Last week, the Delhi Disaster Management Authority (DDMA) met to review the COVID-19 situation in the national capital. The members took a few key decisions related to Covid safety protocols. The most crucial ones were to remove the mask mandate and scale-up the coverage of precautionary doses among the adult population, which has been lagging so far at 24 per cent.
This, while an official order to de-penalise the violation of not wearing a mask in public spaces is yet to come out.
Face masks are hailed as first line of defence against viral respiratory illnesses. Its role has been instrumental in curbing the viral spread of SARS-CoV-2. Among the handful of COVID-19 safe practices, face masks are considered to be the most effective in breaking the chain of transmission. In fact, this is the only tool available in the world so far that has the proven potential to stop viral transmission.
The two key decisions have raised a few eyebrows, especially from the scientific community. Fearing an increase in infection rates in the weeks following Durga Puja and Diwali, public health experts and several political leaders called the decisions contradictory.
The sources said that the huge decline in the positivity rate, fewer hospital admissions, and decreasing virulence were notable to the authorities while they deliberated upon lifting the mask-mandate.
For the last two weeks, the infection rate in the city has gone down below 1 per cent. Meanwhile, official data suggests that in over 53 per cent of the COVID-related deaths reported in August, coronavirus infection was “incidental”.
They succumbed due to co-morbidities or other causes.
About 158 fatalities were recorded in August, the maximum in the last few months. Of them, COVID-19 was found as the “primary cause” in 70 deaths, while it remained incidental in 84 deaths. Four were attributed to “other” causes.
While data infers that COVID-19 is becoming less virulent, the infection and re-infection still remain a worry. Such incidents have a higher probability of occurring during mass gatherings, said experts.
Mask down, vax up - contradictory moves
“These decisions will send a wrong message that COVID-19 is over,” said Dr Suneela Garg, member, National COVID-19 task force, adding that a rise in infection is bound to happen given the gatherings during festive season.
Garg pointed out that a similar situation occurred in Kerala, which led to a spiralling infection rate there after the Onam festival. The southern state recorded a spike in infectivity cases, leading to a surge of over 50 per cent in the new cases post-Onam.
Dr Neelam Roy, Head, Community Medicine at Centre-run Ram Manohar Lohia Hospital (RML) said there is some level of herd immunity achieved in Delhi but the possibility of reinfection lingers on.
“There have been many cases where people got re-infected despite vaccination, so the possibility of reinfection can’t be negated. In such a scenario, it’s prudent that mandatory masking continues, at least during the festivals,” she said.
Experts also said that the state may have to reinforce the mask mandate as the infection will surge in the festive months. Many recalled that it happened just a few months ago.
On April 2, this year, the DDMA lifted the provision of mandatory masking in public spaces when infections and the test positivity rate appeared to be falling back to record lows. However, within three weeks, the move was reversed due to a spike in infections.
Mixed messaging may affect vaccination coverage
The experts also questioned the move as they believe that doing away with mandatory masking is contradictory to the push for improved coverage of precaution doses the government plans to campaign. They believe that a mixed message will be sent out to the public, making it further difficult to increase the booster jab net.
“The decision to scale back effort for booster shots while doing away with the mask mandate is eventually going to confuse the public. Both moves are contradictory to each other. We can’t emphasise one part of prevention while making another redundant. This is a mixed message to the public,” said Dr Jugal Kishore, Head, Community Medicine, Safdarjung Hospital.
“Many have a fear of needles. Such people hesitate to take vaccines. If we make masking optional, then it’ll be a valid reason for them to avoid precaution doses,” he said.
Roy corroborated with Kishore, “The decisions of removing the mask mandate and focusing on vaccination are contradictory. If a lower infection rate is the deciding factor behind the mask-mandate, then why focus on precaution vaccination? Our first-generation vaccines against COVID-19 don’t prevent transmission.”
Meanwhile, apart from public health experts, political personalities have also been vocal in rejecting the idea of de-penalising the mandatory mask provision for festive season.
BJP’s Praveen Shankar Kapoor was among the first in the political fraternity to condemn the move. “COVID-19 affected me twice. I know what havoc it could wreak. That’s why I’m not in favour of the decision and sincerely believe that masking should continue involuntarily,” he said.
“If an experiment is needed to check the normalcy, then it can be done with the mandatory use of masks. Allow people to celebrate the festivals without any restrictions. Let the crowd gather without any restrictions. But not without a mask,” the spokesperson of the Delhi unit of the party, said.
The experts also drew comparison between the move and that of 2021, when mixed messaging led to a disaster in the form of the second wave.
While the experts were warning of complacency, the political leaders were campaigning for elections. Eventually, the infectivity exploded, making the healthcare system crumble. The wave claims thousands of lives every day.
The other view
However, noted epidemiologist and health system expert, Dr Chandrakant Lahariya, believes that the benefit of masks has been limited to an individual level only. It’s not required for the authorities to continue the mandatory masking, he said. “Earlier, the mask-mandate was logical. The role of the mask is now limited to personal hygiene and precaution only. Those who are cautious will practise it,” he said.
When asked whether the upliftment would not lead to more infections, he said that the infection rate would continue to rise and fall due to seasonal and other factors. “The last three months have been crucial in terms of infection rate. We recorded double digits of positivity for many days. However, the number of sick patients needing hospitalisation was not high. Besides, when would be the right time to make masking optional? After this season, Christmas will come, then Holi, and so on. Masking is easiest, but it’s not the solution,” Lahariya explained.
He said that it’s time for authorities to shift focus to other illnesses that have been ignored since the pandemic arrived.
“Safe practises should always be encouraged. However, we are past the time to enforce it. I believe that the state should no longer control people’s behaviour and should rather shift its resources and focus to other illnesses. India records around 28,000 deaths daily. COVID-19 is causing merely 1 per cent of them,” Lahariya said.
Reconsider precaution vaccination policy
Meanwhile, the experts also argue for a reconsideration of the booster vaccine policy. According to Garg and Lahariya, the booster should be prioritised only for those who are in the risk zone, like the elderly, patients with comorbidity, or those who have undergone transplant surgery.
“There needs to have a relook at the booster vaccination. Though the current vaccine is effective against mutations, we still need to reconsider its inoculation to everybody. The initial decision to vaccinate people over 60 and those on the frontlines was more logical,” Garg said.
Aiding the argument, Lahariya said, “It’s true that immunity lessens with time, but the benefit is limited to healthy individuals. Instead, resources should be diverted to fully cover those on the risk zone.”
‘Precaution doses should be for those in risk zone’
Experts argued for a reconsideration of the booster vaccine policy. According to Garg and Lahariya, the booster should be prioritised only for those who are in the risk zone, like the elderly, patients with comorbidity, or those who have undergone transplant surgery.