10 cities account for half of India’s active Covid-19 infections

As India crosses the 1 million mark for coronavirus disease (Covid-19) cases, here is the most important statistic of the disease’s run through the country : at least half the 330,725 active cases in the country as of Wednesday night were reported from just 10 cities, with a third of all such cases in one state , Maharashtra.

A district- and state-wise analysis of active coronavirus infections by HT shows that urban centres, or city districts, are significantly more affected by the virus and account for a majority of the active cases; just the 10 cities account of 52.7% of all active cases in the country.

Active cases -- those still under treatment -- is a crucial metric because it directly reflects the pressure on the health care system in any region. It is calculated by subtracting the number of recovered patients and deaths from the total tally. As of Wednesday night, of the 968,405 total Covid-19 cases reported in the country, 330,725 (34.2%) were active, according to HT’s Covid-19 dashboard.

To be sure, most states do not release city-specific data, so the analysis has relied on district-wise numbers from states to zero in on the worst-hit cities in the country. Among the 10 districts with the highest number of active cases, eight are city-districts or districts that constitute a single city. Most major metropolitan cities in the country are districts among themselves (with the exception of Delhi, which consists of 11 revenue districts). Raigad (5,192 active cases) and Palghar (4,916 active cases), both in Maharashtra, are the only two districts in the top 10 that are not entirely urban.

Three of the five worst-hit cities in terms of the total number of active cases are in Maharashtra (Chart 1), a fact that highlights the overwhelming numbers emerging from the spread of the virus in the western Indian state. Thane has 34,721 active cases – the highest in the country – with Pune at the third spot with 25,510 active cases and Mumbai at the fourth spot with 22,888 active infections.

Hyderabad, which has the second highest number of active cases in the country, appears with stand-out numbers with nearly 99% (28,783) of the 29,111 cases reported in the city currently active -- a clear indication of how things have suddenly turned bad for the southern city. Among the top 10 cities based on active cases, Delhi has the lowest proportion of active cases – 15.2% – followed closely by Ahmedabad (at 10th spot) with 15.4% of cases active.

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In terms of states, Maharashtra continues to have the highest number of active cases with 112,099 active infections (40.7% of the total Covid-19 cases in the state) as of Wednesday. This means one-third of all active cases in the country are in Maharashtra, which is not surprising as it is the state with the highest number of confirmed Covid-19 cases and deaths and accounts for 28% of all cases in the country.

For perspective on the high active case count in Maharashtra, the state has more active cases than the combined total of such cases in the next four states on the list — Tamil Nadu, Delhi, Karnataka and Gujarat.

Maharashtra health minister Rajesh Tope said that taking cognisance of the lack of availability of beds, especially ICU beds in some cities in Mumbai Metropolitan Region (MMR) the state has ramped up health infrastructure to deal with this rise in active cases. “With the help of community participation and new interventions like antigen tests involving private doctors, the state will contain the spread in MMR and other parts of the state too.”

Dr Avinash Supe, former dean of Mumbai-based KEM hospital and member of the expert committee appointed by the state to recommend steps to curb the spread, said that he expects active cases to come down in a few weeks. “Comparing the total number of cases in the country, Maharashtra’s share has come down drastically; it used to be almost half one point of time. It’s now less than a third of the national total. Even Mumbai’s number of active cases has improved in the last few weeks and we expect it to come down to 15000 in the next couple of weeks,” he said.

With 59% of all cases active, Karnataka has the highest proportion of active cases to the total caseload. The state, which on Tuesday replaced Gujarat as the fourth worst-hit state in the country, has seen a sharp rise in cases over the past two weeks. This recent spike in cases in the state is also responsible for the high number of active cases – with two-thirds of its caseload appearing in just the last two weeks, the state’s recoveries are yet to catch up.

This trend of states with fast-rising caseloads having a high proportion of active cases is also visible in other states such as Maharashtra, Andhra Pradesh and West Bengal (Chart 2) – all of them have a higher proportion of active cases than the national average (34.2%).

With inputs from Surendra P Gangan in Mumbai