Chandrakant Lahariya | Prepare India for endemic Covid: Surge no big worry

There is a fresh spike in Covid-19 infections in India. The Central and state governments in India have conducted a few high-level meetings to review the Covid-19 situation. Ironically, some citizens get concerned when they learn about such government meetings. Rather than getting alerted by the government meetings to review the Covid situations -- which are procedural and the right steps to be taken -- the people should feel assured that the government is keeping track of the situation.

Objectively speaking, though the number of daily cases has increased nationwide from a low baseline of two digits in the early February to around 6,000 by the first week of April 2023, these numbers are lower than any given day after the end of the third and last Covid-19 wave in India in February 2022, and then till September 2022, a period which we did not qualify to be considered a fresh wave in India. The daily cases at present are far lower than the months of March and April 2022.

Epidemiologically speaking, what we are witnessing is likely to reflect the emerging seasonal trend of Covid-19 in India. The SARS CoV2 is now present in all settings (and unlikely to disappear), and such rise and fall in cases at regular but unpredictable intervals should be expected. In this backdrop, there is no indication that the current surge is the start of a fresh wave. Most assuring is that though the reported cases have increased, there is a very marginal change in hospitalisation and deaths. All of these are enough reasons for us not to worry too much.

The fact is that Covid-19 is endemic in India and such spikes in cases are expected. Then, there is an increased likelihood of a surge in other respiratory illnesses in the months ahead, because of variants of other viruses which have emerged in the past three years and the exposure of people to those virus variants has remained limited. Therefore, it is time to prepare society and the health services to handle future spikes in cases of Covid-19 and other respiratory illnesses.

First, the seasonal pattern of viral respiratory illnesses in India is known. During such months, the government should increase the provision of clinical consultations and testing services for respiratory illnesses through primary healthcare facilities, in both rural and urban areas. There is a role for citizens as well, who should know their vulnerability or risk of developing moderate to severe respiratory illness. Such vulnerable populations (such as those older than 60 years, adults with pre-existing health conditions and anyone with chronic respiratory diseases) should be proactive in adapting the “good respiratory etiquette”, when such spikes in respiratory illness are reported. The good respiratory etiquette essentially means that everyone -- irrespective of age -- should cover their mouth and nose while coughing and sneezing. It means that anyone with symptoms such fever, cough and cold should wear masks (at home, to protect other members of the family, and at public places, to prevent transmission in the community). Those at high risk of influenza illness should consider voluntary influenza vaccination. There is no role of mandated universal mask-wearing any longer; however, voluntary mask wearing by those having respiratory illnesses and the vulnerable is a proven and highly effective preventive strategy.

Second, though experience from the pandemic should have nudged people to adopt preventive practices more proactively, ironically, since the start of the pandemic, amongst people and healthcare providers, this has become more medicalized, with focus on unnecessary medication, repeated testing and use of antibiotics -- sometimes excessively and aggressively -- even for minor and self-limiting illnesses. It is time to emphasise and ensure that the government continues to encourage healthy and preventive respiratory behavior amongst citizens which will help in reducing other (non-Covid) respiratory illnesses, including tuberculosis, which together results in around 1,100 deaths, most of which are preventable, every single day in India.

Third, a highly under-prioritised area has been the long and post-Covid syndrome, which has been extensively documented in Western countries but not in India. The long and post-Covid syndrome consists of nearly 200-plus health conditions, essentially affecting every single organ of the human body. People affected with these conditions are often colloquially referred to as “Covid Long Haulers”. This clearly is an area which needs more scientific work at the global level. There are a few hypotheses being proposed as possible explanations for these conditions. A school of thought is that such post‐acute‐illness syndrome may not be something unique to SARS CoV2, but associated with other viral illnesses. As an example, many people, after an acute episode of chikungunya virus illness, continue to report joint pains. It is plausible that in the Covid-19 pandemic, a large number of clinical cases were reported in a short period, such syndrome has received our attention. Another hypothesis is that post- and long‐Covid conditions have more likely been reported amongst those individuals who had pre‐existing autoimmune disease, which was unrecognised till then. These were the individuals who also had a more severe Covid-19 disease than the rest of the people. Clearly, recognition and understanding of post- and long-Covid require extensive clinical and epidemiological research on post‐viral syndrome and related health conditions.