Poll-bound Bihar's impressive Covid-19 numbers have experts puzzled

Congregations, gathering and crowds - the novel coronavirus loves them all. As Bihar, India's second-most populous state undergoes its legislative Assembly elections - in three phases, the number of people gathering in poll rallies, support rallies and even polling booths has become a cause for worry.

However, even though Bihar right now has everything the virus loves - Covid itself is missing from the state. The India Today Data Intelligence Unit looked at the Covid-19 statistics of Bihar, along with the topmost populous states in the country and found that the state has puzzled the experts with its impressive Covid numbers.

Bihar's impressive Covid numbers

So far, Bihar has recorded close to 2.15 lakh coronavirus cases - of which 95.6 per cent have recovered. Considering the population of the state, Covid-19 numbers are relatively quite low.

According to the UIDAI, the projected population of Bihar for 2020 is estimated to be 12.5 crore. This means that for every 1 million of its population, roughly 1,800 people have been infected with the virus, which is almost three times lower than the national average of 6,000 people per million.

Bihar also records a low number of deaths. Of the total 2.15 lakh infected cases, a little over 1,000 people have died. This means for every 200 people who caught the virus, hardly one person died which gives it a fatality rate of 0.5 per cent - three times lower than the national average of 1.5 per cent.

While this might raise suspicion about the state's testing numbers, but here too Bihar shines, at least among the big states.Until Thursday, Bihar's testing figures had reached 1.06 crore, second highest after Uttar Pradesh (1.5 crore). The daily testing in Bihar is averaging 1.3 lakh tests per day which are almost double what Maharashtra does every day (70,000).

Bihar has tested 88,000 of every million of its population, which is relatively lower than many small states like Delhi (2.4 lakh), Andhra Pradesh (1.4 lakh), Karnataka (1.12 lakh), Tamil Nadu (1.25 lakh) etc. However, among the topmost populous states, Bihar still has a lead since Maharashtra, Uttar Pradesh, West Bengal and Madhya Pradesh perform relatively poorer.

Experts puzzled

While Bihar seems to have been moving in the opposite direction when it comes to following Covid-19 protocols, experts seem to be puzzled about the state's impressive Covid-19 numbers.

Murad Banaji, senior lecturer Mathematics at the Middlesex University London, who has deep interests in disease modelling, told India Today that Bihar's numbers are 'surprisingly low '.

"When we look at data from different states there is a trend where more rural states report fewer cases and deaths. What is unclear is whether this is because the disease spread is lower or whether more infections and deaths go unreported in rural areas," Banaji said.

"Bihar saw a big increase in testing which might have helped to control the spread. But the data and reports suggest that testing was not targeted very clearly. Some districts have lots of tests and few cases and other districts have lots of cases and not so many tests. Why? Even after testing had increased, early reports from the second national survey suggested that only a very small percentage of infections had been detected," he added.

Six districts of Bihar had participated in the second national serosurvey conducted in the month of August, whose results published in local media reports had highlighted how the state had low levels of antibodies.

"The pandemic is spreading to different areas, and no area is immune," said Giridhar R Babu, professor and head of lifecourse epidemiology at the Public Health Foundation of India.

"It is surprising that some states including Bihar have not detected adequate cases per million. It is counterintuitive that few areas will have a lower case burden while the rest of the states have a high case burden. It is time to improve case detection and improve the testing strategy," professor Babu told India Today.

Professor Banaji had written in detail how young and rural areas have recorded a relatively lower fatality. Though most Bihar is rural and young, yet it surprises him.

"Bihar's population is young and we know that Covid-19 fatality is strongly related to age. This might partly explain the low death toll, but it is not the whole story. Even taking this into account deaths are lower than expected. Based on international data - and even Indian data available so far - Bihar's low number of deaths is surprising. It does not seem to be consistent with fatality rates that we are seeing across the world or even close by in Chhattisgarh," he said.

A big-wave coming?

Though Bihar is conducting 1 lakh-1.3 lakh tests per day, the majority of it is being done through the less sensitive Rapid Antigen Test, which has a high incidence of false negatives. Because of high reliance on antigen tests, many positive cases go missing, the health ministry had pointed out last month in its press conference.

Bihar's 'tests will win the war' attitude might have worked out when it faced floods and the migrant crisis, however, with the massive congregations taking place in election rallies, suspicion may arise over maintaining its "shining among other states" streak.

Even Delhi, that increased its testing significantly, is currently facing a possible third wave with daily cases going beyond 5,000 on Friday. Unlike Bihar, Delhi didn't have an election in the times of Coronavirus. But is a poll-bound Bihar safe from a big Covid wave given that elections, bundled with Diwali and Chhath (Bihar's annual sun festival) are happening shortly?

"Any large gathering could potentially be dangerous if people do not follow social distancing and face protection guidelines. From what I see Bihar is doing quite a bit of testing compared to other states with similar case counts. That is a good thing and could lead to early detection and containment. The lower fraction of urban areas in the state can also contribute," said Bhramar Mukherjee, professor of epidemiology at the University of Michigan's School of Public Health, USA.

Speaking to India Today, Professor Bhramar said, "In the first wave in March there were several places in Italy that had surprisingly low infection rates and people were trying to understand the contrasting differences between Lombardi and Veneto. Genetics, cross-immunity, population density, lifestyle and administrative policy differences were mentioned as potential causes. But many of these places in Italy have surged in the second wave."

Speaking on the ongoing Bihar elections, professor Bhramar said, "We cannot stop being part of a democracy and refrain from electoral processes. It's a combination of caution, courage and care now."

"There are safe ways to participate in social and political processes like voting. My opinion is that we should engage in such processes and protect ourselves by wearing masks and avoid crowding in closed indoor places," professor Bhramar concluded.