India’s 2021 COVID Fight Is a ‘Test Match’ That Needs Endurance

India’s match against COVID-19 is no T20. It’s a test match that needs both endurance and enterprise.

Image of India’s map and the coronavirus used for representational purposes.

(Photo: Altered by Kamran Akhter / The Quint)

The biggest and strictest lockdown in the world — that is what India experienced from the midnight hour that bridged 24-25 March 2020. A hint thrown on 22 March, through a daytime janata curfew, did not fully prepare the nation for the total lockdown imposed with a four-hour notice.

The social consequences of that sudden shutdown have been long debated, due to the many tragic pictures — of suffering migrant families struggling to trek back home from urban areas which no longer offered them shelter or income. At the end of an eventful year, it is the continuing public health challenge of a pandemic that refuses to fade away that still dominates our discourse, and calls for a review of where we did well and where we faltered.

COVID Battle 2020: Expert Advice vs Fear vs Calls for ‘Unlocking Economy’

The lockdown helped to hold the transmission in check, to give the health system, administrative machinery and social support services time to prepare themselves — both for a nimble early response, and a sustained long haul endurance effort.

Modelled estimates indicated that the lockdown in India reduced the COVID case count and deaths during April and May 2020, although critics viewed that as a mere postponement of the surge to a later date.

Coordination between Central and State governments was geared up for a concerted response, and the National Epidemic Act was invoked to give the Central government a lead role.

Models, proposed by some international and Indian ‘experts’, created high levels of fear and anxiety by predicting millions of cases and a devastatingly high number of deaths by June-July.

The cry of “test! test! test!” rang loud from TV screens, as India’s low testing rates came in for strong criticism.

Other experts suggested a path of least resistance, to let the ‘relatively innocuous coronavirus’ find its own way to create ‘herd immunity’ in the population.

Even as the public health community was riven by these debates, the captains of the Indian industry as well as the small traders urged the government to quickly enable resumption of normal business operations, to protect an already sluggish economy.

Protecting both lives and livelihoods became a challenge, where public health priorities and economic imperatives did not always ride together.

India’s Partial Success In Battling COVID During 2020

As the lockdown eased, people’s mobility and mingling increased rapidly to let the coronavirus travel with people and celebrate with the crowds.

Masks were globally recommended at this point, after experiential wisdom of the Orient finally prevailed over smug Occidental assumption of scientific superiority in research.

This was also backed by knowledge that asymptomatic and ‘pre-symptomatic’ persons too can spread the virus, making universal masking in public places and indoor gatherings a wise precaution.

Social distancing, better termed as ‘physical distancing’, and frequent hand washing, were advisories carried over from earlier experience with respiratory viruses. Knowledge of ‘super-spreader’ events grew to sound warnings on crowded events and work places, especially in ill-ventilated indoor locations.

Attempts to enforce various containment measures, after unlocking, were only partially successful. States like Kerala and Karnataka, which performed very well early on, started seeing surges, as mobility and crowded events increased.

Maharashtra, which has been the worst-hit state throughout, has seen an unrelenting spread of the coronavirus most weeks of the year.

Delhi declared victory several times, only for the city to be tripped yet again by the sly virus. The more urbanised the state and more developed its industrial economy, with high volumes of travel, the higher the virus transmission. Less urbanised states and rural areas remained comparatively less-affected.

There was reluctance to accept the evidence of ‘community spread’ till the epidemic was well advanced, but there were several regional variations in the levels of spread.

What Happened When Complacency & Laxity Set In Over COVID Pandemic?

A combination of COVID-appropriate personal behaviours (even if partially implemented), increased testing (albeit with rising use of less sensitive rapid antigen tests), and intermittent enforcement measures against public crowding led to a steady decline in daily cases and death counts after September 2020.

As they reached low levels by January, a false perception of the epidemic having ‘ended’ in India gained popular credence.

The heralding of ‘herd immunity’s’ arrival, by some scientists and public figures, led people to believe that the virus was no longer a threat. Elections to local bodies and assemblies, religious gatherings and social celebrations took place with little heed to public health advisories.

At the same time, the novel coronavirus was expanding its armoury, by producing mutants which were spreading globally, with higher levels of infectivity than the precursor wild virus.

These forms too entered India, as international travel picked up speed. Laxity in people’s behaviour, vacillating commitment to administrative enforcement of containment measures and possible spread of mutants are reasons why the feel of victory in January 2021 has given way to regional lockdowns and national anxiety as we approach the anniversary of the national lockdown on 25 March 2021.

This is despite the start of the vaccination programme from mid-January, a cause for justified optimism about our growing power against the virus.

COVID Battle 2021: The Road Ahead & What We Must Focus On Now

How can we now respond with strategy and resolve, to wage a battle — better informed by the intelligence we have gained over the past year?

These are the actions we must focus on:

1. reinforce COVID-appropriate behaviour through constant reinforcement of health messages through both mass media and community networks
2. exhibit political will and administrative skill to rigorously curb large gatherings and violation of regulations on masks
3. use testing wisely, to detect new cases early and screen for mutants
4. recognising that high testing rates alone did not reduce cases or death counts in Europe or the US
5. place a high premium on symptom-based household surveillance followed by early testing of suspected cases and energetic contact-tracing (especially needed now for mutant strains)
6. increase the pace and spread of vaccination against COVID-19, to cover all persons above the age of 40 years, and even younger persons with co-morbidities
7. create vaccine-confidence among people, using multiple channels of communication

It is most important for both policymakers and the public to realise that our response to the COVID-19 pandemic must be steady, strong and sustained for several months more, and cannot spring back and forth like a yo-yo.

We not only need to factor in trends within the various regions of India, but also of other regions of the world.

We cannot presume to be safe till we and most of the world have seen a decline that is maintained at least for six months.

That does not mean we need to be tied down completely.

If we are strict in our observance of COVID-appropriate behaviour, we can resume essential economic activities, travel and education. In the meanwhile, we must speed up our vaccination programmes.

How India Can Win In COVID-19 ‘Test Match’

The match against COVID-19 is not a T-20 affair.

It is a test match that calls for both endurance and enterprise against hostile bowling.

A sound defence through COVID-appropriate personal and public health measures for containment of transmission, coupled with brisk scoring strokes on vaccine delivery to reduce the vulnerability gap, will provide the right partnership for India to win the global test championship in the COVID-19 ‘contest’.

(Prof K. Srinath Reddy, a cardiologist and epidemiologist, is President, Public Health Foundation of India (PHFI). He is the author of ‘Make Health in India: Reaching a Billion Plus’. This is an opinion piece. The views expressed are the author’s own. The Quint neither endorses nor is responsible for them.)