Signs of Covid uptick as states lower guard

NEW DELHI: Three states and one Union Territory have seen their seven-day averages of daily Covid-19 cases rise by between 20% and 69% of lows seen after the end of the first wave of the pandemic, an analysis by HT shows. This highlights the potential risk of a surge in cases amid fears of mutant strains gaining ground, and laxity in adhering to protocols due to Covid fatigue being reported across the country.

In addition to the regions mentioned above — Maharashtra, Punjab, Haryana and Jammu & Kashmir — the first wave continues unabated in the southern state of Kerala.

To be sure, all this comes even as India has vaccinated 10 million people, although an outbreak now could divert the attention of the public health system from vaccination to managing infections.

The increase in cases is being reported from these areas as restrictions on several economic and social activities have eased, and people and governments appear to be getting complacent, with almost no mask discipline in many parts of rural India, and even some cities. At the same time, testing is over 50% of its peak across India; in Delhi, too, it is 30% lower than peak capacity levels.

While Maharashtra, the state worst-hit by the disease, is again seeing a strong resurgence of infections with cases rising rapidly over the past week, Punjab, Haryana and Jammu & Kashmir also face the immediate risk of

seeing a second Covid-19 surge, according to HT’s analysis. Kerala, meanwhile, remains the only state in the country which is yet to bring its primary wave of infections in control.

This resurgence in new cases, along with rising positivity rates and a drop in testing comes at a time when cases across the majority of the country are at the lowest in eight months, which has prompted local governments to start relaxing norms, and encouraged people to drop their guards.

To identify the regions where cases are rising again, HT analysed data from India’s 20 most populous states and UTs to narrow down on four regions where the case rate (the seven-day average of daily cases) appears to have bottomed out and has again started rising — Maharashtra, Punjab, Haryana and Jammu & Kashmir. In these regions, the case trajectory has risen as high as 69% and at least 20% from the lowest levels since the peak of the first wave.

Epidemiological estimates by the University of Michigan’s Centre for Precision Health Data Science show that while India overall has an effective reproduction number (Rt) of 0.95, only these four states have an Rt of above 1 – Punjab (1.16), Maharashtra (1.12), Haryana (1.05) and Jammu and Kashmir (1.03). An Rt of more than 1 means an outbreak is expanding in a region.

Experts warn that these cannot be treated as isolated islands of infection, and with travel restrictions eased, an outbreak in one state can easily spread to another.

In Maharashtra, which leads the country with 2.08 million infections and 51,669 deaths as of Wednesday, cases have gone up 69% from their recent trough. In the past week, 4,088 new cases have been reported in the state on average against a low of 2,415 on February 11.

Another alarming sign for the state is the rapidly rising positivity rate. On average, 8.4% of all samples tested in the past week have been positive – this has doubled in the last three weeks. The single-day positivity rate in Maharashtra in the past five days, for instance, has been 6.3%, 12.2%, 9.8%, 9.0% and 8.4%. HT reported on Tuesday that the increase has coincided with the resumption of suburban train services – with almost no social distancing norms.

To contrast these numbers against the rest of the nation, India’s overall Covid-19 number has deviated only 3% above the lows seen since the end of the first wave, while the average positivity rate is only 0.1% above the lowest point (1.6%).

Testing has also dropped significantly in the western state. In the past week, the state has tested 51,060 samples a day on average, nearly half the peak capacity — at its peak the state was testing an average of over 101,893 samples a day in midSeptember.

In Maharashtra, the administration has gone into damage control mode in the past week. On Thursday, Mumbai reintroduced many of the peak-Covid-19 containment policies of 2020, including filing FIRs against those violating quarantine rules. High-risk contacts will again be stamped with indelible ink on their hands for identification. Buildings in Mumbai with more than five positive cases will now be sealed as well. On Wednesday, seven districts in the state (Amravati, Buldhana, Yavatmal, Akola, Nagpur, Parbhani and Jalna) imposed restrictions on movement of people and have restricted gatherings to five or fewer people.

In Punjab, the case trajectory now stands 32% above the postfirst wave trough. In the past week, 260 new cases have been reported in the state on average against a low of 181 on January 27. And while the positivity rate has not spiked as high as Maharashtra, it has climbed from 1.2% to 1.5% in just the last week. To be sure, this rate is still comfortably below the 5% threshold recommended by the World Health Organization (WHO).

Average testing in the state has dropped 35% from peak levels — it was testing 28,352 samples a day for week ending September 15 and has tested 18,311 samples a day in the last week.

Similarly, cases have risen 32% and 20% post first wave in Jammu & Kashmir and Haryana. While the former has seen only a 19% drop from peak testing, in Haryana, the rate of testing has dropped over 70% from peak levels. Both states still have low positivity rates of 0.3% and 0.8%, well below the WHO-recommended threshold.

Testing is an area where most states have slipped in recent weeks. On average, 726,562 samples a day have been tested across the country in the past week – a drop of over 50% from peak levels when the country was testing an average of nearly 1.5 million samples a day.

Experts said that the real impact of the relaxation of curbs in states such as Maharashtra may be yet to surface.

“While it would be too early to extrapolate what is happening in Maharashtra to the rest of the country, there is no denying that what is happening in the state is really concerning. There has barely been enough time since the local trains opened up in the state to see the real on-ground impact of the spread of the disease,” said Dr Lalit Kant, former head of epidemiology and communicable diseases at the Indian Council of Medical Research (ICMR), adding that the state should be looking to isolate as many regions that develop into hot spots as possible.

“Moreover, we can’t afford any drop in testing numbers anywhere in the country. If we have built up the testing capacity to run 1.5 million tests a day, we should try to stay as close to that number as possible instead of letting our guard down.”

Kant, like many others is also worried about the new strains. India has so far reported 187 cases of infection of the UK variant, four of the South African variant and one of the Brazilian. “My real fear right now is new variants of the virus. If a large number of people develop antibodies against the virus, then it undergoes mutations in order to survive – something we’ve seen happen across the world where new strains have become dominant. We need to keep running genome sequencing to keep a track on variants of the virus.”