Amid the ongoing vaccination drive euphoria over the efficacy of the Phase 3 trials of the indigenously manufactured Covaxin, the fresh outbreak of COVID-19 infections in the country leaves little room for optimism. Despite assurances from various experts that India will not experience a second wave, the rise in the rate of infections in February after several months of a declining trend appears to indicate otherwise.
The third national sero-survey, conducted by the Indian Council of Medical Research (ICMR) between December 17, 2020, and January 8, 2021, revealed that 21.4 per cent of the population had developed antibodies to COVID-19, indicating that a large section was still vulnerable to the virus. This, in itself, is a significant jump from the results of the second sero-survey (conducted between August 17 and September 22) that showed that 7.1 per cent of the population had been exposed to the virus. In sheer numbers, this meant that the number of Indians who were infected had risen from 74.3 million to 225 million or 22.5 crore. As Frontline had pointed out earlier, this happened at a time when the daily cases had crossed their peak and were on a decline.
On January 8, the last day of the third national sero-survey, India reported 10.4 million cases confirmed by tests. The third survey clearly showed that at least twice the number of people had been infected. Globally, India had the second largest number of cases after the United States. In terms of mortality, India had the fourth highest number of cases after the U.S., Mexico and Brazil.
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The trend of a rise in infections, which had been observed as early as October in at least five States—Kerala, Karnataka, Maharashtra, Chhattisgarh and West Bengal—and four Union Territories, continues. At present, as many as eight States—Maharashtra, Kerala, Tamil Nadu, Karnataka, Punjab, Haryana, Gujarat and Madhya Pradesh—show an upward trajectory in the number of daily new cases. On March 2, the Ministry of Health and Family Welfare (MoHFW) announced that 80 per cent of the new cases had been reported from the five States of Maharashtra, Kerala, Punjab, Tamil Nadu and Gujarat. There were six States and Union Territories where the weekly positivity rate was higher than the national average of 2 per cent.
In the week ending February 28, India reported 1,06,591 new confirmed cases of COVID-19, a jump from the 89,261 cases reported in the previous week. It was the highest weekly total since the week ending January 11, and pointed to a reversal of the downward trend in cases since mid September 2020.. The last week of February was the third successive week that showed an increase in numbers over the previous week. This steady increase in the nationwide numbers of confirmed cases has raised legitimate alarms that India may be on the verge of experiencing a second wave.
The COVID-19 numbers in India are still relatively low in most parts of the country and the rise is still very slow. Maharashtra accounts for a large share of the recent increase in numbers. In February, from less than 18,000 in the first week, the number of cases reported in the State shot up to over 54,000 in the last week. Gujarat, Punjab, Chandigarh, Madhya Pradesh, Delhi, Haryana, Karnataka and Telangana have also seen a rise in weekly confirmed cases in the last two weeks.
The numbers in Kerala continue to be high although they are not rising. In many other States, the declining trend, too, seems to have stalled.
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In other words, the base of the rising numbers is by no means geographically concentrated and cannot be therefore explained by purely State-level or local factors. The fact that Maharashtra, and particularly Mumbai, are reporting larger numbers indicates that any notion that India’s population has achieved herd immunity because of widespread exposure to infection may be misplaced. The first signs of the subsequent all-India surge that became India’s first wave had come from Maharashtra.
India and the world
India’s first COVID-19 surge started later than it did in Europe and the U.S. Though the rise in numbers was less steep in India, its rising trend lasted much longer, and the peak was reached only in mid September 2020. The longer surge eventually neutralised the effects of a slower and more delayed rise in confirmed cases and deaths, with the result that the number of cases and deaths per million population in India became very high.
At the aggregate level, India’s per capita numbers remained much lower than in Europe but exceeded the levels seen in most of Asia (particularly among the countries of South, South-East and East Asia) and the average for the entire African continent. Further, the number of cases and deaths in several individual States in India—including Maharashtra, Delhi, Karnataka and Tamil Nadu— crossed those in European countries of comparable population sizes.
There was a surge in numbers in Europe with the onset of the second wave in the second half of 2020, approximately four months after the first peak had been reached. India reached its first peak on September 16, 2020; some States peaked a little later, in October 2020. If India, therefore, is seeing a trend of declining cases in February, it would not be inconsistent with the general pattern shown by the COVID-19 pandemic. In fact, David Nabarro, the World Health Organisation’s Special Envoy on COVID-19, had cautioned in December 2020 that India would see another resurgence of the virus in 2021.
Interpreting the curve
Since India’s COVID-19 numbers maintained an almost steady decline after crossing the peak, the widespread notion was that the worst was over. There are experts who still believe that a second wave is unlikely in India or will be milder. While some scientific reasoning or predictions from modelling based on existing data are offered in support of this claim, these remain speculative and cannot be confirmed on the basis of existing evidence.
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India’s total number of cases topped 5 million just the day before its highest daily total of 97,894 cases was recorded, on September 16. On February 21, 2021, this tally crossed the 11-million mark. That is, even as the daily numbers were declining, they were not coming down as quickly as they had increased. Thus, it took fewer number of days to reach the six million plus cases after September 16 than it took to reach the first five million cases.
In other words, the downward part of the curve of daily cases has not been the mirror image of the rising part. Further, this divergence of the actual trend from the mirror image of the rising trend had been steadily increasing over the last three months. That the virus was still rampant in India in the last quarter of 2020 was also indicated by the threefold rise in the estimated proportion of the adult population exposed to it that emerged between the second and third nationwide sero-surveys. However, as mentioned earlier, the most recent sero-survey showed that 21.5 per cent of the adult population may have been exposed—an exceptionally large number and yet a long way short of what would be needed to achieve “herd immunity” and prevent a second wave.
Slow vaccination pace
Many experts therefore continue to maintain that vaccination is the only viable way of achieving “herd immunity”. India’s vaccination programme was launched amid some controversy in January 2021. On March 1, 2021, a new phase was launched targeting those above the age of 60 and those above 45 and having comorbidities. The next phase is to cover those above 50—by the completion of which a population of about 30 crore (300 million) would have been covered by vaccination, still below a quarter of the total Indian population. Even this limited target may, however, take a fair amount of time. By March 1, 2021, a month and a half after the start of the vaccination programme, 1,22,56,337 people had been administered one dose of the vaccine and another 25,97,799 had received both doses. In other words, a total of 1,43,01,226 doses had been administered. At this speed, administering 2 doses each to 30 crore people would take several years.
Till date, the maximum number of doses administered on any one day has been a little over 8 lakh. Even if this was increased two and a half times to 20 lakhs (2 million) and that became the daily average, covering the 30 crore would take all of 2021.
Meanwhile, if active cases keep going up as they now are, the country’s health care system may be stretched by the double burden of managing the sick and vaccinating the healthy.
The current situation in India raises the question—did India’s COVID-19 control strategy fail not once but twice in not pursuing a more aggressive strategy of testing to halt the virus in its tracks? The growth of testing had been very slow in the initial days of the epidemic and expansion of capacity eventually ended up only chasing the rising numbers of infections rather than helping control them. Let alone any further expansion, the capacity created until then was also not utilised fully after the numbers started falling. Testing numbers also declined, from about 8 million weekly reached in September 2020 to less than 5 million by February 2021. The potential to use testing and contact tracing to slow down, and eventually contain, the spread of the virus remained incompletely utilised. The virus thus continued to spread and expand the base on which a second wave could yet hit the country.