10 million Covid+, but India on recovery road

India on Friday became the second country in the world to see the total number of Covid-19 infections surpass 10 million, although this comes at a time when the country is at the best position in months in its fight against the pandemic, and with the roll-out of a vaccine imminent.

The only other country to have crossed this mark is the US, which did so on November 7, and which is currently in the grips of a strong third wave of the pandemic that has taken daily cases and deaths, as well as hospitalisations to record highs. The US has seen 17,661,064 cases and 318,522 deaths to date.

In contrast, almost all of India’s indicators are exhibiting positive signs – the rate of new cases and deaths are the lowest in at least five months and have dropped over 70% from peak of the first wave, and the positivity rate is the lowest ever recorded.

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India ended Friday with 10,004,807 cases, 145,188 deaths, and a cumulative positivity rate of 6.3%.

The global battle against the disease has received a major boost in the last two weeks as two countries – the United States and United Kingdom – have started the rollout of the first Covid-19 vaccine developed by Pfizer-BioNTech. The US Food and Drug Administration (FDA), said on Thursday it is working “rapidly” to give emergency use authorisation to a second vaccine candidate developed by Moderna Inc. An approval was expected later on Friday, US time.

In India, Pfizer is among three companies that have sought an early approval for a coronavirus vaccine. The country’s drugs regulator is assessing these applications, and has asked the other two – Serum Institute of India (which filed for the Oxford-AstraZeneca candidate) and Bharat Biotech to present more data. Pfizer is slated to make a presentation to the agency soon, following which its assessment will proceed.

The viral disease that began in Wuhan, China, a year-and-a-bit ago has infected at least 75 million people around the world and killed 1.7 million people, although experts say that both numbers are likely underestimations.

One in every eight people infected with the Sars-CoV-2 virus, which causes Covid-19, is from India, but the country fares better in terms of deaths. Its case fatality rate (CFR) — the proportion of infected people who have died from the disease — is 1.45%, which is not only better than the global average of 2.22%, but also better than other countries such as the US (1.8%) and Brazil (2.60%) that have been severely hit by the disease.

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India’s first wave of infections peaked in the middle of September with the seven-day average of daily cases touching 93,617. This number has been receding at a rapid pace since, and in the last week has touched 26,851 – a decrease of over 71%.

This improvement in the case rate has come along with improvement in another crucial metric – the positivity rate, which is at its lowest ever. In the past week, 2.6% of all samples tested in India have come back positive for Covid-19 — the lowest this number has ever touched since the government started releasing testing figures in April. According to the World Health Organization, if the positivity rate remains 5% or below for two weeks, a region can be said to be keeping its outbreak under control and is testing adequately. India’s positivity rate has been below this threshold for 25 days now.

This improvement is reflected in every major hot spot state. As recently as October and November, states such as Delhi, Kerala, West Bengal and Rajasthan were still defying the larger trend and reporting rising cases. But for the first time, numbers are receding in the past three weeks in every major state in the country. States such as Maharashtra, which is responsible for the highest number of infections so far (1,888,767 as on Friday), has seen new infections drop by 83% from mid-September levels. Similarly, new infections are down 88% from peak levels in Karnataka, 95% in Andhra Pradesh, 82% in Tamil Nadu and 73% in Delhi.

Experts said they don’t expect another massive wave of infections like the country did in September.

“The downward trend in cases has come right after the festive season and the Bihar elections – both factors that many of us were predicting would lead to another spike, but that never happened,” said Dr Shahid Jameel, virologist and director of the Trivedi School of Biosciences at Ashoka University. “Part of the reason for that is that while officially 10 million people have been infected, this number is at least 15-to-20 times more if we look at the findings of sero-surveys. This, and the fact that millions will get the vaccine in the near future, should see us avoiding another wave.”

THREAT OF A SECOND WAVE

Trends in Europe and the United States, however, have shown that subsequent waves are significantly more severe than the first onslaught of the disease. Countries such as the US, France and the United Kingdom have all seen devastatingly strong second (in the case of the US, third) waves.

In the US, seven-day average of new cases in the first wave peaked at 32,809 new cases a day. In the second wave, it was 70,511 – a 115% increase from the first wave. And the number is currently at 220,690 – another 213% increase. The trend is just as clear in other nations as well. In Britain, the second wave was 407% more severe than the first wave: the first wave peaked with a seven-day average of cases at 4,999 while the second wave touched 25,331. In France, the second wave surpassed the severity of the first wave by 1,172% — the first wave touched 4,433, while the second wave peaked at 56,377 new infections a day.

“This virus is going to stay with us for at least a couple of years. Over the next year or two we will see localised spurts in cases, but it will be nothing of the magnitude of the first wave… The vaccine is really needed because it will help in keeping in check these pockets of infections,” said Dr Jameel.

Other experts warned that measures like masks will remain the key defence against the spread of the disease. “A vaccination campaign, anywhere in the world (and much more so in India), is going to take several months to reach the large numbers that would make a strong difference to rates of transmission. So the short-term future of infection spread patterns is still going to be dependent on the use of standard physical distancing steps such as masks,” said Dr Satyajit Rath, immunologist and visiting faculty at Indian Institute of Science Education and Research, Pune.

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