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(As told to Indira Basu, Asst Editor, Op-Ed, The Quint)
The notion that India's experience with the COVID-19 pandemic would be very different from that of other countries has been demolished by the second wave. India's current numbers of daily cases have far exceeded peaks in the US and Brazil, and it currently accounts for more than 60 percent of new cases worldwide.
To understand what could happen in the future, we need to understand our present circumstances better, so that we may be prepared for future waves and their consequences.
The numbers of COVID-19 cases rose very sharply after about 15 February 2021 and have been continuing to rise. At some point, when enough people have been infected, standard epidemiological theory would tell you that it becomes increasingly more difficult for someone infected to come into contact with someone uninfected. Multiple restrictions and lockdowns have also been implemented across the country. So, what can we say about when that might happen? Is it going to happen in two months, could it happen in one month? That's where models come in.
Professor Mukherjee has been modelling this pandemic for a while, and so has our group, a modeling group associated with the Indian Scientists Response to COVID-19 (ISRC). Combining the projections of these and other models, there is a general belief that reported numbers should turn down somewhere around the middle of May. This is just from an overall synthesis of what different models are saying currently.
But there is a very broad error on this. It could happen somewhat later, perhaps two weeks later. And this is mainly because the quality of the data that goes into this model has definitely been decreasing. There are many cases of people with symptoms who are not being tested because they just prefer to stay at home rather than be tested. Or they may refuse to be tested in the first place because they worry that they will be taken away, against their will, to COVID treatment centres. There are currently huge delays in testing, so any test results announced now may have come from a test that was taken 5 days later, or 3-5 days earlier.
For a mathematical model, all these inputs are required. Thus, these are the uncertainties, but even taking the uncertainties involved into account, I think it's reasonable that somewhere between the 15th and maybe the end of May, is a reasonable estimate at this point.
Estimates for the numbers of cases at the peak are all over the place currently, but this is because models use different estimates for the fraction of those infected who experience symptoms serious enough to warrant getting tested.
What is unusual about the Indian epidemic is that it had a peak around the 12 September 2020 and then daily case numbers came down more-or-less steadily for almost five months. Because usually the sequence of waves of the pandemic in other countries, and also in other parts of India, had seen relatively short intervals between successive peaks, it was believed that maybe India had many people who were already infected — and that this would protect us against a further rise in cases provided we were careful enough.
But several new things have happened since the tapering down of the last wave of the COVID-19 pandemic. For one, a number of variants have come to India from other parts of the world. These include the variant B.1.1.7 (UK) which is now well-entrenched in Delhi and Punjab, as well as the variant called B.1.351 (South Africa). But there are variants that are indigenous, such as the B.1.617 variant and various sub-lineages of it.
When viruses mutate, most of the time, nothing unusual happens. But occasionally they mutate to transmit more easily between people. If that happens, that lineage of the virus will take over the previous lineage and become the dominant lineage. I believe that this is what has happened with the rise in cases in Maharashtra which signalled the second wave, mainly because of the B.1.617 variant.
So, while what specific variant could drive the second wave and when it would happen couldn’t have been anticipated in advance, we should have looked to the examples of what was happening in other countries to understand what could change the dynamics of COVID-19 inside our country.
I will not comment on the several model estimates of the fatalities because there seems to be considerable undercounting in this wave, and there's virtually no good data to compare with. The extent of this is not fully known. In many places there are large queues outside crematoriums and burial grounds, and the variance between official numbers and counting on the ground seems large.
The other thing is that many people are dying who should not be dying — they are dying because of lack of access to medical facilities, ICUs and oxygen supplies.
It's true for this disease that many, many people will be infected by it, but not know that they have had the disease, simply because they don't show any symptoms.
When it comes to deaths, the factor is probably somewhere between 2 and 3, between actual deaths and reported deaths in the previous wave. It also depends very much on which part of the country we are discussing. Right now, in the second wave, that factor may be considerably larger, but that is all we can say.
I hope there will be some progress on that front, since there is definitely more expertise in this area outside government than within it and a proper analysis would be very useful in our understanding.
The applied mathematician Murad Banaji has studied mortality in Mumbai city carefully and come to a related conclusion. Reports from both Bangalore and Chennai, with the Chennai analysis coming from the ISRC group, supports this. This is heartening.
There have been reports of ‘breakthrough’ events, where someone who has been fully vaccinated, has ended up getting COVID-19 within two weeks after their second vaccine dose.
There have been questions about whether fatalities and serious disease among the younger populations are being seen more in the second wave because the 18-45 age group largely constitute the unvaccinated lot. I would say no — it could happen for many reasons. Usually, epidemiological experience has been that the first wave of the disease is when the older people are affected, often those in care homes or other situations where they are potentially more vulnerable as a group.
In the second wave it's the younger people. So, the nature of contact at the level of age groups — younger people tend to go out more — may also have a role to play in this.
But whether they represent a larger fraction of reported cases vis-a-vis older people is as yet unclear, and can only be assessed with large-scale data.
I should also point out that some trends can only be seen retrospectively when you look back at the data and then try and understand where these trends came from. It's so hard to say anything definitive in the middle of an ongoing pandemic.
I would assign that largely to the fact that the dominant variant of the virus in Delhi is what is called the B1.1.7 variant. This is known to be more transmissible. It may also have the characteristic of immune evasion — you have antibodies from a prior infection, but when you're infected again, the virus is able to circumvent those antibodies to some extent, reducing their ability to counteract disease. (It is important to remember that vaccines prevent severe disease or death, almost surely, but don't prevent infection from COVID-19.)
At this moment, I would say I'm worried about the state of West Bengal, mainly because there's a whole mix of variants there with some of them known to be more infectious than others. The general lack of attention to COVID protocol during the long election cycle has led to this, and the situation as seen from reports on the ground is worrying. Karnataka may be seeing the effects of its lockdown, recently extended, soon.
Cases are rising at a fast rate in the northeast of India as well as in Jharkhand and Goa, but it is possible that this just reflects better reporting. These are also low population states, so their impact on the Indian numbers as a whole will be small.
Bihar and Gujarat seem to be seeing substantial undercounting, at least from newspaper reports and other reports from the ground, so, the true scale of the epidemic there is hard to gauge. It is likely, at least from anecdotal reports, that the situation is far worse there than the numbers would indicate.
(Gautam I Menon is a Professor at the Departments of Physics and Biology, Ashoka University. He tweets @MenonBioPhysics. This is an opinion piece. The views expressed above are the author’s own. The Quint neither endorses nor is responsible for them.)
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