to be seen.”
Bihar Congress chief Madan Mohan Jha talked about the recent Covid deaths of two state ministers to punch holes in the government’s impeccable statistics.
“The numbers that they give for deaths of Covid are absolutely impossible… I know more people in districts who have succumbed to the disease. My own two aides died within a span of a week and two ministers (Minister for Backward and Extremely Backward Classes Welfare Vinod Singh and Panchayati Raj Minister Kapil Deo Kamat) have died,” he said.
“The way the numbers are, there are only two possibilities — either there is no Covid (and) this is all imaginary. Or the numbers have been whitewashed. There is absolutely zero Covid-appropriate behaviour in Bihar, yet how can the numbers be the way they are?”
In a recent petition to the Election Commission, opposition RJD has urged it to ensure that Bihar elections do not become a super-spreader event.
Manoj Jha, the party’s Rajya Sabha MP, told ThePrint: “I have serious doubts about whether the testing data is accurate. I believe very strongly that Bihar is doing antigen tests to a very large extent compared to RTPCR tests. That is why we submitted that petition. We fear Bihar may be headed for a Covid crisis.”
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Antigen tests “even” if over 80% cannot explain the low TPR, since doubling it, accounting for a 50% false negativity would still not significantly increase the TPR. Numbers fudging cannot be ruled out(more a serious possibility). At the end of the day it all boils down to mortality. And for lack of medical infra, stigma of Covid, rational fear of hospitals etc. would mean people dying of Covid in their homes. Unreported, unconfirmed, misreported Covid deaths could easily be at least 5 times the claimed mortality. Comparing deaths with last year for the same period would be worth looking into. However the opaque system in place rules.