While NITI Aayog has predicted four-five lakh cases a day in September, the ground reality suggests otherwise. Daily cases in all States except Kerala have been steadily declining since the second wave peaked in early May. Unlike in other countries such as the U.S. which is witnessing a surge in cases caused by the Delta variant, the second wave in India was driven primarily by the Delta variant. With a large proportion of the population nationally already possessing antibodies against the virus, it is unlikely that the virus would spread furiously as seen in April this year.
NITI Aayog’s penchant for projecting unrealistic trends of daily COVID-19 cases without sharing the basis on which such projections are made continues.
On April 24 last year, at the daily Health Ministry briefing, NITI Aayog member Dr. V.K. Paul presented a chart predicting the trend of COVID-19 cases in India. With over 1,500 daily new infections, it showed the cases peaking on May 3, 2020 and then dropping to 1,000 cases by May 12 and down to zero by May 16, 2020. In reality, on May 16, India saw 4,987 cases, the highest single-day spike. In the fourth week of May last year, Dr. Paul clarified that no one had ever said that the number of cases would go down to zero on a particular date. He called it a “misunderstanding”.
Now, when the daily fresh cases are under 30,000 since it peaked at over 4.14 lakh cases on May 6 this year, Dr. Paul has come up with a dire warning that India might witness a staggering four to five lakh cases a day next month.
With all States except Kerala witnessing a steady decline in daily cases, it is unrealistic to expect daily fresh cases to reach such high numbers in a day in September. For it to come true, the daily cases should very soon begin to increase sharply and grow at an exponential rate all in a matter of three-four weeks.
“This strikes me as near-impossible. Delhi, for example, is seeing a record low number of cases in a situation where crowds have certainly increased with respect to a month ago. The situation is the same in all major cities of India,” says Dr. Gautam Menon, Professor of Physics and Biology at Ashoka University and co-author of COVID-19 modelling studies.
The fourth sero survey of ICMR found that on an average over 67% of the population nationally have antibodies against the virus. Despite the many limitations of the sero survey, it cannot be denied that a sizeable population have some form of protection against the virus unlike the case early this year. Also, the vaccination coverage has been increasing with every passing day — about 35% have received one dose and less than 10.5% are fully vaccinated as of August 26. Therefore, it appears very unrealistic that the daily cases would not just reach the peak of the second wave but also exceed it to reach five lakhs a day.
Delta variant drives the second wave in India
Unlike the U.S., the U.K. and other countries now experiencing a new wave with a sharp increase in daily cases caused by the Delta variant, the second wave in India is primarily driven by the Delta variant. Despite unrestricted movement of people in almost all parts of the country and almost all businesses are open, the daily new cases have not witnessed any surge in India since the second wave peaked in early May.
“Given that the bulk of infections in the second wave came from the Delta variant, India’s present situation is substantially different to that in other countries. Serosurveys suggest that more than 67% of Indians have antibodies to SARS-CoV-2. Since the larger fraction of them would have been infected recently with the Delta variant, it seems inescapable that most Indians are already protected, either by infection or by vaccination, against the disease,” Dr. Menon says.
But is there a possibility that the Delta variant might again cause a huge number of cases each day despite daily new cases steadily declining since it peaked in early May? “It is more likely that the Delta variant will spread steadily through the population at least in some States, picking those who have not encountered the virus yet, but without cases rising at the speed and intensity of the second wave. We are already seeing this in Kerala where serosurveys suggest an overall lower seroprevalence,” says Dr. Menon.
But Dr. Giridhara Babu, epidemiologist at the Public Health Foundation of India, Bengaluru, thinks otherwise. “The Delta variant can spread faster and result in a high number of cases, especially in areas that had lower seroprevalence and poor vaccination coverage. We cannot rule out a high number,” he cautions.
No evidence of a new, highly contagious variant
t is indeed possible for India to witness a large number of daily cases in September if a variant that is even more transmissible than the Delta variant has already emerged. According to Dr. Babu that doesn’t appear to be the case. “According to the INSACOG’s genomic sequences report of August 16, there is no supporting evidence for the emergence of extremely transmissive variants other than the Delta variant,” he says.
Another scenario where a huge number of daily cases can arise is when breakthrough infections in the fully vaccinated and reinfections in the unvaccinated become rampant. For instance, about 25% of infections among Los Angeles County, California residents occurred in fully vaccinated residents from May through July 25; over 71% were in unvaccinated persons. “On July 25, infection and hospitalisation rates among unvaccinated persons were 4.9 and 29.2 times, respectively, those in fully vaccinated persons,” the report said. The New York Times reported that breakthrough infections in fully vaccinated people accounted for at least one in five new cases in six States in the U.S..
Breakthrough infections in fully vaccinated people have been recorded in India too but at a low level. But two doses of the vaccine still confer reasonable protection against symptomatic disease and are highly protective against severe disease and death. “That a substantial fraction of the population might turn susceptible again in the month of September seems unlikely. That protection against disease should evaporate altogether, even more so,” Dr. Menon says.
So is the dire warning a ploy to ensure that people don’t lower their guards but follow COVID-appropriate behaviour so India does not once again experience the terrible situation in terms of new cases, hospitals turning away patients due to lack of beds, and oxygen shortage? “Models don’t always predict the exact number of cases for the future wave. Assuming the worst-case situation and preparing for it is the best thing a planning agency can do. If anything, NITI Aayog should be complimented for this effort,” says Dr. Babu defending the agency. But Dr. Menon counters the alarmist projection saying: “I fully understand the need for preparation, but preparing for an unrealistic scenario diverts resources that could be better spent elsewhere.”
In all probability, with a large proportion of the population possessing antibodies against the virus either through natural infection and/or vaccination, it is reasonable to expect a milder wave nationally, especially if there is good adherence to COVID-appropriate behaviour and if no new highly contagious variant arises. There is a possibility that places where the earlier infections were few and most people are unvaccinated would record more cases.