New Delhi, India – On Tuesday, India reported 7,579 coronavirus cases – the lowest rise in 543 days, despite huge festival gatherings in recent weeks.
“Even after [Hindu festival of] Diwali, we are not seeing a surge,” Dr M D Gupte, former director of National Institute of Epidemiology, was quoted as saying in media reports, attributing it mainly to the presence of antibodies in a huge majority of Indians through natural infection.
“I think we are much safer now,” Gupte said.
According to government surveys, nearly 70 percent of Indians were naturally infected by July, following a record rise in infections and deaths during a brutal second wave in April and May.
In a statement last week, the health ministry said active cases account for less than one percent of the total, the lowest since March 2020.
Even as India emerges from its festive season and is currently gripped by raging air pollution and falling temperatures – conditions presumed to be optimal for a surge in coronavirus infections – the country seems to have dodged another deadly wave.
For the past 21 weeks, India has logged less than 50,000 cases a day. Since the second week of October, it has remained below 20,000 – a far cry from the deadly second wave in April and May this year with more than 400,000 daily cases at its peak.
The government and health experts feared a third wave of the virus, with media reports in August and September warning of the wave peaking in October or November.
One of those reports quoted the National Institute of Disaster Management (NIDM), under India’s Ministry of Home Affairs, warning of a third wave in October. The report, published in mid-August and submitted to the Prime Minister’s Office, cited government experts and institutions warning of an imminent wave.
Among those cited in the report was K VijayRaghavan, the principal scientific adviser to the government, who during a May 2021 press briefing, said the third COVID-19 wave was “inevitable” and that children would be at a greater risk.
The report highlighted possible scenarios predicted by the Indian Institute of Technology – Kanpur, one of India’s premier state-run institutions, whose study anticipated more than 300,000 coronavirus cases a day – lower than the second wave peaks – in October if there were no restrictions in place.
With strict interventions, a peak of more than 200,000 a day was anticipated in late October.
However, with no such surge in sight, experts are now talking about a scenario where the disease might have entered an “endemic phase” in India.
“We need to understand that the disease is nowhere near being eliminated. It is present and continues to spread. It is endemic only when it does not take on the proportions of a pandemic,” says T Sundararaman, the global coordinator of the People’s Health Movement and a former executive director of the National Health Systems Resource Centre.
For that to happen, Sundararaman explains, COVID-19’s R0 value should remain below 1. In epidemiology, R0 or R-naught is the average number of people that a single infected person can transmit the disease. In short, it indicates how contagious an infectious disease is.
Some recent studies have put this number for the Delta variant, the coronavirus responsible for the second wave in India, between 5 to 8 – meaning it is as infectious as, say, chickenpox.
“It will be a low level of transmission which might persist quite indefinitely, like the way we have flu or typhoid persisting. In an endemic, there is no endpoint,” said Sundararaman, describing what an endemic COVID-19 scenario could look like.
In February this year, a Nature journal survey found an overwhelming majority – almost 90 percent – of scientists “felt that SARS-CoV-2 was either very likely or likely to become an endemic virus”. Months later, scientists in India at least are anticipating the same.
“The Himalayan magnitude of the second wave made us reach what epidemiologists call ‘herd immunity threshold’ at which point epidemic has to yield to ‘endemic’ phase with low and steady numbers,” renowned virologist and retired professor Dr T Jacob John, who claims that India is the first country to reach endemic phase, told Al Jazeera.
While some are convinced of COVID-19’s endemicity, others remain cautious.
“I am cautious of saying that India has reached endemicity because one bad variant emerging anywhere can alter this balance,” Shahid Jameel, an eminent virologist and a research fellow at the Green Templeton College, University of Oxford, told Al Jazeera.
Fear of emerging variants
Earlier this month, fear of another lockdown was rumoured as the southern state of Karnataka reported seven cases of the new Delta Plus variant, AY.4.2, a sub-lineage of the Delta variant.
According to news reports, about 40 cases of AY.4.2 were reported in at least six states.
Later, the Indian SARS-CoV-2 Genomics Consortium (INSACOG) said the frequency of AY.4.2 is too low (less than 0.1 percent of all variants of concern and interest) in India.
Delta lineages are said to be driving the third wave in the United Kingdom. The sub-lineage AY.4.2, speculated to be 10-15 percent more transmissible than Delta, is tearing through Europe, triggering restrictions amid rising case rates and hospital admissions.
The variant’s prevalence in the UK, according to the UK Health Security Agency (UKHSA), has increased to nearly 13 percent of the Delta cases. Delta Plus, which was first detected in July, was declared a “variant under investigation” by the UKHSA last month.
“Clinical cases in western countries are now among the non-immune (mostly unvaccinated). That means the population immunity (or herd immunity) due to past infections remains low, like a debt they owe to Delta variant,” said Jacob John.
UKHSA data suggest that the ongoing surge is driven by the younger, unvaccinated group. Jameel placed the blame on “poor compliance” and “opening up” of the country where infections are driven by school-going children and teenagers.
“But severe disease and mortality are very low (0.2 percent compared with 2 percent earlier). This is due to high adult vaccination rates and naturally mild infections in younger people,” Jameel said.
Vaccines to the rescue
According to virologist John, Delta had a relatively free run in India. And with two-dose vaccinations slowly climbing up, it has added to very high herd immunity due to the enormous second wave.
Last month, Mumbai, one of India’s worst-hit cities, reported no deaths for the first time since the beginning of the pandemic. New Delhi has already seen several zero-death days in the past few months. The two cities, worst-hit by the second wave, have found high seropositivity (an indication of infections) in their population.
“We found that 90 percent of the vaccinated people had antibodies and among the unvaccinated, we found antibodies in around 79 percent of them,” said Dr Daksha Shah, the deputy executive health officer with the Brihanmumbai Municipal Corporation (BMC).
Shah points to the last serosurvey conducted by the BMC, released in September, which found that 86 percent of the residents in Mumbai had antibodies against coronavirus.
“The whole economy has opened up, from trains, buses to even theatres have opened. Most of the restrictions have been eased out. Even then the cases are not increasing. And of course, there is an effect of vaccinations,” said Shah.
New Delhi’s recent serosurvey – its sixth – reported more than 95 percent of seropositivity in the samples from each of its districts either due to vaccination or past infection. The national capital has consistently reported few fresh cases and deaths despite the lifting of all restrictions.
In eastern India, Kolkata observed a spurt in daily cases after the Hindu festival of Durga Puja.
“Cases are falling, official figures show that and in hospitals, we can see vacant beds again. There was a surge in cases after Pujo but never became a raging wave like the second wave,” Kolkata-based Dr Arjun Dasgupta, who is the president of West Bengal Doctors Forum, told Al Jazeera.
“Immunity attained in exchange for millions of deaths and the first dose of vaccinations together may have done the trick.”
The Indian government celebrated a considerable milestone of administering one billion COVID-19 vaccine doses on October 21, with Prime Minister Narendra Modi commemorating it with an address to the nation. This month, the government complimented itself for vaccinating nearly 81 percent of the eligible adult population with the first dose.
Despite early celebrations, only about 40 percent of the population is estimated to be fully vaccinated and millions are skipping their second doses. Government data shows that more than 120 million people did not turn up for their second dose.
India has reported a total of 34.5 million COVID-19 cases, second only to the United States. Deaths rose by 236 in the past 24 hours to 466,147.
Meanwhile, India’s reliance on digital solutions for its mega vaccination plan has been criticised for being exclusionary and limiting in approach.
On November 2, in an attempt to ramp up vaccinations and vaccinate those due for second doses, the Indian government launched a month-long door-to-door campaign, called “Har Ghar Dastak” (Knocking at Each Door).
“Vaccine hesitancy is a serious problem. You can’t do it with OTPs [one-time passwords] and apps. They [people] need to be traced, from house to house. We have an army of people who have done wonders. That is how we have eradicated smallpox and polio,” said Dasgupta.