Why does Maharashtra have the highest number of new COVID cases?

On Sunday, April 4th, India registered more than 1 lakh COVID cases in the country in the highest one-day surge for the first time. Alarmingly around half of these fresh cases were found in the state of Maharashtra alone, the highest single-day surge in the state since the pandemic began. The trend continued on Tuesday as well when 55,469 were registered in Maharashtra, the second-highest one day spike since March 2020. On Wednesday, Maharashtra crossed that number to record 60,000 new cases. The number of COVID cases in the state has continued to be one of the highest throughout the pandemic.

Meanwhile, Maharashtra’s neighbour Gujarat reported 3,280 fresh COVID cases on Tuesday. Another neighbouring state, Madhya Pradesh, registered 3,722 new cases. Goa reported 2,471 new cases on Tuesday, while Karnataka recorded 6,150. While it seems questionable why the difference between new cases in Maharashtra and its neighbours, with which it shares quite porous borders, is so large, experts and administrators have attributed the numbers to the mutations as well as a higher reporting of cases in the state.

Double Mutants

While the scientists say that the current phenomenon cannot really be explained accurately, the huge inexplicable surge in COVID cases in the state has been attributed mainly to the mutations that have been identified in Maharashtra. “The virus causing the spread of COVID-19 in the second wave is not the original one. There are variants, which are being called double mutants. We fell short of preventing the spread of these mutations,” said Avinash Bhondwe, Maharashtra President of the Indian Medical Association (IMA).

Speaking about the same, Vineeta Bal, a retired scientist from the Indian Institute of Immunology who is currently with the Indian Institute of Science, Education and Research (IISER) in Pune said, “Maharashtra saw a larger number of COVID cases in the initial months of the pandemic last year as well. After the September peak in the cases, people in the state heaved a sigh of relief as the number of cases suddenly began to drop. Lockdown restrictions were relaxed during this time, almost all the activities had resumed, there were crowds everywhere. But amidst all this, the disease was spreading.”

While the COVID-19 cases seemed to have decreased in India around the last trimester of 2020, the virus was still spreading fast globally. “And it was mutating. Viruses mutate, that’s very natural. So at some point, the mutations became an advantage to the virus, and the rate of infections increased. However, there were no limitations or restrictions, people were travelling, and the virus spread faster,” Bal explained.

Even in Maharashtra, mutations have been identified in the three-four cities where genome sequencing was done. “However, more genome sequencing was needed. We should have identified which mutation is found in which area, and in where it is spreading the fastest,” Bhondwe said.

Higher Reporting of Cases

“When you test more, you will obviously find more cases,” said Dr Pradeep Awate, Maharashtra State Surveillance Officer. “Testing and reporting of COVID cases have been higher in Maharashtra since the pandemic began. Our tracing is also more sensitive, so we are catching more cases,” he added.

In fact, Awate added, even during the Swine Flu pandemic of 2009, Maharashtra had reported one of the highest numbers of cases. “Since 2009, Maharashtra has been one of the states to report the highest number of Swine Flu cases. The same has been the situation with Dengue. This doesn’t mean our health services are perfect. There is a lot to improve. However, we definitely have a better record as far as diagnostics are concerned, as compared to many other states, that too when we are the second largest populated state in the country,” Awate said. Asserting the importance of testing, he also pointed out that Kerala, which in comparison has the 13th largest population in India, has been one of the states to report the highest number of cases in the country.

Bal also said, “Despite its limitations, Maharashtra certainly has a better health system than several other states. Not as good as Kerala, but better than many others.”

However, as per the IMA Maharashtra President, there is a need for a much more efficient contact tracing. “Considering the way the disease is spreading in the state, there was a need to trace at least 30 persons after each new patient. However, hardly five to six contacts are tested in cities like Mumbai or Pune. In other cities like Nashik, the number is even lower. Many people who are getting infected this time are asymptomatic. Therefore, the need for contact tracing is more essential than ever,” Bhondwe said.

More Urban Centres

Awate also added that as compared to most other states in India, Maharashtra has more urban centres. “If you see worldover, many developed countries with more cities and other urban centres have had the maximum effect of the pandemic. That has been the case with the USA or UK or other European countries. Maharashtra is one of the more urbanised states in the country. Around 55 to 60 percent of the state’s population resides in urban centres. Cities tend to have a higher population density, which makes the spread of infections easier, faster,” he said.

He also added that the large migrant population in the state also added to the push and pull of the population, leading to a faster spread of infections. 

The Way Ahead

“We need to work on vaccination hesitancy now. We need to convince more people to come forward and get vaccinated,” Bal said. “Vaccination definitely isn’t an immediate solution. It won’t improve the situation in a couple of days. But we must remember that the pandemic won’t go away in two days either. There is no choice. To avoid another surge, we need to get a larger population vaccinated,” she added.

While those above the age of 45 years were more vulnerable to getting infected last time, it’s those in the age group of 18-45 who are seen testing COVID positive more in the second wave. “It’s the earning population. Everything was shut the first time around, most people were indoors. However, by the time the second wave began, many people had started going out for work. This is the population that also goes to marketplaces, frequents restaurants, malls, gyms, cinema halls, etc. It is, therefore, necessary to expand the scope of vaccination to this age group now,” Bhondwe said.

The IMA has recently written to the Central Government to extend the COVID vaccination programme to everyone above the age of 18 years.

Along with this, Bal has also emphasised that people need to take care of themselves, as well as others, and ensure hygiene and distancing is maintained. “We need to wear masks. Do whatever that you regularly do, but avoid crowds,” she concluded.