It’s too soon to say that India’s second Covid-19 wave has ended

The second wave of Covid-19 is now abating slowly but steadily across India, with both new cases and deaths decreasing. Unfortunately, economic output and the potential for economic growth is also continuing to fall further, hurting tens of millions of Indians across the country. The Center for Monitoring Indian Economy has told IndiaSpend recently that almost 97pc of Indians are now poorer thanks to Covid-19.

In this context, how can we emerge from the various lockdowns in several states and resume economic activity? Given that only about 22.3 crore Indians are partly or fully vaccinated, with the majority (80pc) having received only one shot of a Covid-19 vaccine, what are the guardrails we should have in place to unlock?

To understand the precautions we need to keep in mind, and what we should be doing to prepare for a potential third wave, we spoke with K Srinath Reddy, president of the Public Health Foundation of India, adjunct professor of epidemiology at Harvard TH Chan School of Public Health and former president of the World Heart Federation.

Are we (India) really reaching the end of the second wave? Or are we misinterpreting some of these early signs?

From several indicators, it does appear that the second wave is subsiding. We are seeing the Covid-19 case counts dropping. Despite the challenges in terms of actual testing and interpretation, there is a consistent directional change towards a drop in cases. We are also seeing deaths dropping.

Again, despite some undercounting, the trend is visible. We are also seeing test positivity rates dropping over a period of time. And, most importantly, we are seeing that hospitals are no longer so crowded with people in intensive care, or waiting outside desperately pleading for admission. So all of these taken together would suggest that we are actually seeing a substantial decrease, at least in the larger cities where the [second] wave started.

Even in some of the smaller towns, I believe we are now seeing a downward trend. The [situation in the] villages is a little more difficult to gauge because testing is inadequate and our data systems are not good enough, but even there, we are not seeing as many horror stories as we were about two or three weeks ago.

But this is in a period where a good part of India is under lockdown. So it is difficult for us to say with surety that this is going to be the happy state of affairs when the lockdown is lifted. Because we saw in the first wave, that after the lockdown was relaxed in June 2020, the cases went up and peaked around mid-September. Covid-19 deaths [also] peaked around September.

We do not know how much of a rise will happen now, though compared to 2020, we have had many more people exposed [to Covid-19] and thus at least partially immune. Many are vaccinated, [even if] not fully, but again are partially immune. So given that, it is likely that the number of susceptible people will not be as large as when we opened up after the first wave.

But a countervailing factor is that now we have [Covid-19] variants, which are much more infectious. In fact, even in January, as we were celebrating what appeared to be “the great escape” from the pandemic, the Kent variant, now called the Alpha variant, came in and that started ramping up the case numbers.

Then we saw the Delta variant emerge in Maharashtra, and started seeing what the challenge was in terms of that particular variant spreading across different parts of India. So, we now recognise that we still have the Delta variant, which emerged in Maharashtra but has now spread all across India and in many parts of the world.

It has been declared to be much more infectious than even the Alpha variant and certainly much more infectious than the original virus, [which is] still on the prowl. Given that, we cannot lay firm bets that the second wave has ended. We have to wait and see what happens when the unlocking process begins. We have to keep a careful watch.

In Maharashtra, we have been under lockdown now for almost two months. In Mumbai, the number of new Covid-19 cases has evened out to 900-1,000 cases a day. But it is been at that level for several weeks. Does that suggest that lockdowns only work up to a point? What is the utility of keeping a lockdown going for a long time?

I do not think we ought to really prolong the lockdown. We cannot get stuck in a rut at this point in time. I think the lockdown last year was required to get systems in place, to prepare ourselves, whether with testing kits, or personal protective equipment, or ventilators. [We had to] get the systems in order, get the multiple departments and the Centre and states to coordinate much better. And it helped.

The lockdown this time was because suddenly we woke up. We had actually taken it for granted that there would not be a second wave. We had dismantled many of the temporary structures that we had set up for hospital care. We had sort of let the coordination mechanisms go into slumber.

As a result, we were caught off guard when the cases went up in such a huge surge. We were overwhelmed. In order to catch our breath and get the systems back in place, I think we went into lockdown.

Now everybody is fairly cautious in the unlocking process. You hear the Maharashtra chief minister saying “not yet, let’s watch out”. Even the Delhi chief minister, who has generally been gung-ho about opening up, is saying we will keep a careful watch and we will [unlock] in stages. Once bitten, twice shy. So, it is important for us to unlock, but do it in stages in a graduated manner, so that we can recoup the territory if suddenly there is a problem.

* This article first appeared on India Spend, a data-driven and public-interest journalism non-profit