Second wave of COVID-19 in India

Even as India is in the throes of a second wave, having failed to use testing as a means of checking the spread of the pandemic, all that the Central government has done is to emphasise “COVID appropriate behaviour” and place the onus on the States.

Evening prayers by the banks of the Ganga on the occasion of Mahashivratri on March 11 at the Kumbh Mela in Haridwar. Amid a surge in COVID-19 cases, the Uttarakhand government has issued a new standard operating procedure to contain the spread of the virus.

On March 30, Harsh Vardhan, Union Minister for and Family Welfare released a document titled “Chasing the virus: A public health response to the pandemic”, which covered the period January to November 2020. According to a government release, on the occasion he said: “This is a historical moment for all of us. On 30th January we had our first case and today after 1 year and 2 months we have chased more than 1.2 crore COVID-19 cases.” He added that “these were the cases that were chased” and there were many “cases not on our record”.

It has been argued all through the pandemic that the government response ought to be to “get ahead” of the virus rather than “chase” it. That strategy, which involves a combination of aggressive testing, tracking and isolation, could have helped avoid a second wave. China, Vietnam and South Korea pursued the strategy with amazing results—none of them has experienced a second wave.

Harsh Vardhan said, in a near self-congratulatory tone, that India had converted the “unprecedented pandemic of a global magnitude” into an “exceptional opportunity”. He said the country had become self-sufficient in manufacturing personal protection equipment (PPE) kits, was exporting vaccines and PPE, and had 2,433 laboratories in November 2020 as against one in January. “We have fared better than many countries,” he said.

On the same day, at a separate briefing by the Health Ministry, V.K. Paul, NITI Aayog member and head of the task force on COVID-19, said that the “situation was going from bad to worse”. Trends showed that the virus was very active and that it could “penetrate our defences”, he said. He also highlighted the fourfold increase in both the positivity rate and the daily numbers of cases and deaths.

On March 30, in response to a question about the possibility of an Indian variant of the virus, Balram Bhargava, Director General of the Indian Council of Medical Research (ICMR), asserted: “There is no Indian strain”. While that statement offers some comfort, the second wave seems to be a non-issue among leaders of political parties and their supporters, all of whom move around without marks or adhering to physical distancing norms during campaigns for the ongoing Assembly elections in Assam, West Bengal, Tamil Nadu, Kerala and Puducherry. Besides, the Uttarakhand government permitted the Kumbh Mela to be held at Haridwar.

All that the health establishment has done in the face of such violations of protocol is to emphasise “COVID appropriate behaviour” and place the onus on the States. A high-level meet on March 31 to review the status of COVID-19 in Punjab and Chandigarh advised them to implement the “test, track, treat and vaccinate” strategy. But then it is not only Punjab or Chandigarh where daily surges have been reported, it has been seen all over the country.

By the time India observed the first anniversary of the nationwide lockdown on March 25, all speculation about a second wave had ended and its onset was an undisputed fact. V.K. Paul officially acknowledged it at the press conference. The nationwide tally of new COVID-19 cases in the week ending March 28 was more than five times the number in the week ending February 14.

The number of deaths also increased rapidly in March, rising from less than 700 in the first week to 1,876 by the fourth week. On March 28, India’s cumulative tally of COVID-19 cases crossed the 12 million (1.2 crore) mark. The last million was added in 35 days, as against the 65 days it took to move from 10 to 11 million.

In the seven-week period from February 8 to March 28, the weekly tally of confirmed cases rose from 78,395 to 3,93,563, adding a whopping 1.20 million cases to India’s cumulative tally. In comparison, during the seven-week period from June 8 to July 26, 2020, during the first wave, 1.18 million cases were added and the weekly tally rose from 75,813 to 3,17,410.

High growth rate of cases

While attention has been focussed on Maharashtra because of the exceptionally large number of cases being reported there, the surge is truly a nationwide one, similar to what was experienced in the first wave. Kerala, which had a high number of confirmed cases earlier this year, is the notable exception to the rising trend. In the last week of March the State recorded a little over a third of the level observed in the beginning of February.

From the second week of February, the aggregate number of cases in India from States other than Maharashtra and Kerala have been on the rise. While the initial expansion in Maharashtra was faster than in the rest of the country, this difference did not last beyond February.

In the last week of March, the rate of increase in cases in the rest of India except Kerala was much faster than in Maharashtra. Besides Maharashtra, Gujarat and Punjab reported daily numbers that were higher than the peaks touched in 2020. If this trend emerges in other States, too, the second wave may end up being significantly larger than the first.

The impact of the rising number of cases on deaths is also likely to be significant, aside from Kerala’s exceptional success in keeping the number of fatalities down, even though case fatality ratios generally are lower than in the early stages of the pandemic.

As the numbers rise, the pressure on the health system is bound to increase. At over 6 lakh (as of April 2), the number of active cases has increased many times over the low of 1.35 lakh reported on February 11. At the all-India level, it is still far below the 10-lakh figure crossed in September 2020 when India “peaked”. However, in States like Maharashtra, Gujarat and Punjab clearly the pressure is already as great as or greater than at any point in 2020. And given the rapid rise in numbers elsewhere, no one can rule out the possibility of a similar recurrence of health systems getting overwhelmed in State after State in the next month or so.

Pressure on health system

One indication of the increasing pressure on the system is the story of testing. Although test, track, isolate and treat has been the formula, the emphasis has been more on antigen tests than the more reliable RT-PCR test.

The problem of a high proportion of rapid antigen tests holding down the numbers persists. Despite that, even though testing numbers have increased along with the rise in cases, the test-positivity ratio has also climbed steeply, from much less than 2 per cent in early February to around 5.5 per cent by end March. This concern was also shared by V.K. Paul at the press briefing.

This was exactly what happened in the first surge, but then that was because the testing capacity lagged behind the growth of cases. This time, however, the rise in positivity ratio has been despite the increase in testing capacity countrywide. Rajesh Bhushan, Union Health Secretary, said: “The net has to be cast wider.” However, figures showed that testing rates had slowed down.

Low testing persists

In the week ending on March 28, the total number of tests conducted was 74,18,827, the highest in any week in 2021. This was still less than the 83,78,702 weekly figure notched in October 2020. It would seem that once again India has missed the bus and failed to use testing as a means of checking the spread and growth of the pandemic. The failure this time, though, may be bigger because it reflects a slowness in using existing capacity rather than slowness in creating capacity.

Indeed, other than urging the population to follow COVID-appropriate behaviour and instructing States to do the needful, the Central government does not seem to have any clear strategy for dealing with the surge. It is unlikely to consider a nationwide lockdown again but that does not mean it can prevent the disruptive effects of a raging pandemic on the economy. The government has admitted that infection spread across States and Union Territories despite the lockdown.

Unfortunately, the messaging about COVID-appropriate behaviour also carries little weight in society, for which the Union government has to take the major share of the blame. There is also the utter failure to provide adequate support to sectors and sections of the population adversely affected by the implied restrictions. The long march of thousands of migrants during the lockdown was but an extreme and visible fallout of this approach, which has not really changed since.

Even more significantly, the Narendra Modi government has chosen to use the context of the pandemic as an opportunity to consolidate its power, squeeze and suppress all political opposition, and pursue its communal and economic agendas despite these being the source of widespread aggrievement. This includes the process of hitting at Indian federalism in several ways, such as the Union government shoring up its own financial position by squeezing States of resources to fight the pandemic, and the economic consequences thereof.

Surge effects on vaccination

Meanwhile, the Central government also appears to be urging acceleration in the vaccination process. The lowering of the age groups for vaccinations is one such measure, although little has been done to reduce the cost further in the private sector. However, the failure to use other measures beforehand to control the virus to the maximum extent indicates that not enough time had been bought for vaccination efforts in order to make a realistic intervention amid the second surge.

This is despite the fact that experience across the world demonstrated beyond doubt that that such a surge was likely, with mutations resulting in the emergence of variants more successful in spreading themselves. What will perhaps add to the problem is that this second surge has aggravated the difficulties in balancing the competing imperatives of vaccinating the country’s own population and placing India’s vaccine manufacturing capacity at the service of the rest of the world, particularly developing countries that are falling behind in the race for accessing vaccines.

If that has not so far posed the hardest of choices, it may be only because the sparseness of our public health system, and the Central government’s reluctance to put resources into it even in the midst of a pandemic, is reflected in the progress of vaccination too.

India is way behind other countries in terms of the proportion of the population vaccinated. By end March, only 5.39 crore Indians (against an adult population of above 90 crore) had received at least a single dose of the vaccine, with more than 4.5 crore of them still to get their second dose.

With the maximum number of vaccine doses administered in a week so far being about 1.55 crore, India is clearly a long way away from achieving herd immunity through vaccination. Even at a rate of 2 crore vaccine doses a week, half the adult Indian population would be covered only in 2022. Pinning hopes on vaccination alone to prevent a second surge is futile. Instead, what one might have to worry about is the possibility of the surge slowing down the vaccination process itself, a concern the government is yet to address.