COVID-19 update

More confusion than clarity on the trajectory of the COVID-19 virus

Print edition : November 20, 2020

At Mahim in Mumbai on September 16. The COVID-19 Indian National Supermodel says India crossed the peak in mid September and that the number of cases would come down to fewer than 50,000 in December. Photo: Vivek Bendre

The Sadar Bazaar in New Delhi on October 29. After a decline, the daily number of cases have started rising again in Delhi. Photo: Sushil Kumar Verma

Rapid antigen test at Bajrang Chowk Bhalswa Dairy, north Delhi, on October 11. Photo: Sushil Kumar Verma

The results of the second national sero-survey and a mathematical model on the spread of COVID are at variance with each other.

Eight months into the COVID-19 pandemic, India continues to have less clarity on the trajectory of the virus than what the Central government claims. For instance, there is a huge variance between the findings of the second round of national sero-surveillance by the Indian Council of Medical Research (ICMR) presented on September 29 and a mathematical model on the spread of the SARS Cov-2 pandemic published in Indian Journal of Medical Research (a publication of the ICMR) on September 28. The second sero-survey concluded that 7.1 per cent of the population had been exposed to the virus compared with the 0.73 per cent mentioned in the first sero-survey of May-June and that 91 per cent of the population was still susceptible to the infection.

However, a report of the National Supermodel Committee of experts set up by the Department of Science and Technology in the Ministry of Science and Technology says that 14 per cent of the population had been exposed to the virus by August end, that is, the same period when the second sero-survey was done. It also says that at present 30 per cent of the population has antibodies. Experts say the report published in IJMR was authored by three persons, none of whom is an epidemiologist.

The COVID-19 Indian National Supermodel says India crossed the peak around September 17 and that the number of cases would come down to fewer than 50,000 in December. It also states that active symptomatic cases would be fewer than 40,000 by the end of February if proper safety protocols are followed. Cumulative infections, it projects, will be around 1.06 crore by February end. As of October 30, this figure was over 80 lakh.
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Relaxation in safety measures could lead to 26 lakh new infections a month, the model cautions. The winter and festival seasons would increase “susceptibility to the infection”, it says, reiterating a point the Health Ministry has been making. The conclusions of the model are strikingly similar to what the government has been maintaining all along, that is, had the lockdown been delayed, the peak would have arrived in May (14 million cases by mid May) with health care systems getting overwhelmed. Had no lockdown been enforced, there would have been 140 lakh cases by end June and 26 lakh deaths by end August, it says.

According to the authors, the results (predictions) generated by the model fit the Indian government data reasonably well, including that of the peak the model has predicted and the actual peak of daily cases in India on September 16. The projections for the future, as per the model, therefore are of a steady decline in the number of cases. The authors, however, warn of the need to continue with protective measures such as masks, personal hygiene and physical distancing.

The supermodel’s projection,appears to rest on the validity of one very critical component of it, that India has achieved herd immunity. According to the paper, “the model predicts total population with either infection or antibodies to be around 350 million. If the model is correct and there is no significant increase in R0 value [the number of people that an infected person is likely to transmit the infection to], we perhaps have reached herd immunity.”

Experts T. Jacob John and M.S. Seshadri had derived the same conclusion as the reason for India’s cases to have peaked in September (“Imperatives after India’s September virus peak”, The Hindu, September 29). However, the second nationwide sero-survey results which appeared subsequently (the IJMR paper was submitted on September 28) appear to have put paid to this presumption. Compared with the supermodel’s prediction of 350 million of the population being infected or with antibodies, the nationwide number thrown up by the sero-survey shows fewer than a third of that.

Significantly, the supermodel was also used to study the disease progression in Delhi. According to the paper, not only were the data on confirmed cases said to closely match the model’s predicted path of progression of the infection, but the estimate derived from the model about the proportion of the population having antibodies also matched the results of the first and second sero-surveys in Delhi. In fact, this was closer in the case of the second sero-survey, which showed 33 per cent of Delhi’s population being infected. However, if Delhi was now seeing a third COVID wave that was inconsistent with the supermodel’s projection, then clearly the herd immunity proposition cannot be held valid.
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With several European countries seeing a second wave and the United States seeing its third wave, the global map of the coronavirus epidemic once again resembles the picture in March-April. The epicentre of the pandemic appears to have moved back to the more advanced countries of the Western world, though the current surge has a more pan-European nature, with the number of cases in eastern Europe being greater than in the first wave. As this has coincided with the dip in the infection in India, global attention on the Indian COVID-19 story has ebbed. It has almost disappeared from the front pages of dailies.

Numbers remain high

However, what is happening in the West has scarcely affected India’s position in Asia or relative to that of Africa where the pandemic now remains under much greater control. India still accounts for more than half of the new confirmed infections in the world’s most populous continent; this share becomes significantly larger if one excludes the relatively more severely affected West Asia. More importantly, one and a half months after crossing the mid-September peak, India’s daily numbers and those of most States are still far away from dropping to the April-May or even the June level. But the Delhi story is a warning that there are chances of another surge in the number of cases in winter.

Even as Delhi’s Health Minister Satyendra Jain chooses to avoid committing himself either way—neither confirming nor ruling out the possibility—the onset of a third COVID wave in Delhi appears undeniable. The highest number of daily confirmed cases in Delhi was 4,473, on September 16. The daily numbers of new confirmed cases in Delhi from October 27 through 29 (Tuesday, Wednesday and Thursday) were 4,853, 5,673 and 5,739 respectively—the figures clearly breached the mid-September peak. The figures for the corresponding days of the previous week were 3,579, 4,086 and 3,882. They were higher than the figures for the week before that (3,036, 3,324 and 3,483), which in turn were higher than those for the corresponding days the previous week (2,676, 2,871 and 2,726).

In short, after attaining the peak in mid September, the daily number of cases started declining until about early October after which it started rising once again. The surge in Delhi also raises questions about how much credence should be given to the predictions of the supermodel.
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One of the presuppositions of the model is that cases would start coming down in cities that already have a sufficient number of people infected, but this has been proved fallacious, at least in the case of Delhi. The model has predicted that cumulative mortality would be less that 0.04 per cent of the total number of people infected and that 30 per cent of the population had antibodies at present, from 14 per cent in August.

The model also makes out a case that the initial lockdown had saved a large number of lives and “avoided creating widespread panic”. That the lockdown had averted many deaths may not be factual as the model did not concern itself, for lack of a mandate, with the number of non-COVID deaths in the same period for reasons stemming from the denial of health care and also poor recording of deaths by States, especially those with poor health infrastructure. Even the assertion that the lockdown avoided creating panic is belied by the exodus of migrant workers witnessed by the entire country.

Notwithstanding the optimism of the Ministry of Health and Family Welfare over the high rate of “recoveries”, there have been persistently high number of cases and deaths. Until now there has been no break-up of how many of the recoveries were at home and how many in a hospital setting. If the Health Ministry were to be believed, six States contributed majorly to the viral casesload and deaths from COVID in the country: Maharashtra, West Bengal, Delhi, Chhattisgarh, Kerala and Karnataka. Barring Karnataka, all the other States have non-Bharatiya Janata Party governments. At a press briefing on October 27, Health Secretary Rajesh Bhushan mentioned that the idea was “not to run down any government”, though inadvertently it appeared that that was the intention.
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The media conference ignored issues such as election rallies in Bihar, including by the Prime Minister, where physical distancing norms were thrown to the winds, or the ethical issues involved in the declaration of a free vaccine in the BJP’s election manifesto. It has also baffled experts as to how all the districts in Bihar have shown a consistently declining trend in the number of cases and how none of the people campaigning in Bihar has been infected with the virus. There has also been, until end October, no information about the RTPCR (reverse transcription polymerase chain reaction, the gold standard for testing) and Rapid Antigen Test figures in “high testing” States such as Uttar Pradesh and Bihar.

On the other hand, the rise in the number of cases in Kerala was blamed on the relaxation of norms during Onam festival, a charge the State government has denied. Chief Minister Pinarayi Vijayan was emphatic that all precautions were taken during Onam and if any section had acted irresponsibly and shown laxity in that period, it was the opposition parties which had staged continuous public protests without exercising any caution.

Despite conflicting messages from the sero-survey and the supermodel, the Health Secretary has warned against “over-enthusiasm to declare oneself corona free”, adding that there are lessons to be learned from the “experience of other countries”. The candid admission that the situation continued to be serious was a distinct departure from the previous stances of the government, from denial to self-congratulatory messages of the “success of the lockdown” and claims of averting several lakh deaths in the process.

According to NITI Aayog member V.K. Paul, who was also present at the press conference, the decline in the mortality numbers in India was because health care systems had geared up, a pattern which, he said, was on the lines of European countries. “Fortunately, our trend is in a different direction but we have to be vigilant,” he stated, but not particularly giving the details of the “different direction”. It may be recalled that V.K. Paul, an acclaimed pediatrician and the current head of the National Expert Group on COVID, had emphatically stated with the help of graphics that coronavirus cases would come down to zero by mid May. The health establishment does not refer to “peaking” any more. Neither are there any references to “fast-tracking” of vaccine trials.

If anything, there are lessons to be learned from the experience in Europe, where fresh outbreaks of COVID-19 cases have been reported across several countries though the absolute numbers continue to be much lower than India’s. The U.S., too, was seeing a third peak, V. K. Paul, said. As for the Indian situation, Ministry officials were at pains to explain that the lockdown, accompanied by the test, track, treat and isolate strategy, had worked, but there was no explanation as to why India still continued to report a large number of cases.
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The number of cases increased by 22 lakh between September 29 and October 29, which by no means indicates a decline. Tests, on the other hand, have shown a decline in the past one month, with the daily average ranging between 9 and 11 lakh tests. On days when tests have been lower than nine lakhs, the number of cases have also been fewer.

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