Pandemic And The Fact Of Data

It is widely accepted that reported infection and mortality numbers have always been significantly lower than reality. But the current reports are downright dangerous because of two reasons. First, the gap between the numbers and the reality is wider today than six weeks ago, and is widening. Second, even as the situation worsens, the country is starting to believe that we are past the worst and things are improving. Six weeks ago, while the numbers were an underestimate, they were pointing in the right direction—that the pandemic is escalating. Today, the numbers are pointing in the wrong direction. Even as the pandemic continues to escalate, we are starting to believe that it is receding. Whatever data is available publicly, suggests the proportion of antigen tests is over 50%, rising up to 80% in many states. The positivity rate on antigen tests, as can be expected with its very high false-negative rate, is one-third to half of that of molecular tests. The proportion of antigen testing is much higher in rural districts and the slums of large cities. Why is this happening? It is a cascading effect of two forces. First, all states have tried to increase testing. Daily targets for testing have been assigned to all levels of the public health system. Second, it is far easier to conduct an antigen test. Antigen test kits give results in a matter of minutes at the site of collection. For a molecular test, though, the collected sample has to be sent under very stringent conditions to the nearest centre with an RT-PCR machine, which can be hours away. And then, given the shortage of RT-PCR capacity in most parts of the country, the results may take anywhere from two to six days. The far-easier antigen test has been embraced to show that testing is rising, ignoring its inherent inaccuracy. No one on the ground is trying to hide or misrepresent any data. But the design of our data system has ignored this all-important slicing of the data, enabling this perverse development. UP is merely an illustration. Most big states are in a similar situation. Since the pandemic has spread from large urban areas to smaller towns and rural areas—and which is where it is escalating—we are now running blind, given our inadequate and inaccurate testing. The brunt of what follows would be borne by the disadvantaged. The path out of this morass is fairly simple. Change the data system to report all relevant details on testing. Ramp-up molecular testing (or equally accurate methods) capacity—including in rural districts. Have a very strict mandate on antigen testing—only where it is useful; for example, in high-positivity clusters for quick identification. The more difficult part is to rein in our desire to declare victory by staying wilfully blind to reality. The most important lesson from the Spanish Flu that crushed the world in 1918 was not an epidemiological one. It was that a pandemic can only be tackled by truth. We seem to be doing the opposite. We have been silently complicit in developing a system that hides the truth.

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