Chandrakant Lahariya | Don't worry too much as Covid cases surge again

The daily new Covid-19 cases in India are showing an upward trend, driven by a rise in select areas like the Delhi-NCR region and Haryana. For a day, the trend became very steep because of the backlog of cases reported by Kerala.

Alongside, there have been a few reports of Covid-19 cases in school children. These developments have raised some concerns and face masks have once again been made mandatory in some districts of Uttar Pradesh and Haryana, as well as Chandigarh. Is this increase in cases a reason for worry and the start of the fourth wave of the pandemic in India? Are children at risk of Covid-19 and should the schools again be moved back to a hybrid mode? Should masks be made mandatory again? Let’s discuss what is at stake here.

The current rise in Covid-19 cases is largely localised to New Delhi, the NCR region and Haryana. This can largely be attributed to the removal of Covid-related restrictions, resulting in an increased social mobility and travel. Most of those being tested positive are asymptomatic or mild symptomatic and had got themselves tested voluntarily, for travel or other reasons. There is very marginal or no increase in hospitalisation or the need for ICU beds. The remaining Indian states continue to report single- or double-digit cases and there is no upward trend.

At present, the Omicron and its sub-lineage BA.1, BA.2 and recombinant XE (mix of BA.1 and BA.2) are the circulating SARS CoV2 variants in India. A few confirmed cases due to XE are not a cause of worry as it is not a new variant, and just a subtype of Omicron. Considering India’s third wave in January-February that was caused by Omicron, there is no scientific reason to believe that XE, BA.2 or another Omicron sub-lineage will cause fresh waves in the country. In short, there is no reason to worry about the increase in Covid-19 cases. This state-specific rise is not the start of the fourth wave in India.  

The current Omicron wave in China and the stringent restrictions there are also being interpreted with fear and apprehension. However, the situation in China is different from India. China had not faced a second wave for the past two years and the population with natural immunity is low. The vaccines used in China also had the lowest efficacy amongst all the Covid-19 vaccines. India has already faced three Covid-19 waves (and thus has high natural infection) and high adult immunisation coverage with better efficacy vaccines. This puts India in a situation of hybrid immunity and thus better protected from Covid-19 risks.

It is widely accepted now that SARS COV2 will stay with humanity for long, possibly forever. In the months ahead, the rise and fall in Covid-19 cases at regular intervals is going to be a normal phenomenon. However, scientific and epidemiological evidence points that in any future rise, because of hybrid population immunity, the severity of infection would remain low.

It is time to review the response strategies as well. The masks are proven tools in reducing Covid-19 transmission. However, in the early part of the pandemic, when the entire population was susceptible and vaccinations had not started, the universal masking had clear-cut benefits. The Omicron and its sub-variants have indicated that cloth masks have limited role in prevention of SARS CoV2 transmission. The population risk has also come down. Therefore, the way we do not boil the entire overhead water tank in our house to prepare two cups of tea, making face masks mandatory for everyone when the risk is differential is not the right approach any longer. The approach for the time ahead has to be “protect the vulnerable” and the face masks and other Covid appropriate behaviour (CAB) should only be voluntary.

Then, the government policy decisions should not be “knee jerk” and rather be determined by a calm assessment of the situation and informed by emerging evidence. The current localised upward trend in Covid-19 cases is not a justification to rush to make face masks mandatory again. The epidemiological evidence points that a differential and voluntary approach for all CAB, including face masks, should be followed. The fully vaccinated adults and all healthy children can live a normal life with minimal restrictions. The elderly and other high-risk adults need to follow face mask wearing a little more diligently, especially in indoor and crowded spaces and when meeting non-family members. This behaviour needs to be suitably adjusted for local transmission dynamics but still remain voluntary.  

More specifically, the children reported to have tested positive are all asymptomatic or mild symptomatic. There is no evidence that these children had got infection at the schools. Rather, more likely from other family members. Then, the successive sero-surveys have pointed out that nearly 70-90 per cent of all children in India have got the infection (thus protected), when the schools were closed. Studies have noted children do get the infection at the same rate as adults; but the probability of adverse outcomes of moderate to severe Covid-19 disease in children is very low. In this backdrop, children being tested positive is not a reason to worry too much or to close the schools. This risk has not altered with the emergence of the new variants. In Indian states, including in Delhi and Haryana, the schools should be open at full capacity for offline classes – the only exception being that parents should be informed if a child has tested positive in their child’s class/section. The other measure should be that children who are not feeling well or have fever, cough or cold should not attend school.

At this stage of the pandemic, daily new Covid-19 cases are not the right way to track it. Therefore, policy decisions should be made based upon trends in clinically confirmed cases, hospitalisations and ICU admission. There is an urgent need to increase public communications for voluntary adherence to mask wearing, specially by vulnerable populations. At an individual level, people need to do a self-assessment of risk and follow Covid appropriate behaviour accordingly. All those eligible should also get a Covid-19 booster shot.

There is no reason to worry unduly and get concerned about the rise in Covid-19 cases in some parts of India. The trend is not nationwide. This is not the start of the fourth wave. All pandemic-related measures should be voluntary and all economic, social and educational activities should continue without any restrictions, but with individual precautions. Most important, the schools should continue to open with full capacity for offline classes.