Covid-19 - When Will The Nightmare End?
India Today|May 24, 2021
Top experts weigh in on india’s best hopes to halt the rampaging second wave of covid-19
Raj Chengappa

When Bhramar Mukherjee, an Indian American professor of epidemiology at the University of Michigan, noticed an uptick in new cases of Covid-19 being reported in Maharashtra on February 27 this year, she instinctively knew that a fresh wave was going to hit India. Mukherjee tweeted that India should scale up its vaccine rollout and citizens should start double masking and avoid large gatherings. She then dialed her aging parents in Kolkata and urged them to get vaccinated. Her parents didn’t listen to her and neither, apparently, did Indian policymakers, who prematurely declared victory over the virus after the first wave of infection subsided in November 2020.

The folly became evident in the last week of March when a tidal wave of infection hit India leaving its citizens gasping for life. From around 11,000 cases of new infections daily, it skyrocketed to over a lakh, rapidly doubling every week till, by April end and early May, the numbers infected crossed 400,000 daily. It was a world record in daily cases for a single country, the highest such figure since Covid-19 was declared a pandemic by the WHO in March 2020. When Mukherjee warned India of the coming wave, the country had 11 million active cases of Covid infection. In just two months that figure more than doubled and stood at 23.3 million on May 12. Among those infected was Mukherjee’s father who finally took his first dose of the vaccine only in mid-April and is now recovering from the disease. India is second only to the US in terms of the number of infections caused by Covid-19. The death toll has gone up from an average of 1,000 daily in the first wave to a numbing 4,000 daily—and still counting. The big question on everyone’s mind: when will the nightmare end?

WHEN WILL THE WAVE PEAK?

To answer this question, it is important for the central government to get a good estimate of when the wave will peak and the factors that could cause its decline so as to put a strategy in place to halt the pandemic. Research models that make projections based on certain statistical criteria and assumptions are of great help. In mid-April, Mukherjee and a group of researchers at the University of Michigan, who have set up a special model to track the progress of Covid-19 in India, projected that the second wave could peak by mid-May at an alarming 800,000 to 1 million new cases daily and 4,500 deaths by May-end.

Mukherjee still stands by her prediction that India would turn the corner by mid-May though new cases in India, averaging around 350,000 a day currently, have not hit the levels her team had projected. She admits the height of the peak is debatable since “the model rests on the edifice of new case counts…but because of the bottlenecks in testing in India there are a large number of undetected infections happening which makes the actual figure of the infected nebulous.”

Meanwhile, the Institute of Health Metrics and Evaluation (IHME) in Washington University, which maintains a database of worldwide statistical reports of Covid-19, also predicted a mid-May peak for India. It projected that, in the worst-case scenario, by August 2021 India would record a devastating 1.04 million deaths. But if the country followed a universal masking policy, IHME predicted the mortality numbers would drop by 250,000 to around 880,000. This is still frighteningly high, given that the current death toll stood at 254,000, as of May 10. (The IHME estimates that actual Covid related deaths in India are double the official figure.)

MEANWHILE, two groups of Indian data modelers, who also maintain that mid-May will see a peak in infections, are more circumspect in their projections of infected cases and deaths. One of them is the Sutra Group consisting of M. Vidyasagar, distinguished professor, IIT Hyderabad, Manindra Agarwal, professor of computer science and engineering, IIT Kanpur, and Lt Gen. Madhuri Kanitkar, deputy chief of Integrated Defence Staff(Medical). The group has been tasked by the department of science and technology (DST) to work out a ‘supermodel’ to predict the progression of the pandemic. In early April, the Sutra Group first projected that the second wave would peak at around 120,000 cases daily by April end. But by mid-April, as the cases grew relentlessly, the group reworked its numbers and said that the second wave would peak at a moving average of 400,000 cases between May 8 and 15. Vidyasagar says their simulation model is robust because it is built around several key parameters including the rate of infections, mobility of people, virus variants, recovery rate, geographic spread, and the ratio of detected cases to undetected ones.

OTHER MODELLING experts like Gautam Menon, professor of physics and biology at Ashoka University, however, criticize the DST supermodel for constantly “shifting the goal posts” and call it a “stupid model”. (The DST itself has admitted that the Sutra model had underestimated the impact of the second wave.) Menon points out one of the big issues in getting authentic data to make calculations: “In India, for every positive case that is revealed through testing, there are 20 others who have not been tested. Mortality figures are usually completely forged and many Covid deaths are not registered. Any model is only as good as the data you feed it.” The model that Menon developed along with a consortium of scientists, called INDSCI-SIM (Indian Scientists’ Response to Covid-19), factored in these inconsistencies and projects that the second wave would peak in mid-May at around 500,000 to 600,000 cases daily.

WHERE WILL IT SPREAD?

The real worry, though, is that the pandemic that first struck on the west coast of India and has now moved to the east and south shows no signs of abating. Health ministry statistics reveal that 26 of the 28 states in the country have a positivity rate of 15 per cent and above—much higher than the positivity rate of 5 per cent that the WHO set as a benchmark of sorts, below which the pandemic could be deemed under control. Currently, India’s national average is a high 21 per cent positivity rate with some states like Goa registering as high as 49.2 per cent—which means that every second person tested here is found to be positive. The states that are a worry now are West Bengal, Haryana, Karnataka, and Rajasthan, for they are showing positivity rates of 30 per cent and above.

Worse, the Second Wave is now spreading rapidly to rural areas and may upset the projections of those carefully constructed models. Health ministry statistics show that on May 10, 533 of the country’s 718 districts had a case positivity rate of over 10 per cent. In Madhya Pradesh, 45 of the 52 districts had a positivity rate of above 10 per cent. In Uttar Pradesh, the country’s most populous state, 38—or half—of the 75 districts have high positivity rates. In Bihar, as many as 33 of the 38 districts are similarly impacted and in Tamil Nadu, a majority of the 38 districts had high positivity rates (see graphic: National Snapshot).

The worry for experts is that in rural areas there is very little testing being done and no proper record of deaths. So the pandemic may rage on without reflecting in official statistics. The reports of growing numbers of the sick and dead in rural areas are the only indications that the situation is fast getting out of hand. Recent reports of a rapid fall in positivity rates in states like Bihar and UP are viewed with much skepticism by experts. As one of them said, “Figures don’t drop like the Niagara falls–[the decline] either indicates that the states are doing extraordinarily well, which seems hard to believe given the condition in the rest of the country, or their testing numbers have dropped drastically.”

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