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Bihar Chief Minister Nitish Kumar ordered the state’s health department to ramp up testing for the novel coronavirus (SARS-CoV-2) to 10,000 tests per day on May 12, 2020, with only 1,900-2,000 samples currently tested across the state daily.
The order comes even as the state faces numerous issues, including the return of thousands of migrant workers, shortage of healthcare equipment, a lack of support from the Union government and a challenging requirement to increase tests for the state’s nearly 120 million population.
Ironically, just two days before Kumar’s directive, the testing facility at government-run Jawahar Lal Nehru Medical College and Hospital (JLNMCH) in Bhagalpur was forced to halt testing in the absence of testing kits.
The discontinuing of tests has impacted Bhagalpur and neighbouring districts that are in dire need of expanding the number of tests. The state reported 130 positive cases for the disease (COVID-19) on May 12, the largest single-day spike to date, taking the number of cases in the state up to 953 as of May 14.
Bihar — with a total of 39,918 samples tested in its seven facilities as of May 13 — has one of the lowest testing rates in the country.
The state reported seven positive cases for every 313 tests per million. The rate of positive cases in the tested samples increased to 2.32 per cent from an earlier 1.7 per cent.
Only seven deaths were reported so far, with the state’s fatality rate at 0.72 per cent.
Returning migrant workers
There are rising concerns that the number of positive cases and resultant deaths may increase, as thousands of migrant workers — facing long-term unemployment from the nationwide lockdown — return every day through special shramik (labour) trains.
The total number of migrants who tested positive since the lockdown began were 331. Of these, 277 tested positive till May 3, according to the Bihar Health Secretary Lokesh Kumar Singh.
Singh admitted that the sudden rise of cases in the state was related to the arrival of migrant workers in large numbers in the past 10 days.
Two-hundred seventy-seven migrant workers, who returned to Bihar after May 3, tested positive during random sampling, nearly a fourth of the total number of cases in the state.
Kumar said random testing will not work anymore and pushed for intensive testing of migrant workers. Earlier this week, he said all migrants returning to the state should be subjected to COVID-19 tests, instead of random tests, a move must be carried out to break the chain of transmission.
This will be a challenging task, considering the average testing rate, number of testing facilities and availability of testing kits. State government officials claimed more than 150,000 workers reached the state through 137 special trains, as of May 13.
The government has booked 307 special trains to bring 359,000 migrant workers by the next week.
Kumar asks Centre for help
Kumar demanded more testing kits during a May 11 video conference call with Prime Minister Narendra Modi and requested more personal protective equipment (PPEs) and ventilators for the state.
There was, however, no response from the Union government on this front.
“Modi was silent during his national address on May 12, on whether the country should go for intensive testing or not,” said a senior health official. “He did not mention anything on testing kits, PPEs and ventilators to Bihar or other states to scale up testing facility. In such a situation, the state government is on its own,” the official added.
Bihar has about 38,550 viral transport medium kits (VTMs) — used to collect samples for tests — and around 20,250 RNA extraction kits in stock, according to government data as of May 12.
The state has 959 infrared thermometres, 171,451 PPE kits, 411,495 3-ply masks, 43,717 N95 masks, 40 sanitiser ordinance factories and 9,021 500-millilitre sanitiser bottles in stock, according to the data.
The state health department expects no supply of the above materials in the next 24 hours.
The Indian Council of Medical Research (ICMR) supplied kits for testing, since early April, said another health official, who added that RNA extractors were bought by the state from a Singapore-based firm.
Principal secretary of health Sanjay Kumar did not respond to requests for comments — despite repeated calls — on how the health department planned to scale up testing and whether the state had adequate testing kits.
Bihar government to buy ventilators
Health officials said the state government has, however, initiated the move to purchase 150 ventilators.
“At present three government run hospitals — turned into centres for treatment of COVID-19 cases — have only 50 ventilators,” said a health department official. “The state, however, requires more life support systems to deal with the spike in cases,” the official added.
The Narmada Medical College and Hospital in Patna, for instance, has 800 beds for COVID-19 cases, 20 ICU beds, just 20 ventilators and 12 beds in its isolation ward. Anugrah Narayan Magadh Medical College in Gaya has 544 beds, 60 ICU beds and just 18 ventilators. In JLNMCH, there are 1,000 beds, 36 ICU beds and 12 ventilators.
Testing increased from May 8
According to data from the health department, testing increased from May 8. Bihar tested 581 samples on May 5, from which seven tested positive, according to official figures on tests.
There were tests of 596 samples on May 6, from which seven tested positive. On May 7, the state government tested 609 samples, from which 29 tested positive. On May 8, however, the state tested 1,075 samples, from which 32 tested positive, followed by 1,388 samples tested on May 9, from which 52 tested positive.
On May 10, 1,907 samples were tested, from which 89 tested positive, while on May 11, 2,027 samples were tested, from which 54 tested positive. Similarly, 1,927 samples were tested on May 12, from which 118 tested positive.
Of all the tests so far, 21,317 samples were tested at Patna-based Rajendra Medical Research Institute, highest among all the seven laboratories with testing facilities.
Health officials, however, were reluctant to say anything about the decline in testing from May 4-8, contrary to increasing tests conducted by neighbours, including Jharkhand and Odisha and on the national level as well.
What raised questions was that Bihar tested an average 1,000 samples daily from April 23 till May 4.
JLNMCH shuts testing
JLNMCH superintendent RC Mandal said the hospital’s testing facility was closed since May 10, because there were no testing kits available.
The hospital was provided only 350 kits for tests. “As JLNMCH uses cartridge-based nucleic acid amplification test machines and kits imported for the tests, it will take some time to resume testing again,” said Mandal.
Bhagalpur Civil Surgeon Vijay Kumar Singh informed the health department about the absence of testing kits that halted tests.
Taking into consideration the lack of testing facilities at laboratories of the government run hospitals, approved by the ICMR, the state government approved two private laboratories to test samples.
P Das, director of Rajendra Memorial Research Institute of Medical Sciences in Patna, said there is possibility of a further spike of cases in Bihar in view of home coming of thousands of migrant workers. “The government has to increase the testing facilities and capacity to deal with the situation,” he said.