India’s Covid-19 Numbers Have Fallen. A Third Wave Still Looms.

In the state of Maharashtra, one of the first places struck by India’s devastating second wave of Covid-19 earlier this year, scientists are anxiously looking for signs of a third.

New laboratories in the financial capital, Mumbai, and in the city of Pune are searching for dangerous new variants. They have stepped up testing, to over 3,600 samples per month from 134 in December last year, as they search for mutations that could make the virus even harder to stop.

India is still far short of its goal to increase genome sequencing nationwide. While Covid-19 cases and deaths have plunged, according to official numbers, the virus is continuing to spread in some parts of the country. A low vaccination rate and other factors have left India especially vulnerable to variants like Delta, the strain that helped power India’s second wave this past spring.

“We need to track new variants to prepare ourselves for the next wave because waves will keep happening, much like the flu or common cold, which keep recurring because the virus mutates or recombines,” said Dr. Vinod Scaria, the principal scientist at the Institute of Genomics and Integrative Biology in New Delhi. “You can’t really prevent that. But you can always be prepared for it.”

The second wave, which exploded across the country in April and May, exposed both the Delta variant’s increased communicability and India’s inability to cope. Official figures show that about 430,000 people have died since the virus hit early last year, though the numbers are widely considered unreliable and experts say the true toll may be in the millions. The second wave pushed the country’s medical system past its limits and led to anger over the government’s inability to handle the crisis.

For now, the disaster appears to have ebbed. India’s daily official caseload has fallen to about 40,000, compared with the more than 300,000 it saw during the worst of the crisis. The hardest-hit urban centers like New Delhi, Mumbai and Pune have had a dramatic decline in cases. Covid-19 wards in many major cities have emptied.

Some hope that the sheer contagiousness of the Delta variant means that many people have already caught it and developed a measure of protection. A recent survey by the Indian Council of Medical Research, a government agency that funds and evaluates studies, found that two-thirds of blood samples surveyed had coronavirus antibodies, compared with about one-quarter in December and January. In some states, as many as three-quarters of samples surveyed carried antibodies.

But scientists cautioned that the survey, with a small sample size of 36,000, shouldn’t be read as an indication that India is out of the woods. Such tests can be prone to false positives. Also, the survey doesn’t represent all areas, said Giridhara Babu, professor of epidemiology at the government-affiliated Public Health Foundation of India, though it could help Indian officials better target areas for testing and vaccinations.

Even if the numbers are accurate, they suggest that 400 million people in India remain vulnerable to Covid-19.

“What is going to happen now is that areas with low sero prevalence and low vaccination will have more number of cases and more people getting hospitalized and higher deaths,” Dr. Babu said, referring to serology, or antibody, testing.

The potential for new variants complicates the picture even further. Places like India with low vaccination rates and other risk factors are particularly vulnerable to new strains.

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After a chaotic and slow start, India has intensified its inoculation drive, regularly delivering five million doses per day. About half a billion doses have been administered so far, and more than 100 million citizens are now fully vaccinated. Indian medical experts hope the increased vaccinations will help blunt the impact of a third wave because even one shot can reduce the severity of infection.

Still, only 8.5 percent of the population is fully vaccinated. It remains to be seen whether the country can reach its goal of vaccinating all the adult population of roughly 900 million by the end of the year.

Low testing rates are another factor. India now administers an average of about 1.2 tests per thousand people per day, according to the Our World in Data project at Oxford University, well above levels at the beginning of the year. But its rate is still well below those of richer countries, coming in at a bit more than half of the level of the United States, for example.

Those low test rates make charting the course of the virus difficult. Currently, a large number of positive tests are coming from southern states like Kerala, which in general conduct more tests than in other parts of the country. That state accounts for nearly half of the total active cases. Infections in areas with lower testing rates would be hard to detect.

Understand the State of Vaccine and Mask Mandates in the U.S.

    • Mask rules. The Centers for Disease Control and Prevention in July recommended that all Americans, regardless of vaccination status, wear masks in indoor public places within areas experiencing outbreaks, a reversal of the guidance it offered in May. See where the C.D.C. guidance would apply, and where states have instituted their own mask policies. The battle over masks has become contentious in some states, with some local leaders defying state bans.
    • Vaccine rules . . . and businesses. Private companies are increasingly mandating coronavirus vaccines for employees, with varying approaches. Such mandates are legally allowed and have been upheld in court challenges.
    • College and universities. More than 400 colleges and universities are requiring students to be vaccinated against Covid-19. Almost all are in states that voted for President Biden.
    • Schools. On Aug. 11, California announced that it would require teachers and staff of both public and private schools to be vaccinated or face regular testing, the first state in the nation to do so. A survey released in August found that many American parents of school-age children are opposed to mandated vaccines for students, but were more supportive of mask mandates for students, teachers and staff members who do not have their shots.  
    • Hospitals and medical centers. Many hospitals and major health systems are requiring employees to get a Covid-19 vaccine, citing rising caseloads fueled by the Delta variant and stubbornly low vaccination rates in their communities, even within their work force.
    • New York. On Aug. 3, Mayor Bill de Blasio of New York announced that proof of vaccination would be required of workers and customers for indoor dining, gyms, performances and other indoor situations, becoming the first U.S. city to require vaccines for a broad range of activities. City hospital workers must also get a vaccine or be subjected to weekly testing. Similar rules are in place for New York State employees.
    • At the federal level. The Pentagon announced that it would seek to make coronavirus vaccinations mandatory for the country’s 1.3 million active-duty troops “no later” than the middle of September. President Biden announced that all civilian federal employees would have to be vaccinated against the coronavirus or submit to regular testing, social distancing, mask requirements and restrictions on most travel.

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