A three-member central team, which visited Bihar to assess the coronavirus situation, on Wednesday warned that the state’s low testing rate may affect its case fatality rate – the number of deaths among the cases detected, Hindustan Times reported. The team asked health authorities to keep a weekly tab of the case fatality rate to improve the state government’s preparedness.

Bihar has reported 30,369 positive cases with 217 deaths so far. However, experts suspect the real figures could be much higher. The state has tested among the fewest people per million population in the entire country. Its positivity rate – the proportion of people who test positive among those tested – is fairly high, indicating its numbers could sharply shoot up if testing were to be ramped up.

The team, led by Ministry of Health and Family Welfare department Joint Secretary Luv Agrawal, expressed concern about the alarming rise in positivity rate and cautioned the Nitish Kumar-led government that low testing could lead to more cases.

The state is currently testing around 10,000 people on an average every day, significantly lower than states with comparable populations. This has worsened further after rapid antigen tests increased the possibility of “false negatives”. The Indian Council of Medical Research has said that all rapid antigen test negatives should be re-tested in RT-PCR or reverse transcription polymerase chain reaction test. However, anecdotal accounts suggest that this is not followed.

Agarwal suggested that the state government should ensure maximum utilisation of RT-PCR tests to flatten the curve of infections. The central team, comprised of Dr SK Singh of the National Center for Disease Control and and Dr Niraj Nischal from the All India Institute of Medical Sciences, New Delhi, said authorities should also conduct rapid antigen detection tests in containment zones and hospitals in Bihar.

Other recommendations by the team included setting up of temporary field hospitals, a mechanism for patient management in dedicated coronavirus facilities and to ensure infection prevention practices. Videos highlighting the poor condition of government-run hospitals have regularly been shared on social media.

The team also asked the health authorities to give attention to logistics management, such as an adequate supply of oxygen cylinders in hospitals. “We have written to the Centre for support in providing us with oxygen cylinders,” Bihar Chief Secretary Deepak Kumar said. “Special emphasis is being given, as per the central team’s directive, to motivate doctors and other healthcare personnel. Plans are afoot to conduct training programmes for doctors by experts from AIIMS, New Delhi, and also to mentor all state-level health facilities via video-conference links.”

The central team also called for seamless admission of patients in hospitals, including the back-up support of ambulances and call-centres. Kumar said the state government is working on this.

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