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Monday, January 17, 2022

Explained: Why India’s second wave of Covid-19 is different; is lockdown the answer?

Several assessments of the effectiveness of the previous lockdown have already been made. The ongoing second wave of infections offers us another lens to estimate how effective that lockdown was.

Written by Amitabh Sinha , Edited by Explained Desk | Pune |
April 2, 2021 4:37:55 pm
covid 19, testingA person receiving Covid vaccination jab at a government hospital in Srinagar. On Thursday, more than 80,000 new Covid-19 cases were detected in the country. (Express photo by Shuaib Masoodi)

The rapidly rising coronavirus numbers in the last month has brought back the spectre of a lockdown. Limited lockdowns have already been imposed in some cities, and the threat of a more stringent lockdown looms large over a state like Maharashtra which is the worst-affected.

Several assessments of the effectiveness of the previous lockdown have already been made. The ongoing second wave of infections offers us another lens to estimate how effective that lockdown was.

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On Thursday, more than 80,000 new infections were detected in the country. Even as late as February 22, the case count was only about 10,000. The journey from 10,000 to 80,000 cases a day has taken less than 40 days. Last year, the 10,000-mark was first breached on June 11, while the 80,000-figure was crossed on September 2, a gap of 83 days, or more than twice the duration it has taken this time. This, when the conditions for the spread of the disease were far more conducive than it is now.

There are several things about this pandemic that are not very well understood. But a lot of things that health experts and scientists have been pointing out, about the nature and behaviour of a pandemic like this, have held true throughout this period. One of them is the fact that the speed with which the virus spreads in the community is dependent on the number of susceptible people in the population, people who can potentially get infected.

Faster spread in absence of lockdown

Higher the number of susceptible people faster would be the spread, if there are no interventions to reduce contact amongst them. As more and more people get infected, the number of susceptible people starts to come down and after some time the rate of spread also begins to slow down.

In March last year, when the disease had first broken out, the proportion of susceptible people in the population was much higher than it is now. By the time the second wave started in the second week of February, about 1.1 crore people were known to have been infected. Besides, there was a much larger group whose infection was never detected through tests. Serosurveys in December estimated that between 20 and 30 per cent of the population could have already been infected. It would be safe to assume that by the second week of February, between 30 to 40 crore people in India had been infected with the virus. The ongoing vaccination drive has also reduced the number of susceptible populations.

On March 24 last year, when the lockdown was first imposed, the number of known infections was 525. There could be another few hundred — a few thousand at worst — unknown cases. Left to itself, the virus would have spread much faster than it is doing now. And for the first 45 days since the outbreak began in March, it was indeed doing so. Scientists had said the number of infections would increase exponentially, and that is exactly what it was doing till the first few weeks. Starting from zero on March 2, it had taken 14 days for the number to reach 100. In exactly another 14 days, on March 29, the number of known infections had reached 1,000. Then, in another 15 days, on April 13, this number had crossed 10,000.

covid lockdown, pune covid lockdown Some areas in Maharashtra like Nagpur, Amravati and Akola, have already been experimenting with lockdowns with varying degrees of restrictions being put in place. (Express photo by Arul Horizon)

After that, the impacts of the lockdown began to be felt. In the next 15 days, the total case count increased by three times, and not by ten times that it would have had if it had continued to rise exponentially at the same rate.

Several studies last year tried to put a number on the cases, and deaths, that were avoided as a result of the lockdown. One of them, by a government-appointed team of scientists, had concluded that in the absence of the lockdown active cases in India could have gone up to as high 1.4 crore by June itself (instead of the actual peak of ten lakh achieved in September), and could have resulted in more than 26 lakh deaths by October. Not everyone agrees with these numbers. Another modelling exercise, with a different set of assumptions, would result in very different numbers. But there is little disagreement over the fact that the lockdown did prevent lots of cases and deaths.

Real benefit in terms of avoided deaths

More than the infections, it was the avoided deaths that demonstrate the usefulness of the lockdown. The disease was causing many more deaths last year than it is now. The case fatality ratio was well above 3% till the middle of August. There is growing evidence to show that the infection was leading to more serious illnesses last year. Besides, the hospitals were not so well prepared to deal with serious patients. Beds with oxygen-support and ventilators were still in short supply, and even the clinical management was still evolving. Due to scare or stigma, a lot of patients were not reporting their infections in the initial stages and were getting to hospitals only when their situation deteriorated. Several deaths happened because of late admissions in hospitals.

If the lockdown did not slow down the spread of the disease, the death count could have been much closer to the many nightmarish predictions that had been made. It can very well be argued that fewer case detections were not because of any slowdown but a result of our limited testing capacity. After all, India was barely testing two lakh samples a day by the end of June, and less than five lakh a day by end of July. Only in August could we reach our peak capacity of more than 10 lakh tests a day.

covid 19, delhi Delhi Civil Defence volunteers catch passengers for Covid-19 testing following rise in cases in the city. (Express photo by Praveen Khanna)

While that may be true, there is an alternative argument as well. A higher number of tests would not just have resulted in higher detection of cases, it would itself have led to a slowdown after some time. After all, aggressive testing, followed by effective isolation and contact tracing, is still the best control measure the governments have against this pandemic. The fact that we did not have adequate testing capacity at that time meant that the slowdown, visible in the known numbers, was not happening because of aggressive testing, but because of reduced contact amongst people.

Also, if the spread in the community had continued at the same rate as before the lockdown, it would have reflected in the test positivity rates as well. The test positivity rates rose through June, and most of July, but stabilised after that, indicating that the spread had indeed slowed down. From mid-October, it had begun to decline as well, a process that continued for about five months, even when the number of tests started to progressively come down.

Lockdown again?

With the number of cases rising rapidly again, there has been a clamour for re-imposition of lockdown, especially in Maharashtra which is the worst affected state and contributing more than 60 per cent of all cases in the country during the second wave. In fact, some districts in the state, like Nagpur, Amravati and Akola, have already been experimenting with lockdowns with varying degrees of restrictions being put in place.

But it is important to understand the real objective, and achievement, of last year’s lockdown. The lockdown was not supposed to be a control measure. As has been pointed out innumerable times, the lockdown was meant only to delay the inevitable, and it had remarkable success in achieving that.

Theoretically, the lockdown can in fact be a very effective control measure as well, especially at the start of the pandemic. If everyone was compulsorily isolated in their homes, every infected person would, in the worst case, pass on the disease only to those who are isolated in the same space. Continued isolation for some time can actually bring an end to the pandemic.

But a total lockdown is an illusory situation. Even in the strictest phase of India’s lockdown, movement of people could not be brought to a complete halt. Doctors, healthcare staff and emergency workers were of course working. But there was also a big group of people working behind the scenes to ensure that essential supplies and services were not disrupted – food, medicines, milk, and also, phone and internet services.

And, the lockdown did not come without costs. It brought in immense pain, suffering, and loss to millions of families. The only reason it could be justified was that it succeeded in saving potentially lakhs of lives.

No such justification is applicable in the current situation. Hospitals are not as overwhelmed as they were in July and August last year, death rate is distinctly lower, there is plenty of evidence to suggest that the infection is causing much milder form of disease now compared to earlier, clinical management protocols are fairly well-established, there is much less panic amongst the people now, and the awareness levels among the public is considerably high.

A nation-wide total lockdown, like the one which was executed between March 24 and May 1, is not possible any longer, mainly because the accompanying costs cannot be justified. In fact, even a state-level lockdown is not possible, for similar reasons.

And, the effectiveness of limited lockdowns, the kind of which are being suggested and implemented, are extremely doubtful. There is no evidence to suggest that weekend lockdowns, night curfews, or early closure of shops and markets, has had any tangible benefit anywhere. The only purpose they serve is to show that the administration is doing something to control the rise of cases.

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Test, trace, quarantine

Importantly, there are tried and tested methods that are much more effective as control measures. Scientists and health experts have been crying hoarse since the beginning that the only serious way to go about this is to increase capacities to test, trace contacts and isolate the infected individuals. The more we test and identify infected individuals, aggressively trace their contacts, and effectively isolate them, the more successful we will be in controlling the spread of the virus. Maharashtra, for example, is now testing substantially higher number of samples every day compared to its peak last year.

Swab testing by health workers at Juhu beach in Mumbai. (Express photo by Amit Chakravarty)

Countrywide, the daily testing numbers are back to the levels seen in August, September and October last year, but well below the peak of more than 14 lakh tests a day that was achieved in the middle of October. Because the infection is spreading at a much faster rate than last year, it makes sense to increase our testing capacity further. Directing government efforts here can prove to be more productive than in planning and implementing limited lockdowns.

An equally effective control measure is the behaviour of people themselves. Again scientists have been repeating that the strongest immunity against the disease is the mask, and the practice of physical distancing. The five-month decline in the number of cases led many to believe that the epidemic was over. Combined with the fatigue from leading a restricted life, this led people to abandon masks and physical distancing. This lack of ‘Covid-appropriate behaviour’ has played a major role in the rapid rise in numbers during the current wave. But this is also the lowest-hanging fruit. Masking and physical distancing can yield much better results than a limited lockdown.

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