Why some states do better than others in the covid-19 fight

The smaller states of Goa, Manipur and Arunachal Pradesh have recorded 100% recovery rate so far, while Kerala and Haryana are also doing well despite having a large caseload. Doctors and researchers are now looking into why some states do better than others when it comes to tackling the novel coronavirus outbreak.

“Robust health infrastructure, immunity levels among the population, strict adherence to isolation/quarantine and aggressive testing could all contribute to a state recovering well,” said medical researcher Dr. N.K. Venkataramana. “If a state has more industrial zones and high pollution levels, citizens could take longer to recover.”

Of Kerala’s 447 confirmed cases, 324 recovered, putting its recovery rate at 70.69%. It’s the best performing state after Goa, Manipur and Arunachal Pradesh. Kerala is followed by Haryana with a recovery rate of 62.96% (156 of 272 infected people cured of covid-19). Gujarat has the lowest recovery rate in the country. Uttar Pradesh and Madhya Pradesh rank just above it.

Data collated from the Union Health ministry and state portals shows that Maharashtra has the highest number of positive cases as on 22 April at 5,649 but its recovery rate is 13.97%, far better than Gujarat’s 7.44% for a total of 2,407 cases.

Tamil Nadu, which has the highest number of cases in the south (1,683) has a recovery rate of 44.68% compared to Karnataka’s 32.58%. This is despite the fact that Karnataka at 445 confirmed cases has less than half the caseload of TN. Delhi has a high number of cases at 2,248 and a recovery rate of 32.21%.

“The fact that younger people are more likely to recover than the elderly and those with co-morbidities is well known. But what differentiates the states’ recovery rates is the health system’s response. Uttar Pradesh and Madhya Pradesh, have not been able to get suspected patients to hospitals early enough or there are no hospitals at all,” said Prof Giridhar R Babu, Professor & Head, Lifecourse Epidemiology, Public Health Foundation of India (PHFI). “In Kerala or Goa, where the general awareness is high, the public health system is robust and enough testing is being done, the outcomes are better,” he explained.

He said that disparities within states also need to be studied. In Karnataka, for instance, Raichur district has not reported a single case so far, which requires investigation. “The public health system is not strong in Raichur. Literacy and awareness are also low. So, people may be ignoring a respiratory condition. These silent blocks are where we may be missing cases,” he said. In such areas, cases tend to show up only at the critical stage.

The data also has to be studied to understand the demographics of the people who recovered as well as how they contracted the infection to understand why some recover faster than others. “There is a data drought in terms of age, sex, date of detection of the disease and whether the disease was contracted through first, second or tertiary contact in the states,” said Dr Prasanta Mahapatra, Dean, The Institute of Health Systems, Hyderabad. “There is also need to study the viral load of infected persons.”