COVID-19 and the Road Ahead

India’s experience of a ferocious second wave of COVID-19 through April and May 2021 won’t soon be forgotten. But since then, the number of cases has steadily declined. By mid-October, the daily count of new cases came down to around 15,000—the lowest since the start of the second wave in the country. This is a relief for everyone. While the pandemic is far from over—in India or the world—there seems to be a glimmer of light at the end of the tunnel.

Public-health experts and epidemiologists have reached a consensus that as long as the SARS-CoV-2 virus is circulating in any part of the world, there remains a possibility of the emergence of new variants, which can fuel a fresh wave. The practice of handwashing, face masks and physical distancing in public places along with full vaccination are the proven ways to prevent infection and reduce transmission.

A devastating second wave in India also meant that a large proportion of the population was infected and developed natural immunity, as was noted in the fourth nationwide sero-prevalence survey conducted by the Indian Council of Medical Research in June–July this year. The survey estimated that nearly 68 of every 100 Indians above the age of six years had developed antibodies against SARS-CoV-2. Children between six and seven years had antibodies at a nearly similar rate as adults and thus were protected. Since then, India’s COVID-19 vaccination drive has accelerated and by now, nearly 80 per cent of the eligible adult population has received at least one shot of the COVID-19 vaccines.

Should We Expect a Third Wave?

With high sero-prevalence and increasing vaccination coverage, epidemiologically speaking, the probability of a third nationwide wave of COVID-19 in India is low. However, state- and district-specific smaller waves are possible till the pandemic is declared as over. Without confirmed knowledge on how long immunity after natural infection or vaccination lasts, it is important we continue all possible COVID-appropriate precautions.

The long festive and holiday season has started in India. Globally, in the last 21 months, we have witnessed that soon after festivals, sporting events or any instances involving large gatherings of people, a rise of fresh COVID-19 cases occurs. With approximately one-fifth of India’s adult population still susceptible and unvaccinated, this could easily fuel a new wave. While most vaccines are safe and effective, vaccination does not result in absolute immunity: a few vaccinated people are still at risk of disease. Even antibody formation is not a guarantee of protection. However, what is certain is that a vaccinated individual is at far less risk of contracting a moderate or severe form of the diseases than the unvaccinated.

Full Vaccination for Adults

The single dose of the COVID-19 vaccines is known to provide some protection, however, every eligible adult needs to get both shots. More importantly, the vaccines used in India are not proven to reduce the risk of contagion or disease transmission. The COVID-19 vaccines are disease-modifying, meaning they reduce the risk of moderate to severe disease and death. So, with the vaccination rate going up, even if cases rise, the proportion of cases with moderate to severe illness—those who would need hospitalization—is likely to be small.

Children can Attend Schools

One of the major population sub-groups indirectly affected by this pandemic has been children. Soon after the start of the pandemic, schools in India were closed and learning and education of children was severely compromised. Over the last few months, there is better understanding of the virus and disease in the children. Scientific and epidemiological evidence shows that children are protected from moderate to severe disease. This is good news. In fact, the sero-survey has shown that school-age children in India have already developed infection without developing clinical diseases. The COVID-19 vaccine may be initially recommended for high-risk children but healthy children may not need one, until different types of vaccines or more data on the safety of currently licensed ones becomes available.

Scientific evidence demonstrates that children need not be vaccinated to attend school. In nearly all countries children have been attending classes without being vaccinated, As schools are re-opening for in-person sessions, it is the right thing to send kids to school—with strict adherence to age appropriate COVID-19 precautions and safety measures—even without waiting for the start of child vaccinations.

Many times, people and parents in India get apprehensive after reading global news coverage but it is time we develop a better understanding and perspective on these reports. In case of diseases, local context matters. The epidemic pattern of the US or the UK is not necessarily applicable for India. The epidemiological situation in India is very different owing to various factors such as age group, co-morbidities, adherence to COVID appropriate behaviour and prevalence of protective immunity against the Delta variant.

Has COVID-19 become Endemic?

Virologists and infectious disease experts agree that SARS-CoV-2 will stay with humanity for the forseeable future. With increased vaccination and other public health measures, COVID-19 cases will decline but we cannot expect case-loads to reach zero anytime soon. A number of countries such as Singapore, New Zealand and Australia that once planned and implemented ‘zero-COVID’ strategies have since abandoned them.

Experts now agree that a realistic strategy is to achieve a low number of COVID-19 cases through high vaccination coverage and adherence to public health measures. Once the number of vulnerable individuals falls, transmission and the number of daily cases will decline. At that point, the disease can be considered endemic. The decision on when the pandemic should be considered over will be taken by the expert committee formed by the World Health Organization. COVID-19 has not turned endemic in India, yet.

Preparing for the Days Ahead

While the worst of COVID-19 in India seems to be over, we must remain vigilant and respond quickly to any future spike in cases. Adherence to COVID-appropriate behaviour and adults getting fully vaccinated remain key. Until both doses are received, unvaccinated or partially vaccinated people should avoid large gatherings. Taking care of mental and social health, eating and sleeping well as well as keeping fitness levels high will help support us during the critical months ahead. Individuals with post-COVID or long-COVID conditions, should not ignore their symptoms and seek timely medical advice.

The pandemic has taught us a few lessons. First, consistent good health practices is the best protection from any disease, COVID-19 included. We should all pledge to adopt a healthy lifestyle. Second, responding to public-health crises require citizen and community participation for effective implementation of countermeasures. We need to keep doing our bit to ensure India’s victory against the pandemic. Third, vaccines are proven public health tools and citizens can contribute by tackling vaccine hesitancy and convincing every eligible person to get vaccinated. The day when the pandemic will be declared as over, is not very far. The only way forward, is together.

Dr Chandrakant Lahariya, a medical doctor and epidemiologist, is the Executive Director of Foundation for People-centric Health Systems, New Delhi. His forthcoming book Pause is an Opportunity: The Transformative Potential of Schools Re-opening in India is scheduled to release in 2022.