Why is India Facing a 2nd Wave of the Corona Virus?

Till a few months back, we both were in awe of how our country had achieved remarkable control over the spread of Covid-19, across the nation. While a majority of the world was battling a 2nd wave of the virus, Indians had shown remarkable restraint and followed protocols for months on end. Something I have never experienced in our great country in my lifetime. This resulting in the divine union of central government directives with state government policy-making and bureaucratic action and departmental rule-making and the public following the rules, as well people helping the authorities enforce the rules by others.

Wow! This utopian behavior was instrumental in India achieving among the best metrics in the world regarding how the fight with Covid is being measured. i.e. No of cases, No of active cases, The recovery rate, etc.

And then we as a country seem to have performed the hara-kiri that our cricket teams of the ’80s and 90’s were well known for. Before we had won the match, we started celebrating the victory, and seem to have lost the game. We didn’t wait till Covid was completely under control. We started dismantling the specially created Covid Centers. We took our families to the malls and did not care about spraying sanitizers, before and after each interaction with something from outside our controlled environment. We started unmasking at will within our buildings and even at the Kirana stores. We started flying and driving around the country without masks and frolicking on the beaches of Goa. Our house parties were back on, and we destroyed the controlled zone that all India had worked so hard to become over a whole year. All, in less than a couple of months. And so it’s back, worse than ever before, crippling our economy, our spirit, and making us feel bleak about the future. Except for this time, it doesn’t look like everyone wants to tackle it together anymore.

The center and the states don’t seem to get along. The media is pushing up the pitch and the amplitude of the hyperbole. Strangely, vaccines seem to be running out. People are still not masking up. Many are demonstrating utter and complete stupidity with regards to bending the rules. Construction sites are working in full sway as if there is no covid in this world. Watchmen in buildings aren’t sure if they should let delivery in or collect them at the gate, so they do nothing. And the poor Kirana-wala is feeling weird about asking the people coming to his shop to mask up again. My neighboring Kirana-wala told me he is now done arguing with customers who say “khaasi pehle nahin hui kya” (Translates to “Haven’t you had a cold before?”) Sounds like March 2020 again!

We both decided to formally put down our reasons for what has brought us to this stage. Policymakers must not let this happen again

1. The single biggest factor for the wave having arrived is how we have behaved in the recent past.

• People became complacent as the virus numbers fell. There was less social distancing, less effective usage of masks, and much more intermingling.
• The government helped create this complacency by changing the message they were spreading across the nation. Earlier it “Lets fight Covid together” and then in early 2021 we started hearing “We have the best recovery numbers, which within a short period started sounding like We have beaten Covid”, and many Indians started hearing this as “We are invincible”
• Even once the cases started to rise, people did not take it seriously as they believed the virus was already conquered given the vaccine roll-out happening in the background.
• Teenagers and early twenties are a big factor in the spread this time. Many were unaffected by the last surge but the mutated strains affecting their age groups, coupled with the fact that these age groups in India at least are more likely to participate in social events and less likely to follow norms completely gave rise to a larger number of cases.

2. Mutating Strains:

• The nCov Virus can mutate quickly. This gives rise to multiple strains with differing characteristics. The strains doing the most damage are the ones where mutations allow for faster transmission of the virus. The second wave is mainly made up because of such slightly mutated strains which are harder to contain.
• A new variant, called B.1.617, was initially detected in India with two mutations — the E484Q and L452R. It was first reported late last year by a scientist in India and is the chief variant spreading in India, highly contagious. It is also highly likely to evade the immunity provided by vaccines.
• The Current strains affect a wider range of age groups. There are many cases, this time around, of children, teenagers, and pregnant mothers than in the previous wave. Hence a larger population is susceptible.
• The current strains though less damaging are highly contagious. The virus travels further and faster instead of causing more damage to the host. One of the reasons why Ebola does not travel far is its genetic makeup causes a very high and quick kill rate of the host, meaning if a limited number of hosts are contained it cannot travel very far as the host itself dies if not cured. This spread puts a lot of pressure on the public health infrastructure, crippling it beyond a point.
• India was not sequencing enough SARS-COV2 genomes till late Feb 2021. Ref: https://science.thewire.in/the-sciences/india-sars-cov-2-genome-sequencing-roadblocks-resources-b117-n440k-variants/ and https://science.thewire.in/health/insacog-ccmb-igib-novel-coronavirus-variants-genome-sequencing-covid-19-surge/

3. The Vaccine rollout:

• The ability to deliver a large number of vaccines in time and with proper delivery mechanisms is not yet perfect. There is scope for the production to be increased, and the delivery mechanisms improved.
• The fact that 2 doses are needed a few months apart for full efficacy gives the chance for the virus to take the person down in the long interim period. This interim period should have been defined as a period for vaccine takers to be extra careful.
• The virus efficacy was never fully understood, and that the vaccine does not prevent the person infected from still being a carrier is still unknown to most.

4. Policy Changes

• Policy changes allowed weddings and parties to be carried out with an increase in the number of people allowed. It became impossible to control the social distancing protocols at these large events, and they eventually became super spreaders. The increase in Weddings, Parties, Election campaigns, etc went on unabated as restrictions were lifted just as the strains became harder to contain.
• There is a distinct delay between policy change (Begin Again Initiative by the government) such as allowing opening of businesses or removing restrictions on gathering and movement of people to when these translate into numbers in COVID-19 analytics. An increase in the number of COVID-19 cases or admissions or even deaths is not seen immediately within the week or even 2 weeks but much later. The delay is much larger as the spread initially is limited to smaller circles but due to spreader events and clusters forming suddenly rise exponentially. So policy changes in the November-December period showed up as a sudden surge from February onwards, as policy change led to behavior change was fed back to appear in the population-level data.

This article is jointly authored by Aditya Patkar and Nrip Nihalani

This post first appeared on the Technology for Doctors Blog http://technology4doctors.blogspot.com/2021/04/why-is-india-facing-2nd-wave-of-corona.html