ISAS Briefs

Summary

Almost all states of India have now reported confirmed cases of COVID-19. While the southern and western coastal states have a higher number of cases, hinterland states like New Delhi and Uttar Pradesh are witnessing a spurt. However, states with fewer cases cannot afford to be complacent as many of these states lack the capacity to fight COVID-19 and may end up with high fatality rates.

Photo courtesy: by Jak, recreated by Stannered from images byZscout370 and PlaneMad / CC BY-SA (https://creativecommons.org/licenses/by-sa/3.0)

India has been in a complete lockdown since 25 March 2020 in its effort to tackle the spread of COVID-19. With surveillance, contact tracing and testing stepped up across the country; detection has drastically increased compared to the period before the lockdown. As on 1 April 2020, the Ministry of Health and Family Welfare reported more than 1,800 persons with COVID-19 infection, including those who have died and those treated and discharged.

Confirmed COVID-19 cases have now been reported in almost all parts of India. Some states have particularly high incidence of infection (Figure 1; see PDF version). Maharashtra and Kerala are leading the chart, followed by Tamil Nadu, Delhi, Uttar Pradesh and Karnataka. Each of these states has reported more than 100 cases. With more than 1,100 cases between them, these six states account for 63 per cent of confirmed COVID-19 cases in the country.

A large number of COVID-19 cases have also been reported in Andhra Pradesh, Gujarat, Jammu & Kashmir, Madhya Pradesh, Rajasthan and Telangana. The confirmed cases in each of these states, till now, are less than 100, but well above 50. These six states account for almost 500, or 27 per cent of confirmed COVID-19 cases in India. Taken together with the first group of leading states, these 12 states account for 90 per cent of the total COVID-19 cases in India.

To-date, 41 people have died from the COVID-19 infection (Figure 2; see PDF version). Deaths have been reported in 14 states, with the highest number in Maharashtra (9), followed by Gujarat (6), and Punjab, Madhya Pradesh, Karnataka, Telangana and West Bengal (3 each). The number of deaths makes up around two per cent of the total number of people infected by the virus.

The state-wise spread pattern of COVID1-9 in India indicates the following:

• So far, 28 states and Union Territories have reported COVID-19 cases. Jharkhand, Arunachal Pradesh, Sikkim, Nagaland, Meghalaya, Tripura and Lakshadweep are yet to report any confirmed cases. However, the rapid pace of the spread of the virus, combined with the higher detection due to enhanced testing facilities, should result in more confirmed cases in all parts of the country, including the ones yet to report any.
• Maharashtra, Kerala and Tamil Nadu have reported the highest number cases till now. This does not mean that they would remain frontline states or epicentres of the disease. Over the last few days, there has been a sharp increase in cases in Delhi, Uttar Pradesh, Karnataka, Telangana, Madhya Pradesh and Andhra Pradesh. Some of these states and even others might become frontline states as the situation evolves.
• The coastal states from India’s South and West – Kerala, Karnataka, Tamil Nadu, Telangana, Andhra Pradesh, Maharashtra and Gujarat – account for 63 per cent of total confirmed cases in the country. However, COVID-19 is spreading deep into the hinterland states of North and Central India as well. This is evident from the large number of cases being reported in New Delhi, Uttar Pradesh, Rajasthan and Madhya Pradesh.
• Northeast India has reported the least number of COVID-10 cases till now. India’s eastern region, particularly Odisha, also has had very few cases, while cases reported in Bihar and West Bengal are still lower than those in other major states. The Himalayan states of Himachal Pradesh, Uttarakhand and Ladakh have had relatively few cases, while Jammu & Kashmir has reported several cases.
• The correlation between the number of confirmed cases and deaths is positive for Maharashtra. Otherwise, however, there does not appear to be a significant association between the two indicators till now. Kerala and Tamil Nadu have less COVID-19 deaths than Gujarat, Madhya Pradesh, Punjab and West Bengal despite having many more confirmed cases. Deaths have also been reported in Bihar and Himachal Pradesh too, despite these states having fewer COVID-19 cases than the other states.

It is still premature to draw broad conclusions about the overall character of the COVID-19 outbreak in India from the state-wise distribution. The situation is evolving and is subject to rapid shifts. Nonetheless, the statistics confirm the apprehension that COVID-19 has acquired a pan-India dimension. However, in spite of spreading far and wide across the country, it is not yet possible to conclude if the virus is spreading among local communities. This can only be ascertained once more data becomes available over the next few weeks.

States showing a lower number of confirmed cases so far cannot afford to be complacent. These lower numbers might be due to insufficient testing. Eventual casualties, in terms of people dying, might be higher in states and regions with relatively poor epidemic management capacities, including the availability of healthcare professionals, hospitals and protective equipment. These states might also have weaker public finances, which could be deployed to COVID-19 management efforts. In these states, fatality rates, that is, the number of people dying as a proportion of those affected, might be much more even if the overall confirmed cases are lower. Many of India’s hinterland states, as well as those in the East and Northeast, are at risk in this regard.

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Dr Amitendu Palit is a Senior Research Fellow and Research Lead (Trade and Economic Policy) at the Institute of South Asian Studies (ISAS), an autonomous research institute at the National University of Singapore (NUS). He can be contacted at isasap@nus.edu.sg. The author bears full responsibility for the facts cited and opinions expressed in this paper.