Opinion Chandrakant Lahariya writes: Why the rising Covid count is not cause for worry
Today, we know more about protecting ourselves and the virus circulating currently is less virulent. But we need to be vigilant and step up granular data collection
Three years into the pandemic, SARS-CoV2 is now ubiquitous and will stay with humanity for long, possibly forever. (Express photo by Nirmal Harindran) 
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In the last few weeks, the daily reported Covid-19 cases in the country have increased by 30-fold from a low base of fewer than 100 cases. Yet, there is enough epidemiological and scientific evidence to argue that it is not the beginning of a fresh wave of the disease. To start with, this is the first time since the start of the pandemic that no SARS-CoV2 variant of concern (VoC) is circulating in any part of the world. On March 16, the WHO’s Technical Advisory Group on SARS-CoV-2 Virus Evolution downgraded the Omicron to the same category as Alpha, Beta, Gamma, and Delta variants of the earlier variants of concern. The Omicron was VoC for much of 2022 and early 2023 but not anymore.
The other concern has been the emergence of the XBB.1.16 sub-variant. However, every sub-variant is not one of interest and concern. Since the start of the pandemic, more than 700 subvariants and recombinant sublineages have been reported. However, only five have been designated as VoC. XBB.1.16 is one of the 100+ recombinant lineages reported till now. XBB1.16 is a sub-type of Omicron and has some growth advantage and thus higher transmissibility. But it is very similar to the other variants in its ability to cause clinical disease and has no or minimal immune escape. The currently-used vaccines continue to protect against circulating sub-variants and sub-lineages.
Three years into the pandemic, SARS-CoV2 is now ubiquitous and will stay with humanity for long, possibly forever. Therefore, merely getting tested positive for SARS-CoV2 has limited relevance. Its virulence (ability to cause clinical disease) has been blunted. This is reflected in the fact that though the daily Covid-19 cases in India have increased from about 100 to 3,000, during the same period, hospitalisation and deaths have remained largely unchanged. In fact, most of the Covid cases in hospitals are those who have been admitted for other reasons and incidentally found positive for SARS-CoV2.
In countries that have robust and sensitive surveillance systems for respiratory viruses and illnesses, it has been noted that the SARS-CoV2 infection rate is far lower than other respiratory viruses such as influenza and respiratory syncytial viruses. Yet, we can’t afford to ignore the possible risk associated with SARS-CoV2. However, India does need to change once and for all the approach to track the Covid-19 situation.
There is very limited relevance in counting laboratory-confirmed cases. A healthy, fully vaccinated person who is Covid positive has very little chance of contracting serious disease. The granular data on admission, moderate to severe disease and deaths due to Covid-19 should be tracked and used for decision-making. But it is also time to put data in perspective. Every day in India, an estimated 27,000 people die due to a wide range of reasons including old age. Only one of 4,000 deaths are due to Covid-19. In contrast, respiratory diseases kill around 500 people and tuberculosis kills an estimated 4,000 people in India every single day. And, most of those deaths are preventable. The challenge of respiratory illnesses and tuberculosis is 50 and 250 times higher than Covid-19 now. We need to shift attention to preventable deaths due to many other reasons.
Tools like genomic and wastewater analysis and Influenza-like illness and severe acute respiratory illness surveillance can help in the early detection of the emergence of new variants. However, data generated from these surveillance systems can be used more effectively and guide policy interventions only if they are analysed with clinical outcomes.
The fresh surge might increase demand for the fourth Covid-19 vaccine shot. However, in India’s context, there is no immediate scientific rationale to administer a fourth dose of COVID-19 vaccines to any age group. However, all those high-risk individuals who have not received their third shot yet, need to get one, at the earliest.
There is a lot to improve in government and societal response to SARs-CoV2. The response to infectious diseases needs to be calmer and evidence guided. Merely a few weeks ago, an Indian state-ordered school closure because of the rise in viral fever cases, which was completely irrational. Though the government should regularly review the situation at a high level, mock drills for disease preparedness are not necessary. While the handling of the current surge by the media has been better than in the past, sensational headlines and fake social media forwards remain challenges. Science communication from the government needs to be more interactive and press briefings with subject experts and officials should be held regularly. These briefings help in addressing misinformation and getting reporting right. The press advisory, which is rarely read and barely understood, is no alternative to press briefings. Medical experts also need to be more responsible and should speak on topics which they understand and not on everything.
The planet has far more absolute numbers of viruses, bacteria and other pathogens than humans. It is their world, and humans are also here — not vice versa. SARS-CoV2 is part of our ecosystem, as are the other respiratory viruses. We should expect a rise and fall in SARS-CoV2 cases at regular intervals. Fortunately, unlike three years ago, now we know how to protect ourselves.
The writer is a consultant physician and epidemiologist and the Founder-Director of ‘Foundation of People-centric Health Systems’, New Delhi
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