Coronavirus: Mizoram sees sharp rise in active cases, positivity rate over 10% in 8 of 11 districts

Mizoram has seen a sharp rise in its active cases of coronavirus with children and teenagers accounting for nearly 39% of the caseload. It currently has the fourth highest number of active Covid-19 cases after Kerala, Maharashtra and Tamil Nadu.

The state has 16,361 active cases as on October 2, contributing 6% of India’s total active case pool. It has been reporting 1,500-2,000 fresh cases daily in recent days.

On Friday, the central government announced that a team would visit Mizoram to assess the situation.

The surge in Mizoram is to some extent in line with what several experts have been saying, that Covid-19 waves may henceforth occur localised, limited to a few districts or a state. Currently, most parts of North East and Kerala have a higher positivity rate than the rest of the country.

Eight out of 11 districts in Mizoram have more than 10% positivity rate. Across India there are 30 such districts. District Champhai in Mizoram has reported the highest positivity rate at 27.6% in the September 23-29 week. Two districts in Mizoram – Khawzawl and Kolasib – are also of concern as their positivity rates are between 5% and 10%.

What explains the surge now?

Over 49% Covid-19 samples sequenced from Mizoram have the Delta variant, now believed to be the key driver for the latest surge in the state.

Since April, the state has sent 887 samples for genome sequencing. Of them 510 had variants: 437 with Delta variant, one Alpha and one Eta. There are over 70 samples that had Delta sub-lineages, of them three had AY.1 variant, commonly referred as “Delta Plus”, said Dr Pachuau Lalmalsawma, heading the Covid-19 cell in Mizoram.

The spread of the Delta variant and its sub-lineages, rampant across India since March, has come at a much later stage in Mizoram. The variant is twice as contagious as the original Sars-CoV-2 strain and spreads faster.

Lalmalsawma said while Delta is driving the surge, localised community spread is fuelled by inter-mingling of population that seems tired of the lockdown.

Indian Council of Medical Research scientist Biswajit Borkotoky said Mizoram managed to implement a strict lockdown since March 2020 when the pandemic began. “Just like Kerala, it was successful in limiting the spread of infection. There is a large population still unexposed to the virus, and that is now getting infected,” he said.

Last winter, even as Covid-19 related restrictions were eased in most of the country, movement of people continued to be strictly regulated in Mizoram. In fact, barring some exemptions, the state has been for all practical purposes in a perpetual lockdown since March 2020.

Community organisations like the Young Mizo Association, which have a singularly unique position in Mizo public life, diligently enforced the lockdown on the ground. The Mizos’ inherent sense of discipline ensured there were few violations of the rules in place.

This hyper-careful approach paid dividends: for the longest time, the state’s toll was considerably low compared to other states in the North East.

However, there appears to have been a lowering of guard of late – as the high number of cases in recent weeks in the state bears out.

“People were starting to grow sick of the restrictions,” said a politician belonging to the Mizo National Front, which governs the state. “We are a close-knit society, so people started visiting each other.”

Vaccination

Mizoram has covered 80% of its adult population (8.67 lakh aged over 18 years) with the first dose, and 51% with both the doses.

Despite high coverage, the state is noting nearly 1,100 new Covid-19 cases per million population daily. State nodal officer for Covid-19 Dr Lalmalsawma said they are also noting positive cases amongst vaccinated population.

“But the percentage is small, and most are mild,” he said. “Maximum hospitalisation continues to be of unvaccinated population.”

What is worrying is the rise in recorded cases amongst children and teenagers. Data till September 29 shows that out of 16,837 active cases, 6,736 are aged less than 20 years. There were 3,173 children aged less than 10 years and 3,563 aged 11-20 years who remain actively infected.

On September 29, of 1741 new cases 43% were children and teenagers. Children aged less than 10 years account for over 19% of infected cases, much higher than the national average at 7%.

Dr Lalmalsawma said most children are under home or institutional isolation.

Testing limitations 

Experts believe Mizoram’s current positivity rate, hovering between 17% and 19%, is much higher than what the state is reporting, simply because of its choice of testing method. Mizoram has only one RT-PCR lab in Falkawn for 11 districts which carries between 1,500 and 2,500 tests a day.

The state is testing around 9,000 samples a day. While central government guidelines mandate a 70:30 ratio for RT-PCR and rapid antigen test, Mizoram is forced to test over 60% samples through rapid antigen due to limited RT-PCR infrastructure.

About 30% samples are tested through RT-PCR, less than 1% through True-NAT, and over 60% through rapid antigen test.

Since rapid antigen tests have lower sensitivity to catch Covid-19 virus, chances of an infected person testing negative are higher. Experts said it is possible the actual positivity rate in Mizoram is much higher and cases are being missed due to dependence on antigen tests.

Dr Lalmalsawma said to work around this problem, they are quarantining all high risk contacts even if they test negative for the virus. “We are testing all high and low risk contacts through a strict contact tracing policy. If they test negative, we quarantine them for seven days and test them again,” he said.

Mizoram has begun mass screening in 100 villages. “Our testing is specific and scientific,” Lalmalsawma said.” We don’t carry random testing, perhaps that is why the positivity rate is so high at this point.”

In the last fortnight, the positivity rate has risen from 12% to 19%, but total tests carried have not increased. Except on September 26 when the positivity rate shot to 31.77%, the positivity rate has remained below 20% for a month.

Arunabh Saikia contributed to this report.

This reporting was supported by a grant from the Thakur Family Foundation. Thakur Family Foundation has not exercised any editorial control over the contents of this article.