During the first half of March, when the novel coronavirus was simmering its way across the country, Gujarat had zero COVID-19 cases. The state recorded its first two cases only on 19 March (both patients with travel histories) when India stood at a total of nearly 200.
On 22 April, barely a month after, Gujarat became the second-hardest hit state in India, surpassing Delhi and following Maharashtra. As of the morning of 28 April, the state had 3548 confirmed cases, 294 recoveries and 162 mortalities, according to the health ministry figures.
The recovery rate in Gujarat is around 8 percent - one of the lowest in the country - compared to India’s 23 percent. To put this in perspective, Maharashtra’s recovery rate is 14.9 percent and Delhi, with the third-highest cases, stands at almost 28 percent. A similar trend follows for the mortality rate, with Gujarat at 4.5 percent as opposed to the national average of 3.1 percent.
What are the possible explanations for Gujarat’s rapid progression of COVID-19 cases? FIT explains.
Cases Concentrated in Few Cities
Before going into the reasons, mapping the spread of the virus in the state is important. Ahmedabad, Surat and Vadodara have the highest number of cases within Gujarat, at 1298, 338 and 188 respectively. According to a PTI report, the death rate in Ahmedabad alone (4.71 then) is above the national average (around 3.1).
Speaking to FIT, Dr Dileep Mavalankar, Director, Indian Institute of Public Health (IIPH), Gandhinagar, says that the rural parts of the state hardly have any cases.
In the ministry briefing on 27 April, Lav Agarwal had a similar response to a query on the incidence of rising cases in Maharashtra and Gujarat, and attributed it to the population densities of their cities.
In fact, the pattern is not unique to India and has been observed world over, where most cases have been concentrated in ‘dense urban centres’ like Wuhan, Milan, Seattle, Madrid and New York, Fortune reported. Crowds, huge venues, public transport and events can become a breeding ground of a virus and may allow its easy spread.
Dr Mukesh Maheshwari a Pathologist from Ahmedabad, however, tells FIT that the low cases in the rural areas may also be because of a lower rate of testing there. “Diagnostic facilities are mostly in urban areas. All 15 testing laboratories in Gujarat, for instance, are in the larger cities.”
A Lot of People Travel to and From Gujarat: Experts
Another reason Dr Maheshwari points out which may be especially applicable to Gujarat, is that people from the state travel a lot. Since the virus was first encountered in China before it spread across the world to other countries, travellers coming from abroad are understood to be the initial carriers, starting a chain of transmission from their own contacts.
Gujarat is also known for its robust business community which makes international as well as domestic visits all through the year.
This fact is substantiated by data by the tourism ministry, according to which, over 30 percent Indian tourists are Gujaratis.
Another article by Travel News Digest stated that Gujaratis continue to be the most avid Indian travellers. “Gujaratis top the chart as the community that travels the most, whether within their country or abroad,” it said.
Dr Mavalankar also stressed that the initial hypothesis for the rising cases in Gujarat was, in fact, the habitual foreign connections that people from Gujarat seem to have and maintain.
In a similar analysis FIT had done for COVID-19 in Maharashtra, Dr Sumit Ray, critical care specialist in Delhi, had highlighted that this impact on ‘big cities’ was seen even during the time of Spanish flu. “We should look at it as Mumbai and Delhi, not Maharashtra and the rest of India. There is much more international travel and much more intermingling in tighter urban spaces overall. Mumbai was the place with the maximum Spanish flu and plague cases- at that time it was Calcutta and Mumbai - the ports."
Cases Likely to Increase Once the Lockdown Is Lifted: Dr Maheshwari
“Since many people are asymptomatic and can remain undiagnosed, lockdown is an efficient way to contain the virus. In Gujarat, we can estimate that it is being implemented well, with over 95 percent of the population staying inside. This is why we haven’t entered the stage of community transmission yet,” Dr Maheshwari told FIT.
The municipal corporation has been proactive in contact tracing, door-to-door surveillance, random testing, sending teams to various areas and slums for screening and sample collection, he says.
According to estimates, the number of tests conducted in Ahmedabad alone is 2,700 tests per million people, while the figure in Delhi, for instance, is 1,400 tests per million and Maharashtra is at 679.
“The proactive measures taken by us might have increased the number of cases for the moment, but this will bring down our numbers very soon and finally make us feel safe,” Ahmedabad municipal commissioner Vijay Nehra had said.
But while the Gujarat government has maintained that contact-tracing and screening in hotspots is being diligently conducted, an article in The Print reported that people in Ahmedabad’s more ghettoised areas had not been following social distancing, and the police had made no visit to check them even after receiving complaints. In fact, the officials had ‘missed out’ on screening some families in the area, risking the lives of all others living in the extremely crowded space, the report stated.
As the numbers rise rapidly, Dr Maheshwari feels there will be a need for the state to adopt alternative ways of containment, as adopted by other countries such as the US.
On these lines, the central government on 28 April, released its guidelines for home quarantine for those with very mild symptoms or those who are pre-symptomatic.
As lockdowns ease - social distancing and robust testing seem to be the only way forward.
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