The Telangana government which had dropped the mask mandate from April 1, announced a couple of weeks later that it was compulsory to wear a mask in public places.

Representative image of tailors stitching face masksRepresentative/PTI
Delve COVID-19 Wednesday, April 27, 2022 - 18:32

On March 31, when Dr G Srinivasa Rao, Telangana Director of Public Health (DPH) announced that COVID-19 restrictions in the state would be lifted from April 1, people couldn’t really believe what they had heard. Lifting of COVID-19 regulations meant no masks, no penalty for not wearing a mask, no physical distancing, and a strong message that things were going back to pre-COVID-19 times. With the month of Ramzan around the corner, it meant Charminar would be bustling again after over two years, too.

While the lifting of COVID-19 regulations was announced, the DPH advised the elderly, pregnant women and people with comorbidities to continue to wear masks for their safety. On April 21, while addressing a press conference, Dr G Srinivas Rao advised people to continue COVID-19 appropriate behaviour and also went on to say that wearing a mask was compulsory in public areas, which left people confused.

The change in rules, the multiple announcements and the feeling that COVID-19 is no longer a threat has made people more relaxed about masking. The recent increase in daily cases in north India hasn’t really instilled too much fear as many are still giving masking and distancing mandates a miss. We asked doctors and looked at data to ascertain what the situation in the state is and whether it is time to ditch the mask.

Spikes in infections and vulnerable populations

Dr Viswesvaran Balasubramanian, Consultant Interventional Pulmonology and Sleep Medicine, Yashoda Hospitals Hyderabad, is not in favour of a blanket ‘no-mask’ mandate. “With more variants emerging with a higher transmission rate and the increase in cases being reported, especially from north India, we may see modifications to the existing advisory on the need for wearing masks. Though most of the reported infections are mild, these viruses are still capable of causing serious forms of infection amongst the elderly and those who are immunocompromised. So, a blanket ‘no mask’ mandate is not appropriate. We may have to go back to the mask mandate at least in these vulnerable populations and in settings like crowded places and metros.”

“However, it is too early to predict the magnitude of the problem, and adhering to distancing norms and mask mandate and mitigating transmissibility, at least in crowded places, by wearing masks, are a few of the time-tested modalities that can be tried,” added Dr Balasubramanian.

While the Telangana government dropped the mask mandate and again brought it back, some doctors are of the opinion that the mask mandate should continue at least for another six months. Dr Hari Kishan Gonuguntla, Consultant Interventional Pulmonologist, Yashoda Hospitals Hyderabad, said, “Various state governments recently made the mask non-compulsory. However, we believe that compulsory masking should be followed for another six months at least as there is an increase in the number of cases being reported in India in the last two weeks. Proper respiratory hygiene and vaccination are the only preventive strategies against serious infection.”

What the sero-survey in Telangana revealed

Meanwhile, a sero-survey was carried out by the National Institute of Nutrition (NIN) to estimate the prevalence of SARS-CoV-2 antibodies among the population aged six years and above and among healthcare workers in the 33 districts in the state. The study was carried out between January 4 and February 2, 2022 and a total of 14,179 samples were collected from the public, and 3,843 blood samples from healthcare workers.

The survey found that there was an overall sero-positivity of 92.9%, with it being 95% in adults. The highest overall sero-positivity was in Hyderabad at 97%, followed by 89.2% in Bhadradri Kothagudem and Rajanna Sircilla. The sero-prevalence was higher among 18 to 60-year-old adults as compared to children between six and nine years of age, and adolescents aged 10 to 17 years. As expected, it was found that sero-positivity was significantly higher in participants who’ve had a previous history of COVID-19 infection compared to those who had never contracted COVID-19. The survey also found that the prevalence of sero-positivity was very low among non-vaccinated participants as compared to those vaccinated.   

According to Dr Balasubramanian, sero-surveys conducted across the state help us understand the prevalence of the population who are already infected and/or vaccinated and have developed an immune response to the virus. “While sero-surveys are helpful, however, the mere presence of antibodies does not protect against re-infection as it was observed during the third wave caused by the Omicron variant.”

Breaking down the numbers of the sero-survey, Dr Hari Kishan said, “With around 90% of adult vaccination rate achieved and almost 93% sero-prevalence, as found in the recent survey by NIN, even at a time when there is a sudden surge in cases in the country, the future of the state seems to be well controlled even if another wave of COVID-19 occurs. We have already achieved the threshold for herd immunity (both by infections and vaccination).”

Dr Hari Kishan added, “The NIN survey shows 95% seropositivity among the adult population, which will be protective for the adult population. However, the seropositivity rates were 67.3% and 77% among children and non-vaccinated groups, making them more vulnerable for future infection from SARS CoV-2.” He believes that the under 18 population now needs to be vaccinated to prevent further spikes in COVID-19 infection numbers.

Read: COVID-19 4th wave may not be deadly, but here’s what India needs to watch out for

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