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What is Driving India's Second COVID-19 Wave? How is It Different from the First Wave?

Editor, TRANSFIN.
Apr 12, 2021 4:29 AM 7 min read
Editorial

Much like the virus itself, India’s tryst with COVID-19 has been unpredictable and, at times, inexplicable.

About a year ago, the country was averaging fewer than 600 new reported cases of COVID-19 a day. This was against the backdrop of its all-out nationwide lockdown - the world’s most stringent at the time.

By September, daily new cases were registering daily highs before peaking at 97,895 on September 16th and then gradually decreasing. By January, this number had dropped below 10,000, and to the world it seemed as if India had staged a miraculous escape from the pangs of the pandemic.

Since mid-March 2021, however, cases have been rising again - and at a pace not seen before. On Wednesday, 1,26,789 new coronavirus cases were reported in the country - the highest since the pandemic began. We are now in the midst of a “second wave”.

What is a “Wave”?

Usually, pandemics come in waves. There’s the first strike, when countries are relatively unprepared and there are a lot of susceptible people for a virus to infect. Restrictions and safety measures are then put in place to curb the spread - and thus the infection rate dips.

But then as a country reopens, restrictions are slashed, human activity increases, the virus again has more hosts to attack - and thus the infection rate increases again (aka the second wave). Subsequent waves happen in similar cycles.

There’s no rule that a pandemic will only have two or three waves. This depends on a country’s response. The US, for example, entered its second wave in June and may now be facing its fourth. Europe is currently struggling through a crippling third wave.

For a country as big and complex as India, the same etymology may not hold. For starters, the Government’s initial response was an overwhelming lockdown and then a phased “Unlock” process. This may have blurred the lines between what could have been two (or more) separate waves (as was the case in the US). Second, there are many regional disparities - again, because of differences in local response. Delhi, for example, is technically in its fourth wave right now.

Etymology aside, looking at the chart above of India’s COVID-19 new case-count, it can be broadly inferred that the country is going through a serious resurgence in cases.

 

What Caused India’s Second Wave?

There are many possible answers.

 

People and politicians letting their guard down

One of the reasons given for India’s dramatic drop in cases post-September was its effective mask mandate. Face masks became omnipresent at the peak of the pandemic, particularly in urban areas, helped by awareness campaigns and strict penalties. Social distancing - which was thought to be oxymoronic in a nation of 1.3 billion - was also adhered to (to an extent). 

Over time, however, as the country “unlocked”, compliance turned into complacency. The masks came off, public areas became crowded again and social distancing became impossible to maintain. In recent weeks, five ongoing regional high-stakes elections have sparked massive political rallies, with candidates holding massive road shows and campaign speeches attended by too many people covering too little of their faces. Festivals and sports matches have added to the din, much to the joy of the coronavirus.

 

Reopening of the economy

Cases were relatively muted in April-May last year because of the lockdown. Today, virtually all sectors of the economy are up and running. This means more people running about = more infection grounds for the virus = another wave.

 

Variants

Viruses mutate, and COVID-19 is no different. There are variants from the UK, South Africa, Brazil and Japan, among others, and these behave differently, can spread more easily and evoke different efficacy rates from the available vaccines. On March 24th, the Government announced that 771 variants of concerns (VOC) had been detected from across the country. Also on the radar is a “double mutant” which can change parts of the coronavirus spike protein - something vaccines have been designed to target against and something vaccines may be powerless against if the proteins are tampered with by the virus.

Many experts fear that the recent surge in infections is due to variants, but the Government has so far rejected this theory.

 

Reinfections

Surviving COVID-19 once or possessing antibodies against it is not a guarantee against reinfection. There are many instances of the virus infecting again - especially if it’s a variant - and it’s still unclear how long vaccine-induced immunity will last. But the spectre of reinfections is still relatively under-studied, despite the dangers it poses, including to the possibility of herd immunity.

 

The “Herd Immunity” Hypothesis 

Back in September, when the first wave showed no signs of abetting but the economy continued to be unlocked, many said that India could no longer afford a lockdown and so Indians would have to "learn to live with the virus". The idea was that the virus could run freely amongst the population and infect so many that it would eventually run out of people to infect. This was the herd immunity hypothesis.

The problem with this stance is that “herd immunity” is not a clear-cut line in the sand. The magic number of how much of the population needs to be infected for it to be immunised varies from virus to virus - and we don't know what this number is for COVID-19. In October, 76% of blood samples in Manaus, Brazil tested positive for coronavirus antibodies. But Manaus has been brutally hit by Brazil's current wave.

So, 76% (assuming it represents the actual number) is probably not the threshold for herd immunity. But, for argument’s sake, let's assume this threshold is, say, 80%. In India, a national serosurvey of nearly 30,000 people conducted by ICMR between December and January found a positivity rate of 21.4%. Even if you assume that 30% of Indians have COVID antibodies, the road to 80% is a long and bloody one. And 80% may not even stop future coronavirus waves! (Read more about herd immunity here.)

 

How is India’s Second Wave Different from the First?

Speed

This time around, the spread of the virus has been staggeringly quick. Since February 15th, the number of cases has jumped 10x. Another way to look at this: The journey from 10,000 daily new cases to 80,000 has taken less than 40 days during the second wave. During the first, this jump took 83 days.

This worrying momentum may be because the conditions for the virus to spread are more conducive now, with the entire country unlocked. Another reason may be that newer variants are more infectious than the original virus.

 

Economic inequality

The first wave hit urban centres with airports and well-connected transport systems hard. Rural areas, whose citizens were less likely to have been in contact with someone from initial hotpots like China or Italy, fared relatively better. Over time, as movement between places returned to pre-pandemic levels, the virus sought and found susceptible victims amongst the populace in rural areas and tier-2 and tier-3 cities.

But economic divides can help us interpret the renewed outbreaks in big cities too. During the first wave, the virus spread freely in slums and less affluent neighborhoods where social distancing or working-from-home were difficult to implement. These demographics were hit hard but those that didn’t die at least developed antibodies. The better off, meanwhile, could afford to be cooped in their homes and apartments and wait the lockdown out. During the second wave, on the contrary, everybody is out and about and the virus has found an audience (so to speak) even amongst the well-to-do.

 

Mortality

One silver lining with the second wave is its relatively less mortality vis-a-vis last year. (Well, at least so far.)

The drop in the mortality rate may be explained thus:

  • Newer variants may be more infectious but less lethal.
  • This time around, the country’s health systems are better prepared. Mildly symptomatic cases are advised home quarantine whilst severe cases are dealt with with better knowledge at hand.
  • People are still wearing masks - this may reduce the viral load entering infected people, enabling their immune systems to put up a winning fight against milder or fewer quantities of the virus (ironically akin to how a vaccine works).

 

Where Do We Go From Here?

There is light on the horizon: India’s vaccine rollout, which is among the world’s fastest. With an average daily rate of 30,93,861 vaccine doses, the cumulative number of coronavirus vaccine doses administered in the country as of April 7th crossed 8.7 crore.

However, despite vaccine optimism, there are three major concerns.

One, the inoculation drive may be curtailed due to a variety of factors. Already, Maharashtra, the worst-hit state, has sounded the alarms saying it has enough vaccines for only three more days. Meanwhile, vaccine makers like Serum Institute are struggling to manufacture enough doses to meet both domestic demand and international commitments.

Two, the proliferating variants. Both vaccines currently being administered - Covidshield and Covaxin - are reportedly effective against the UK and Brazilian variants while research is yet to be concluded on the South African variant and the Indian double mutant. Besides, newer variants may be around the corner, and there’s no saying if they'll be more dangerous or if the vaccines we have will be effective against them.

Three, in response to the second wave, some parts of the country have announced restrictions. Maharashtra has embraced lockdown lite, with public spaces barred and movement curtailed. Delhi and Punjab have announced night curfews. Many districts have declared regional lockdowns. But a full-fledged national lockdown 2.0 may not be in the offing. Not only because it beats the intentions of the first iteration but also because of the sky-high costs of such a move. (Remember - the coronavirus kills people and livelihoods, but so do lockdowns.)

Therefore, the Indian economy may be staring at a period of sporadic local lockdowns, which are no doubt not as destructive as their pan-India counterparts. But that doesn’t mean they are painless.

The current wave is expected to peak sometime this month, but if or when future waves can be expected is difficult (and perhaps impossible) to predict. Until then, stay at home as much as possible, keep your hands clean, wear a mask and maintain social distancing when you’re out and about!

FIN.
 

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