COVID daily case reports in Delhi-NCR are likely missing over 80% of the cases

May 11, 2022, New Delhi: The national capital has been the epicenter of COVID cases in India since early April. Delhi Government has been reporting between 1000-1700 cases each day for the past 3 weeks, with a test positivity rate (TPR) between 4-9%. At the district level, several districts in Delhi-NCR have been reporting a TPR of 10-16%. However, the daily reported cases might be grossly understated as many Delhi-NCR residents have been sharing 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, uneasiness, etc.—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 RT-PCR test and Rapid Antigen Test (RAT) have become important to trace if an individual has been infected by COVID after exhibiting symptoms. Per ICMR’s advisory on ‘Purposive Testing Strategy for COVID-19’, only symptomatic individuals may get tested with RT-PCR, which can be taken in a laboratorial setting and the result can be obtained within 8 hours. Whereas the rapid antigen test has become popular among citizens as it can be taken at-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% of them were opting for only a Rapid Antigen Test. In this latest study, LocalCircles has attempted to understand the magnitude of people that are having 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’s 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. 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. 64% respondents were men while 36% respondents were women.

Of Delhi-NCR families that had 1 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, uneasiness, etc.) do you/they take any type of COVID test?” In response, the majority, 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 1 or more members exhibiting COVID-like symptoms in April-May, 2 in 3 did not take the COVID test. This question in the survey received 11,235 responses.

One of the insights received from people of Delhi-NCR received in the last 2-3 weeks is the increase in symptoms like stomach ache, nausea, fatigue, especially in children along with fever in some cases. While it’s possible that some of these cases are related to gastroenteritis or heat stroke, a comparison to previous years shows significantly higher numbers of people especially children, having such symptoms.

55% families so far in Delhi-NCR have 1 or more individuals who were down with 1 or more COVID symptoms in April and May

If the feedback from those residents of Delhi-NCR who had 1 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, diarhhoea, nausea”, 9% said “Breathing difficulties”, and 5% said “Uneasiness”. However, 45% said “No one thankfully has been unwell in our family in this period”. This question received 12,422 responses. It must be noted that some had family members who had multiple symptoms and the same is reflected in the chart below.

To summarise, the survey indicates that 55% of Delhi-NCR families have had 1 or more members in the family down with 1 or more of these COVID symptoms in April and the first 10 days of May. In years pre-COVID, similar studies have typically indicated that 15-20% of families having someone who was unwell in summer months. The second finding from the survey is that 2 in 3 respondents said that despite symptoms they/their family member did not take the COVID test. This means only 33% of respondents or their family members with symptoms took the test. The data from last week’s LocalCircles report indicates that of those who took the COVID test in Delhi-NCR, 42% only took the at-home Rapid Antigen Test, which translates into only 19% of respondents with symptoms taking an RT-PCR test. This could be extrapolated to say that of those with COVID symptoms in Delhi-NCR, only 19% are coming under any kind of Government data and 81% are getting missed out. This translates into saying that the daily reported cases must be multiplied by atleast a factor of 5 to calculate the total daily cases. Knowing that COVID is highly infectious, if multiple family members are having such symptoms, another multiplication factor of 2-3 may be applied to get the actual number of daily cases.

With only 20% of potential cases getting tracked, it makes that much harder for the State and Central Governments to root variants causing surges via genome testing. And as the number of samples keeps getting reduced further as 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.

At the state and district level as well, this is evident in Delhi-NCR. 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 Central Government, 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 sever sub-variant emerges in the coming months.