Since early April, New Delhi and the national capital region (NCR) have been the epicentre of COVID cases in India. A survey by LocalCircles reveals that 55% of Delhi-NCR families have had one or more members in the family down with one or more of these COVID symptoms in April and the first 10 days of May. Of those with COVID symptoms in Delhi-NCR, only 19% are falling under any kind of government data and 81% are getting missed out, LocalCircles says.
In a report it says, "This translates into saying that the daily reported cases must be multiplied by at least a factor of five to calculate the total daily cases. Knowing that COVID is highly infectious, if multiple family members are having such symptoms, another multiplication factor of two-three may be applied to get the actual number of daily cases."
"With only 20% of potential cases getting tracked, it makes it that much harder for the state and Union governments to root out variants causing surges via genome testing. And as the number of samples keeps falling further as more and more people opt for no testing or at-home antigen testing, it will be very difficult for the government to track the pandemic and have an effective and timely pandemic response," LocalCircles says.
Over the past three weeks, the Delhi government has been reporting between 1,000-1,700 cases each day, with a test positivity rate (TPR) between 4% and 9%. At the district level, several districts in Delhi-NCR have been reporting a TPR of 10% to 16%.
However, the daily reported cases might be grossly understated as many Delhi-NCR residents have been stating on LocalCircles platform that they either have someone in their immediate family or close network with one or more COVID symptoms—fever, sore throat or cough, cold or congestion, fatigue or body ache, stomach ache, diarrhoea, nausea, breathing difficulties, and uneasiness—and many are not taking the RT-PCR test, or are taking the rapid antigen test (RAT) at home or simply not taking any test.
The reverse transcription polymerase chain reaction (RT-PCR) test and RAT have become important to trace if an individual has been infected by COVID after exhibiting symptoms. As per an advisory from the Indian Council of Medical Research (ICMR) on 'purposive testing strategy for COVID-19', only symptomatic individuals may get tested with RT-PCR, which can be taken in a laboratory setting and the result can be obtained within eight hours. The rapid antigen test has become popular among citizens as it can be taken in home settings and the results can be obtained within just 10 minutes.
To understand the magnitude of underreporting, LocalCircles conducted a study last week and found that of the people that were undertaking testing, 42% were opting for only a RAT.
In this latest study, LocalCircles has attempted to understand the magnitude of people who have COVID symptoms but are choosing to not take the test at all. Also, the survey may give some insights to experts on the prevalence and what lies ahead for Delhi-NCR if a majority of people have just been infected with one of the Omicron sub-lineages in the months of April-May.
Of the Delhi-NCR families that had one or more members exhibiting COVID-like symptoms in April-May, 2 in 3 did not take the COVID test.
The question in the survey asked residents in Delhi-NCR, "When you or someone in the family was unwell in April or May (with symptoms like fever, sore throat or cough, cold or congestion, fatigue or body ache, stomach ache, diarrhoea, nausea, breathing difficulties, and uneasiness) did you/ they take any type of COVID test?"
In response, the majority, that is, 66% of Delhi-NCR residents, said 'no'. Only 22% said 'yes, once', and another 12% said 'yes, multiple times'. This means, of Delhi-NCR families that had one or more members exhibiting COVID-like symptoms in April-May, two in three did not take the COVID test.
LocalCircles says one of the insights received from people of Delhi-NCR in the past two-three weeks is the increase in symptoms like stomach ache, nausea, and fatigue, especially in children and fever in some cases. "While some of these cases may be related to gastroenteritis or heat stroke, a comparison to previous years shows significantly higher numbers of people, especially children, having such symptoms," it added.
55% of families so far in Delhi-NCR have one or more individuals who were down with one or more COVID symptoms in April and May
If the feedback from those residents of Delhi-NCR who had one or more members of their household unwell in April and May is further analysed, the findings suggest that 27% suffered from 'fever', 32% said 'sore throat or cough', 14% said 'cold or congestion', 23% said 'fatigue or body ache', 27% said 'stomach ache, diarrhoea, nausea', 9% said 'breathing difficulties', and 5% said 'uneasiness'.
However, 45% said "no one thankfully has been unwell in our family in this period."
It must be noted that some had family members who had multiple symptoms and the same is reflected in the chart below.
According to LocalCircles, despite TPR ranging from 5%-15% in various Delhi and NCR districts, the graded action response plan (GARP) was not deployed due to the reported daily caseload numbers.
"It is strongly suggested that Union and state governments and district administrators take another look at how they will track, find out the root cause, respond and manage the pandemic in case a more severe sub-variant emerges in the coming months," it added.
The survey received more than 23,500 responses from residents located in all districts of Delhi and the NCR cities of Noida, Ghaziabad, Gurugram and Faridabad. About 64% respondents were men while 36% respondents were women.