How India can survive subsequent waves
The World Health Organization designated B.1.617 a variant of concern. When tested in hamsters, which are reasonable models for human infection and disease, B.1.617 produced higher amounts of virus and more lung lesions compared with the parent B.1 virus. Global data shows the B.1.617 variant to be diversifying into three sub-lineages. In a preliminary report, British and Indian scientists found the B.1.617.2 variant in vaccine breakthrough infections in a Delhi hospital. With these variants circulating through India’s still mostly unvaccinated population, public health officials here are trying to determine when the second wave might peak, how big it will be and when it will end. The estimates vary widely. The Supermodel Group, preferred by the Indian government, estimated cases to have peaked at about 380,000 cases per day in the first week of May. The simulation model by the Indian Scientists Response to COVID-19, a voluntary group of scientists, predicts that daily cases will reach a peak sometime in midMay, but it forecasts a much higher peak, about 500,000 to 600,000 daily cases. The COV-IND-19 Study Group at the University of Michigan predicts a peak by mid-May with about 800,000 to one million daily cases.
All models predict India’s second wave to last until July or August, ending with about 35 million confirmed cases and possibly 500 million estimated infections. That would still leave millions of susceptible people in India. The timing and scale of the third wave would depend on the proportion of vaccinated people, whether newer variants emerge and whether India can avoid additional superspreader events, like large weddings and religious festivals. What worries me is that we may not even be able to measure the peak cases accurately. Data show that testing is increasing at a far slower rate than cases. In this scenario, numbers will reach a plateau — not because case numbers have stopped rising but because testing capacity will be tapped out. The national average test positivity rate is over 22 percent, but several states have rates that are, alarmingly, even higher — including Goa at 46.3 percent and Uttarakhand, which hosted the Kumbh festival, at 36.5 percent. “India will have a manufactured peak of about 500,000 daily cases by midMay,” argued Rijo M. John, a health economist.
COVID-19 vaccines mitigate disease, but they may not prevent infection, especially when transmission rates are as high as they are now. Though good data is lacking, variant viruses with evasion potential may also have a role in “breakthrough” infections in vaccinated people.
The immediate need is to reduce spread by increased testing and isolation of people who test positive. Several Indian states are under lockdown. This would “flatten the curve,” allowing health care facilities and supplies to regroup. Rapidly enhancing the health care infrastructure will also save lives. India should increase available hospital beds by setting up temporary facilities, mobilize retired doctors and nurses, and strengthen the supply chain for critical medicines and oxygen.
At the same time, India cannot allow the pace of vaccinations to slow. It must vaccinate at scale now, aiming to deliver 7.5 million to 10 million doses every day. This will require enhancing vaccine supplies and doubling delivery points. There are only about 50,000 sites where Indians can get vaccines right now; we need many more. Since only 3 percent of these delivery points are in the private sector, this is where capacity can be added. All of these measures have wide support among my fellow scientists in India. Decision-making based on data is yet another casualty, as the pandemic in India has spun out of control. The human cost we are enduring will leave a permanent scar.