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Waiting for the Endgame: Will There Ever Be a Post-COVID World?

Jun 18, 2021 3:46 AM 6 min read

India recorded 6,148 COVID-19 deaths in 24 hours last week, the highest daily count for any country since the pandemic began.

This staggering statistic was largely on account of Bihar revising its total death toll from 5,424 to 9,375 (a 73% upswing) after it accounted for those who died at home and in private hospitals.

Regardless, Thursday’s spike is hardly an outlier. The country’s reported coronavirus deaths have been averaging around 3,000 for weeks now even as the number of reported cases has steadily climbed down. This lag between cases and deaths is unsurprising - there is usually a two-week gap between new cases detected and new deaths.

Besides, we’re only talking about reported numbers here. The Bihar fiasco only reaffirms the poor state of record-keeping across the country. Coupled with low levels of testing, there are likely hundreds or thousands of unreported cases and deaths - probably every day. The actual picture is likely far worse than what we see in news headlines and government reports.

A Very, Very Thin Silver Lining

That being said, the overall situation seems to be gradually improving. Well, at least on paper.

Cases and deaths have consistently declined. The test positivity rate has dipped below 5%. Hospitals are no longer overcrowded. Former hotspots Delhi and Mumbai are no longer the hubs of armageddon they were in April. And social media isn’t flooded with desperate calls for oxygen cylinders or emergency medicines.

Is India finally in the endgame of the Second Wave?

Quite simply, no.


And Now Our Watch Is Ended (Not)

For starters, the last time someone confidently affirmed that the country was in the “endgame” of the pandemic was in March and that “someone” was the Health Minister. We now know, thanks to sombre experience, that that was a reckless and brash characterisation.

Secondly, even though case and fatality numbers are climbing down, they are still sky-high. Look at the number of daily cases reported this week - around 1 lakh a day: those were the same levels during the peak of the First Wave last year.

Thirdly, there’s the omnipresent threat of variants. The current wave was largely fuelled by the alpha (B.1.1.7) and delta (B.1.617.2) mutations of the coronavirus. Newer variants - more infectious, more lethal, possibly even vaccine-resistant - may surface at any time and wreak havoc again. There are already worries that a Third Wave may be on the horizon.

Fourthly, the most sure-shot way of defeating the virus is through rampant vaccination. India’s vaccination drive continues to fall short of expectations (here’s why). Five months since the rollout commenced, only 3.3% of the population has been fully vaccinated. Despite the Centre’s recent U-turn on vaccine procurement and the call for foreign pharma majors like Pfizer and Moderna to apply for emergency use authorisation, there are doubts whether there will be enough doses to inoculate the entire adult population before December 31st (which is the Government's new sanguine target).

Fifthly, regional disparities in data. As of this week, new cases and test positivity remain high in states like Tamil Nadu, Kerala and Karnataka. But considering the duplicitous record of data-keeping in states like Gujarat, MP and UP, the regional mismatch of the Second Wave’s toll might have to be digested with a bucketful of salt. Unless India ensures trustworthy data reportage - no matter the inevitable (but honest) jump in numbers and fatality rates - the COVID crisis will continue to spring ugly surprises.

Sixthly, regional disparities in vaccination. It’s more difficult to fudge vaccination data, so a relatively reliable picture can be painted. Here, there’s a gross poor-rich and rural-urban divide. Poorer states have seen slower vaccine rollouts. Of the 10 districts with the lowest vaccination coverage, six are from UP alone. Even within metros - which are generally rolling out doses more robustly - the variance is glaring. Nearly 53% of wealthy South Delhi’s residents have received at least one dose. But for the capital as a whole, this number is only 23%.


Beyond Our Borders

Even as India struggles with the Second Wave, many countries are slowly but surely returning to some degree of pre-pandemic normalcy.

Boosted by strong vaccine rollouts, the US recently dropped its mask mandate and has fully reopened much of its economy. The UK has all but lifted its wide-ranging lockdown; on June 1st it happily reported zero deaths for the first time since March 2020. Germany and France, despite dragging their feet in administering doses, are relaxing restrictions too. As many as seven countries have reported no new cases for four weeks in a row.

But the US and Western Europe account for a minuscule minority of the word population. Elsewhere, the picture points to a sobering reality: the pandemic is far from over.

In most countries, the COVID curve is either still rising or slowly plateauing; distinctive dips are still rare or short-lived. Vaccine inequality is rife: many countries are yet to administer even a single dose. On the supply side, manufacturing billions of doses at breakneck speed is proving to be a historic challenge, due in no small part to the crisis in India, which houses the world’s largest vaccine maker. Moreover, places that managed to flatten the curve before - like South Korea, Japan, Taiwan and Vietnam - have witnessed a worrying uptick of late.

All said and done, the factors that cloud the near-term COVID outlook for India (new waves, variants, slow vaccination rates) do the same for the rest of the world. Without herd immunity, a Fourth or Fifth Wave may engulf Europe. Without widespread vaccinations, Brazil may devolve into another crippling health crisis. New variants may nullify America’s impressive strides towards mass inoculations.

The bottom line being: the pandemic continues to rage on. And until everybody is safe, nobody is.


Will We Ever Reach the Endgame?

Let’s say, hypothetically, by the end of this year every nation on every continent manages to fully vaccinate virtually the entirety of its population.

What then? Would that be the post-pandemic paradise we have all been yearning for?

In such a future, daily cases and deaths would no doubt plummet. Economies would reopen, outdoor spaces would be crowded, face masks would come off and hand sanitizer sales would go down.

But, crucially, COVID-19 would still exist.

Newer variants might still be circulating, probably causing local outbreaks now and then. Herd immunity - which is still not fully understood - may not last long. Vaccine-induced immunity may wear off over time, making people susceptible to infections again. This would mean the requirement of booster shots to reinvigorate protections. In fact, COVID-19 vaccination may become a periodic affair in the near-term, requiring annual doses to ensure updated immunity.

Is disease eradication unheard of? No. Humanity has completely removed two infectious diseases from the face of the Earth till now: smallpox and rinderpest. Their eradication was the result of decades-long international efforts involving historic and fruitful collaborations between governments, health bodies and citizens’ groups.

With COVID-19, such efforts are complicated by a variety of factors. Vaccine efficacy, vaccine hesitancy and virus mutations are obvious explanations. But there’s also the way this virus spreads.

Animals can be vectors - so even if we immunise the entire world population, the virus can still circulate in the animal kingdom and jump the species barrier. And then there’s asymptomatic transmission. Vaccinated people can still catch COVID - albeit the effects would be mild and akin to a mild bout of the flu. But say someone carries the virus - they may exhibit zero symptoms and still manage to spread it far and wide.

So, eventually, COVID-19 is likely to fall into the class of diseases that we aim to manage and not wipe out. Think of polio, measles, mumps, malaria, influenza and the common cold.

We can defeat the virus. But we may never be able to fully eliminate it.


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