Not very long ago, India was touted by the WHO as an unlikely success story in taming Covid-19. Several Western agencies and media outlets went gung-ho with wonderment as to how India managed to significantly lower the spread of infection and fatality rates. They were of course premature opinions and India is currently grappling with a formidable second wave. While the chorus has gradually grown louder for a complete national lockdown, it is ironic that the experts are still debating whether the focus should be on speeding up the vaccination drive along with Covid-appropriate behaviour or a total India shutdown.
In his address to the nation on 20 April 2021, Prime Minister Narendra Modi urged the states to impose a lockdown only as an ‘absolute last resort’. Within a span of three weeks, 28 states/UTs have imposed lockdowns of some form. Of these, around 16 states have enforced a complete/extensive lockdown while the other 12 have declared partial (night/weekend curfews) curbs. But are restrictions imposed by individual states enough? Antagonists of a national lockdown argue that India’s economy, however resilient, may not have the capacity to withstand another shutdown. And people may not have the bandwidth to hold up to a lockdown again. Although India’s active cases have increased to more than 37,45,000, the case fatality rate still remains a small 1.1%. With nearly 2.5 million inoculations every day, India has so far administered around 170 million doses of vaccines comprising more than 12% of its total population. It is hence argued that mankind must learn to live with the virus by strictly following rules of Covid-appropriate behaviour. These arguments, however, suffer from obstinate denial of the present reality.
First, India recorded over 4 lakh single-day new infections consecutively for four days recently. Deaths have at times soared past 4,000 per day. While confirmed cases have increased by 43%, deaths have risen by 33% over the last three weeks. Recovery rate has dropped to 82% (from 85%) whereas the active ratio has spiked to 17% (from 14%). This must be seen in the context of the highest number of people who have already been infected and recovered. A study led by Prof. Brahmar Mukherjee (epidemiologist, University of Michigan) finds that for one known Covid-19 case in India, there is likely to be anything between 10-20 undetected cases. For instance, Pune (currently the world’s worst affected city with more than 1,17,000 active cases) is officially reporting over 10,000 cases per day. Assuming the lower case of 10 unreported cases, the safe undercount would be 1,00,000 new infection cases per day in a city that has around 7 million people. It implies that 1 in every 70 are getting infected. But the seroprevalence study reported that close to 85% of the city’s population have already been exposed to the virus and developed antibodies. If we add to this the mathematics of an exponential growth model, the predictive results will have the alarm bells ringing.
Second, there is a distinct time lag between the reported daily infections and the number of resulting daily deaths, usually, three-eight weeks. Should we then wait and react only after the country reaches catastrophically high mortality figures? Based on seven-day averages and data till May 8, confirmed cases in India are doubling in just 17 days whereas the death doubling time has dropped to only 14 days, raising serious concerns. India is currently clocking 3,840 deaths per day (based on the last seven-day moving average), at a growth rate of 3.6% per day. Then to argue that the case fatality rate is ‘still’ quite low would be famous last words.
Third, we know that we are grappling with increased transmissibility (reproduction number R0=1.38). But we are yet to know whether we are dealing with a possible ‘immune escape’. Even if the variants of concern do not raise fatality, the corresponding increase in caseloads will eventually overwhelm our healthcare system and compound the fatality rate.
Fourth, even if we scale up vaccinations to seven million per day from the current level of 2.5 million, we would be vaccinating only about 210 million people in the next 30 days. Vaccinating a population of 1.21 billion (since more than 12% are already vaccinated) with the first jab in a country like India will alone take up 180 days (or six months). A stage may soon be reached when the demand (domestic as well as export obligations built into contract) for vaccines in India would overwhelm the manufacturing capacity. So mere scaling up of vaccinations will not help; proportionally raising vaccine manufacturing is needed.
Hence, just like we prepare for any natural disaster, India must prepare for a series of punctuated lockdowns and plan for the worst-case scenario. The idea of punctuated lockdowns is important since it gives the necessary time for the overstretched health infrastructure to recover to deal with the ensuing increase in infections at regular intervals. It is a blunt but effective method of temporary intensive physical distancing and infection control. If we do not prepare for such punctuated lockdowns, we could fail in mitigating the secondary effects and cause severe misery. From a psychological perspective though, we must learn to live with Covid-19 following simple rules of appropriate behaviour—masking up all the time, maintaining physical distance and sanitising hands.
(Views are personal)
Saswat Kishore Mishra
Assistant Professor, Administrative Staff College of India (ASCI), Hyderabad
(saswat@asci.org.in)
Madhusmita Dash
Assistant Professor, IIT Bhubaneswar