Two Indian states having populations at par with the two countries have about 550 and 65 cases. These are the densely populated Uttar Pradesh and Bihar.
Bihar has reported 65 cases of the novel coronavirus with 1 death while Uttar Pradesh has recorded a little over 550 patients with 5 fatalities.
Other states like Maharashtra with more than 2,300 cases and 160 deaths or Tamil Nadu with close to 1,500 cases and 10 deaths appear much worse off.
Bihar and UP together have a population of 330 million (33 crores), which is almost equal to the population of the United States. Holding more than one-fourth of the Indian population, the states of two states have about 6% of the total 10,300 cases.
But is this because of the precautionary measures taken or the healthcare facilities of the states? The answer may not be that obvious.
According to experts, the low number of coronavirus cases in Bihar and Uttar Pradesh is specious. The situation in the two states is unclear “probably due to low levels of testing and also a weak health system. States with the strongest health systems are more likely to detect cases quickly,” says Ramanan Laxminarayan, founder and director of the Center for Disease Dynamics, Economics & Policy in Washington.
Laxminarayan had suggested that if mathematical models applied in the US or UK were applied to India, the country could be dealing with 300 million cases.
The two states also have marked paucity in healthcare facilities. According to a 2016 report by Bihar's department of industry, out of the required 40 medical colleges and hospitals the state only had nine.
Talking about district hospitals, of the 38 required the state had 36, while for the 212 required sub-divisional hospitals, Bihar only had 44.
The state is also deficient in primary healthcare services, having 1,350 primary health centres (PHCs) of the required 2,787, and 9,729 health sub-centres of the required 20,997.
Bihar received around 50,000 migrant workers from Delhi around the time the nationwide lockdown commenced, while it received additional 3,500 tourists from abroad.
According to the Indian Public Health Standards (IPHS), which set infrastructural and human resource benchmarks for public health institutions in India, a third of the rural population in Uttar Pradesh has been deprived of primary healthcare infrastructure.
UP requires 31,037 sub centres, 5,172 PHCs and 1,293 community health centres (CHCs) to meet the healthcare demands of its population, an IndiaSpend report said. The state is 33% short of sub-centres and primary health centres and 40% short of community health centres, according to government data from 2015.
Laxminarayan suggests that the lower number of cases in Bihar and Uttar Pradesh could be due to inadequate testing performed in India. “We don’t know the situation unless we have better testing data.
It is clear in other places that increased testing reveals more cases, which can then be quarantined. The same is needed in UP and Bihar as well,” he adds.
As per data obtained till April 10 from the Indian Council of Medical Research, Bihar conducted 6,250 tests, while Kerala conducted 14,163, Delhi did 11,287, UP did 10,398 and Maharashtra conducted 35,855. It is pertinent to note that Kerala having less than half of the population of Bihar conducted twice more tests.
Similarly, Maharashtra having half the number of people as UP conducted three times more tests. Testing per million in Maharashtra and Kerala are 264 and 399, while Bihar and Uttar Pradesh have conducted 51 and 44 tests per million of population.
India is conducting 137 tests for coronavirus per million population, while the testing in the US and France is 8,155 and 5,114. The disparity in testing is worse in densely populated states. Data suggests that more number of tests is throwing up more cases and vice versa.
Preliminary data suggests that the UP and Bihar remain two of the best performing states with very few coronavirus cases and low fatality rate.
Bihar has one of the highest recovery rates at 30% with national figure a little over 10%. However, the low testing numbers and poor health infrastructure suggest a different story.