Omicron cases fuelling the surge in India’s third COVID-19 wave

However reluctant the government may be to admit to the fact, it is clear from the data that not only is India in the midst of the third wave but that it had begun in significant parts of the country in the first half of December. The latest surge suggests that this may not be the last one unless the government shapes policies accordingly.

Dr V.K. Paul, NITI Aayog member and head of the COVID Task Force, and Balram Bhargava, Director General of the ICMR, at a press briefing in New Delhi on January 5. Bhargava told reporters that there was an upsurge of infections in cities and Omicron was the predominant circulating virus.

IN the second week of December, the top scientific establishment of the country and officials of the Union Ministry of Health and Family Welfare tried hard to convince people through the media that the Delta variant of the coronavirus accounted for the bulk of infections in India. Within a week, that perception changed. At the press briefing on January 5, Balram Bhargava, Director General of the Indian Council of Medical Research (ICMR), told reporters that there was an upsurge of infections in cities and Omicron was the predominant circulating virus.

The Health Ministry’s daily COVID-19 update, issued on December 28, 2021, as usual included several numbers in addition to the fact that 6,358 new cases had been reported in the past 24 hours. In continuation of the pattern that has been followed for several days, these numbers were also sought to be put into “perspective” to suggest that that the situation was improving steadily. It said that the number of active cases countrywide stood at 75,456 and that these were just 0.22 per cent of all cases, the lowest since March 2020. Further, the recovery rate, at 98.40 per cent, was said to be the highest since then.

The daily positivity rate (the percentage of all coronavirus tests that are positive) of 0.61 per cent was said to have been lower than 2 per cent for the previous 85 days while the weekly positivity rate of 0.64 per cent was said to be below 1 per cent for the past 44 days.

No such comparable perspective was, however, to be found in the updates issued just a couple of days later. As had been the case in the previous week, on January 6, only the bare numbers were reported in the update: 90,928 cases in the previous 24 hours, 2,85,401 active cases, a recovery rate of 97.81 per cent, a daily positivity rate of 6.43 per cent and a weekly positivity rate of 3.47 per cent. The Ministry’s press briefing of January 5, however, acknowledged that there had been a surge of cases in urban centres, but officials were reluctant to admit to the onset of a third wave.

That India’s third COVID-19 wave has arrived is, however, hard to dispute. Despite the warnings indicated by the patterns observed in several other countries after the Omicron variant came into prominence, the steepness of the rise in numbers in India seems to have caught the government by surprise. The week ending December 26 saw a total of 46,495 confirmed COVID-19 cases being reported nationwide, fewer than the 49,978 reported in the previous week. It seemed, therefore, that the declining trend in COVID cases, which has more or less held since the second wave peaked in early May 2021, was continuing. However, the subsequent week, ending January 2, saw the number of confirmed cases jump to 1,29,549, or 2.79 times that of the previous week. In just the three days since then, that is from January 3 to 5, another 1,86,404 cases were reported, 44 per cent higher than the previous seven-day total.

The distribution

Moreover, it would be wrong to conclude that the surge began right at the end of December. At least two weeks prior to that, there were signs of the onset of a rising trend. Much was made for several months about the large contribution of Kerala to the nationwide total of cases. What escaped attention in December was the fact that cases started rising in several States while the numbers in Kerala and a few other States were declining, thereby keeping in check the total nationwide increase in the number of cases. In the week ending December 6, Kerala accounted for well over half the confirmed cases in the country. In the week ending January 2, its share had dropped to just over 13 per cent.

Table 1 presents data based on a division of all 36 States/Union Territories (U.Ts) into four groups. The first group (A) of only four are the ones where cases reported in the week ending January 2 were not higher than in the previous week. The second group of 15 States and U.Ts includes those where the jump in weekly total numbers happened only in the week ending January 2 and not before that date. A third group of 10 is of those where the increasing trend was first seen in the week ending December 26. In the final group of 7 States/U.Ts, the numbers started rising even earlier, typically through most of December.

Table 2 lists the States/U.Ts in each group. As it shows, Kerala is the only major State in the first group of four, and even there the number of cases has subsequently started going up again. Group D has several major States of northern and western India, and there are many more of them in Group C, including Karnataka, Puducherry and the Andaman and Nicobar Islands. The eastern and north-eastern States are typically in group B, along with the remaining southern States with Himachal Pradesh and Jammu and Kashmir. The surge, even if concentrated in urban centres, had therefore begun in significant parts of India in the first half of December itself and enveloped most States by the end of the month. The regional patterns through which such an all-India trend eventually emerged are also not dissimilar to those seen in earlier phases of the pandemic.

Deja vu

Seen against this background, it would seem that the government was rather late in catching the signs, which must create a sense of deja vu given that this is a repeat of what happened at the time of the second wave. Relatively speaking, however, the second wave took some time to produce very large absolute numbers of COVID-19 cases, though it was faster than in the first wave in 2020. The third wave seems to be offering an even shorter time to react. As Figure 1 shows, the second wave took 55 days to climb from less than 10,000 confirmed cases in a 24-hour period to over 90,000. In the third wave, this same journey has been traversed in 10 days flat.

It is also notable that the surge in numbers did not reflect an increase in testing across the country. The number of COVID-19 tests being conducted weekly showed no trend of increase before the surge showed up, and in fact in the week ending January 2, fewer tests were conducted than in three of the previous four weeks (Table 3).

The sharp rise in the number of COVID cases in the space of a few days has put paid to any hopes that the combination of a high seropositivity among Indians because of exposure to infection and vaccination placed them in a particularly special zone of comfort. The fourth all-India sero-survey, conducted in June-July 2021, estimated that 67 per cent of Indians had COVID-19 antibodies and the proportion of people with these antibodies even among those who had not received a single dose of the vaccine was as high as 62 per cent.

The second wave had, therefore, led to a large spread of the infection in the Indian population, far beyond the reported numbers, which were only of the test-confirmed cases. Almost every expert accepted this and also the fact that the number of deaths due to COVID exceeded the official count several times over. It was, however, hoped that the country would gain some benefit from that failure through the population developing natural immunity. Back then, the vaccination drive was still struggling to take off, but by the beginning of 2021, more than 90 per cent of the adult population had received at least one dose of the vaccine and almost 66 per cent had also got their second shots. In several parts of the country, according to official records, the first dose coverage among the adult population is nearing 100 per cent while over 80 per cent of adults have received their second dose. Even such States are experiencing a surge.

If immunity acquired through past infection and vaccination is not going to prevent the fast growth of infections, concerns will arise of the preparedness of the health system of the country and the price that must now be paid for the failure to anticipate this possibility. Memories of the catastrophic second wave are still fresh, and fears about a repetition of it have some real basis. Health Ministry officials have themselves cautioned against complacency on the ground that the Omicron variant is mild.

At a media briefing, V.K. Paul, NITI Aayog member and head of the COVID Task Force, cautioned that the current R naught factor (the rate of transmission) was 2.69 as against the 1.69 recorded in the second wave. In response to a question on the number of health workers infected in the present wave, the Ministry pleaded ignorance, stating that it did not keep records of disaggregated data.

Booster doses

Administering of precautionary doses or booster doses was to start for health care workers and people over 60 with comorbidities from January 10, but placing hopes on vaccination booster doses to check the current surge may be futile. Quite apart from the lack of evidence about the effectiveness of such doses among the options viably available to India, the time required for that to reach a sufficiently large number of people is simply too long. Comfort, however, is still being derived from the fact that notwithstanding the surge, there is some evidence to indicate that it might not get so bad this time.

The first source of such comfort is that though the Omicron variant is more transmissible and capable of bypassing immunity, it supposedly has a milder impact on the infected person’s health. Therefore, a smaller proportion of the people infected will require hospital care than was the case with the Delta variant. Even assuming, however, that the Omicron variant alone is at work and will run its course without any more dangerous mutations emerging, it is still possible for the number of serious cases to become unmanageably large if the total number of infected people increases rapidly and for long enough.

Then there is the betting on the possibility of the rapidly transmitting variant resulting in a steeper but shorter period of rise. This was hinted at during the press briefing. This would mean that the peak in the number of active cases at any point of time would not be too high even though this figure tends to multiply rapidly during a surge because every new infected person takes several days to recover and exit the active cases list, more so where the cases are severe. However, how many people will need to be infected before the rate of transmission of a more transmissible virus naturally brings the number of new infections down is not clear. The number of active cases has already grown exponentially and reached levels not seen since the end of September. If the number does not stop rising sometime in the next 10 days or so, or if the rate of increase does not slow down drastically, it is not beyond the realm of possibility that the number of active cases could hit or cross the peak levels seen in May 2021. Even if this does not happen across in the country, it could certainly overwhelm the health system in some parts of it. The risk is that much greater because health workers are also more at risk this time given the immune escape properties of the Omicron variant.

However, it is also being hoped that even if immunity acquired through infection or vaccination is less effective in preventing infection by the Omicron variant, it will still work to reduce the numbers of those infected and the proportion among them who have severe infection. This is the third factor that might keep the third wave and its effects in check. However, even if it works, the health system might still be put under strain in a different way. As some experts pointed out, even if many people did not develop severe infection requiring hospitalisation, they would still need medical attention to monitor their condition and to decide whether they need hospitalisation or not. Another factor is that unlike the first and second waves, the current one is taking place in the middle of winter when higher levels of pollution and lower levels of ventilation in several regions can play a big role in influencing the transmission of the virus.

At the end of the day, the nation’s hopes as it faces the challenge of the new phase of the pandemic do not rest on increasing the public health system’s capacity to respond to the pandemic but on the following three factors: the variant may be mild, the wave may be short and the effects of hybrid immunity might afford protection.

Political rallies amid the surge

Official statements, of course, keep warning of the need to take preventive measures such as masking, physical distancing and avoiding large congregations. As a result, some restrictions are have been imposed on ordinary citizens, including those on their ability to exercise their democratic rights. However, television channels have every day shown Prime Minister Narendra Modi addressing gathering after gathering as part of the Bharatiya Janata Party’s (BJP) campaign for the upcoming election in Uttar Pradesh even as the third wave was creeping up. This is an exact repeat of what happened at the time of the second wave and the West Bengal election and local body elections in Uttar Pradesh. The Allahabad High Court appealed to the Prime Minister and the Election Commission of India to consider stopping the rallies in Uttar Pradesh and postponing the election.

As the ones controlling the levers of administration and power, and thus creating and enforcing the restrictions on ordinary citizens, the BJP and the Prime Minister have a greater responsibility to avoid transgressions than the other political parties. Instead of discharging that responsibility and setting an example, government functions and resources have been rampantly used to further the BJP’s propaganda and to mock all the opposition parties. When Health Ministry representatives were asked at a press conference about the risks posed by the continuing run of rallies, they evaded the question by saying this was a matter for the Election Commission to decide. It was on January 5 that the Director General of the ICMR said categorically that “mass gatherings should be avoided”.

Transferring the burden on to people

The Uttar Pradesh election-related gatherings, and the communal polarisation promoted through them, only partly reflect the Modi government’s severe limitations in creating the conditions for a unified response to the COVID-19 pandemic. From the nationwide lockdown to the present, the Modi government has transferred most of the burden of controlling the pandemic on to the people of the country, without providing them the necessary support. The lockdown and the subsequent economic disruption destroyed livelihoods and incomes even as the cost of living increased, but those affected the most have hardly received any compensation for their losses. Instead, they are forced to continue taking avoidable risks in the struggle to just survive or stay afloat. And restrictions on movement and even weekend lockdowns affect the working classes the most.

Even as mass political rallies have been allowed to take place and cinema halls are opened or allowed to function at half capacity, the education sector has faced a prolonged disruption, with institutions remaining closed for most of the time since March 2020, but little has been done to address the massive consequences of this.

More generally, the government has been so stingy with regard to spending that virtually no investment has been made in two years to create the conditions for the continuation of social, economic and political activities in a way that is consistent with the objective of controlling the pandemic. While a relatively small sum was committed to the vaccination campaign, which was delayed beyond what was necessary, little has been done to improve the public health system on the scale required. The short-term measures are based on the assumption that it will soon be over or that the reality of “living with the virus” is going to last for a very long time.

This problem has a global character, but this only magnifies the dangers of any country’s individual failure to formulate an adequate long-term response. For a country in India’s situation, the consequences may be much greater. The latest COVID surge, no matter what its eventual trajectory, serves to also tell us that this may not be the last one unless we assume so and shape policies accordingly.