Nearly nine months into the COVID-19 pandemic in India, the country has recorded over 75 lakh cases and has reported more than 1.15 lakh deaths. In terms of total confirmed infections, India is second only to the US while it has the third highest fatalities in the world. But, a recent study commissioned by the Department of Science Technology (DST) suggests that the worst may be behind India.
A mathematical model developed by the DST's expert panel concludes that India reached its peak in late September. “In actuality, the peak of active cases came in late September at around 10 lakhs,” it states. The committee says that the nationwide lockdown imposed in late March helped defer the peak from June to late September, giving the country’s healthcare system enough time to prepare for the caseload. “With no lockdown, the pandemic would have hit India very hard, with a peak load of 140+ lakh cases arriving in June. Given our lack of preparedness back then, the healthcare system would have been overwhelmed, leading to many additional deaths,” says the seven-member committee.
Projected course of the pandemic under current safety measures (Image courtesy: DST committee)
Speaking to TNM, Jayaprakash Muliyil, former Principal of the Christian Medical College, Vellore, and the Chairman of Scientific Advisory Committee of the National Institute of Epidemiology, says, “I want to believe the peak is behind us.” However, he points out that India cannot be taken as a homogeneous entity, with exposure to the virus varying from location to location. “Look at a state like Kerala, which is now hitting its peak,” the epidemiologist says.
Bhramar Mukherjee, a professor of epidemiology and biostatistics at the University of Michigan, however, says that no other model has predicted a peak in late September. In an email interview to TNM, she says, “I have to say when you mention models, I look for transparency and details. What are the exact assumptions driving the conclusions? Unfortunately I could not find the details in the media reports, It will be great if those modeling details will be released to the public and to the scientists. We recently undertook a comparative study of five models for India including the Imperial College London model, none of our models could predict a peak in late September standing even in August, so there is a lot we do not know and is beyond the grasp of the models. We try to always quantify our model uncertainties and acknowledge the gaps with scientific humility. Stochastic crystal balls have finite radius.”
And while India has witnessed a drop in its daily COVID-19 cases, Bhramar expresses cautious optimism, pointing to Europe and the US, which have recently seen a surge in coronavirus infections after a period of containment. “I want to be cautiously optimistic that the first wave is over in India, but I am certainly not confident that we are through with the crisis.” She explains that the reason for the slowdown is due to a large number of people (30-45%) being infected in cities, as indicated by the sero surveys, and the slower rate of spread in less populated and rural areas. “I expect a second surge, hoping it will be milder than the first one. The reason being we are still far from herd immunity as a nation. However, winter and pollution are double jeopardy for respiratory diseases, so we have to watch out for higher rates of deaths and hospitalisations,” she warns.
In fact, the DST’s expert committee also doesn’t rule out a spurt in infections during the upcoming festival and winter season. It concludes that a relaxation in protective measures “can lead to a significant rise: up to 26 lakh infections within a month.” However, the committee goes on to state that if protocols for COVID-19 are followed, “the pandemic can be controlled by early next year with minimal active symptomatic infections by February-end.”
Projected course of the pandemic under different safety measures (Image courtesy: DST committee)
Concurring with the modelling study, Jayaprakash Muliyil says, “I would expect this to happen earlier. But yes, February seems to be enough time.” Bhramar, however, says that how the pandemic plays out depends on human behaviour. “I am skeptical about long term projections from these epidemiologic models, including our own, as they change every day as the reality on the ground changes. We update our models each day for this reason. Universal mask wearing, avoiding large gatherings and not going overboard with the festive seasons will be absolutely essential. As long as we are not overwhelming the healthcare capacity at a given location, we can navigate and manage this long term,” she points out.
Muliyil says that until there is a vaccine, which he observes will be a long time away, the number one priority should be in protecting the elderly, who are most vulnerable to the disease. “The use of masks is crucial. Masks must be worn even indoors,” he recommends.
Bhramar says India must continue conducting national periodic sersurveys, so as to know how far the disease has spread within the community.
“Intensify messaging regarding public health recommendations and explain that this is a long haul and that success is tenuous. Particularly around Diwali, Navaratri, Durgapuja,” she suggests. Bhramar adds that follow-up with recovered COVID-19 patients for long term adverse effects is important and emphasises on not letting our guard down. “Continue testing, tracing, treating,” she concludes.