Opinion Never mind pandemic fatigue, we aren’t free of Covid yet

Rajesh M Parikh writes: Our best defence against the pandemic continues to be vaccination, respiratory and hand hygiene, physical distancing and mask-wearing. As cases rise across the world, it is time we shake off our fatigue

Individuals with no symptoms or mild symptoms either test at home or not at all. The US Department of Health and Human Services reported that the number of at-home tests done daily was around two to four times those done by labs.

Rajesh M Parikh

October 13, 2022 04:43 PM IST First published on: Oct 13, 2022 at 04:04 AM IST

Worldwide, Covid-19 cases continue to average approximately 5 lakh daily, while India has about 3,000 daily cases. Although these numbers are not alarming, the virus continues to be a matter of concern. On average, over 1,500 people die daily due to Covid. Survivors run the risk of long Covid symptoms, which we are just beginning to understand.

Research has indicated that about half of those infected with SAR-CoV-2 have long Covid symptoms up to four months after the initial diagnosis. Based on these estimates, nearly 300 million people are suffering from Long Covid. More conservative estimates place the figure at 10 to 20 per cent. Around 80 per cent of adults with symptoms of long Covid are experiencing limitations in their daily activities compared to before they contracted the virus. Research has identified more than 200 different symptoms of long Covid so far.

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We are approaching winter, which has previously seen spikes in cases. The UK was reporting over 50,000 cases a day by the end of September. The festive season in India has already put experts on alert.

Current statistics do not provide a representative picture of the pandemic. With the advent of home testing kits, vaccination and the flu season, thousands of Covid cases are undetected or unreported. Individuals with no symptoms or mild symptoms either test at home or not at all. The US Department of Health and Human Services reported that the number of at-home tests done daily was around two to four times those done by labs. In India, the ratio is skewed even higher towards home detection. Improper use of home testing kits (errors in procedure and lack of reporting) leads to high transmission with little awareness. From the onset of the pandemic, testing has played a vital role in keeping communities safe. Yet, with the paucity of the gold standard of testing, the RT-PCR, being administered, we do not have appropriate figures about the gravity of the pandemic.

In April 2022, the Institute for Health Metrics and Evaluation (IHME) estimated that only 7 per cent of positive Covid-19 cases in the US were being detected. The last time the infection detection rate was this low was at the outset of the pandemic, in March 2020. In India, the IHME has projected that the current estimated cases are 262 per 100,000 people while the reported cases are 0.73 per 100,000 people.

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As dashboards continue to report a minimal number of cases, we have entered a zone of false security. While we have turned lax towards the pandemic and the virus has become smarter. The dominant variant, Omicron BA.5, did not have a significant impact in India, due to its similarities to the Delta variant. However, India is already reporting a new Omicron variant BA.2.75. Vaccination continues to be one of our strongest defences. However, the mutating virus is side stepping vaccine-induced immunity.

A study in the New England Journal of Medicine on vaccine efficacy against the Omicron B.1.1.529 variant reported that Covishield did not provide protection after 25 weeks of two doses; efficacy, however, increased with booster shots. A meta-analysis in the Lancet reported that one month after the primary vaccination (two doses), vaccine effectiveness against severe Covid-19 disease was lower for Omicron compared to other variants.

Over the last few months, most of us have experienced versions of pandemic fatigue. We seem to have forgotten the basics. Our best defence against the pandemic continues to be vaccination, respiratory and hand hygiene, physical distancing and mask-wearing. As cases rise across the world, it is time we shake off our fatigue.

In Shakespeare’s The Tragedy of Julius Caesar, Caesar exuded a false sense of security minutes before he was assassinated on March 15, 44 B.C. He had been warned by a soothsayer of the dangers that awaited him but chose to ignore the warning. On spotting the soothsayer in a crowd, he mocked him that the predicted day had arrived to which the soothsayer responded that it was not yet over. We ought to do better than Julius Caesar.

The writer is director, Medical Research and Hon. Neuropsychiatrist, Jaslok Hospital & Research Centre