By Niha Masih and Gerry Shih
NEW DELHI — Earlier this year, a catastrophic surge in coronavirus cases ripped through India, killing tens of thousands in a matter of weeks, before plunging just as sharply. But even as markets reopened and street life resumed, the virus hasn’t faded away.
In parts of India, it might even be inching back.
Just weeks after India regained its footing from its second wave, pockets of sustained transmission nationwide, including in the south, are creating ripples of concern about a resurgence. Fresh daily cases, which have sometimes edged above 40,000 and have been concentrated in the state of Kerala, are highlighting the difficulty in stamping out the highly infectious delta variant even in a country where antibody studies suggest that two-thirds of the populationhas previous exposure to the virus.
India’s experience with the delta variant, which was responsible for nearly 90 percent of cases in Mayat the peak of the second wave, offers a preview for other countries, including the United States and China, as they grapple with the stubbornly persistent variant.
In some states in India, the rate of transmission is going “in the wrong direction,” V.K. Paul, a senior health official, told reporters Tuesday. “That shows the virus wishes to expand. We must curb it with all our might.”
Public health experts and government officials have been divided about how severe India’s next surge will be and when it will arrive — if it comes at all. But they largely agree that the coronavirus is likely to continue to dog vulnerable swaths of India, and the world, until at least 80 percent of the population is vaccinated or has acquired antibodies from exposure.
The country’s genomics surveillance consortium said in July that the delta variant remains the “dominant lineage for new cases” in the country. The variant was first identified in India in 2020.
“We’re going to live with this virus whether we want it or not, because this virus is going to find a way to live with us,” said Giridhar Babu, an epidemiologist based in Bangalore at the Public Health Foundation of India. “Vaccination is the only exit strategy for this pandemic.”
Less than 10 percent of India’s population is fully vaccinated, and the country’s vaccine drive is rolling out slower than expected amid hesitancy and production woes.
Now, worrying data is beginning to resurface.
This week, researchers said the basic reproduction number, or R0, in several Indian states rose back to 1 or exceeded 1 for the first time since early May, suggesting that the rate of transmission could be re-accelerating.
The current epicenter is Kerala, a southern state that was hailed globally for its pandemic management in the first wave in 2020. The state accounted for nearly half of the 30,000 cases reported in the country on Tuesday. Neighboring Karnataka and Tamil Nadu states have ordered travelers from Kerala to present negative coronavirus tests at border checkpoints. The other area of concern is the northeast, where at least six states are reporting a positivity rate of more than 10 percent.
The delta variant is continuing to vex health officials and researchers two months after India’s case numbers touched a horrific peak in May of more than 414,000 daily cases, then suddenly dropped and stabilized at about 40,000.
Britain faced a similar drop recently, with new cases plummeting daily for a week even as its public health experts had predicted an exponential surge caused by the variant.
In India, some experts say the sharp decline was a result of Indians staying at home amid harrowing and unprecedented scenes: Entire families were infected, hospitals were overwhelmed. Patients died for want of oxygen, and bodies were cremated in parks and parking lots as crematoriums ran out of space. Others attribute the falloff to the virus exhausting itself; it infected everyone it could.
My whole family was infected in India’s devastating coronavirus surge. Not all survived.
Whatever the reason, the delta variant is lingering in India, while taking root elsewhere. In the United States, the Centers for Disease Control and Prevention warned that the variant spreads as easily as chickenpox and should be treated almost as a novel virus, according to an internal document obtained by The Washington Post.
Epidemiologists say a nationwide seroprevalence survey released in July, which checks blood samples for the presence of coronavirus antibodies, may offer clues about which regions will be susceptible. Two-thirds of the country’s population appeared to have antibodies after the spring wave, the study showed.
Kerala reported 44 percent seropositivity, the lowest among major states, while Maharashtra, a sprawling western state devastated in April, reported about 58 percent.
“Increased mobility from lockdown relaxations combined with the fact that there is a larger susceptible population will lead to more cases,” Rijo John, a health economist based in Kerala, said about the current spike in the state.
As of Tuesday, India had administered 476 million coronavirus vaccine shots, but only 105 million out of a population of nearly 1.4 billion have received both doses, according to government data. Months-long supply shortages continue to mar rollout efforts.
In Tamil Nadu, which neighbors Kerala, Senthil Karuppiah, the head of the coronavirus response at Madurai’s Rajaji Hospital, said that his hospital administered thousands of vaccine doses at its peak earlier this year, but that a constant shortage has lowered that to 500 to 800 per day, which he said is far too few.
“We can definitely do more because this is an emergency,” Karuppiah said. “We could’ve vaccinated all of the southern states in two months if we had the vaccines.”
The Indian government has shared varying numbers about India’s monthly vaccine production. But Bharati Pawar, the junior health minister, told Parliament recently that the “estimated production capacity” for the two locally produced vaccines was 147.5 million per month — much lower than the number of doses needed to achieve its target of vaccinating all adults by the end of the year. Sputnik, the Russian vaccine, is also available in the country in limited quantities.
Another lesson in India’s experience dealing with its delta wave: Infection among children isn’t likely to be severe. That has steered the conversation in India about whether to reopen elementary schools that have been shut for more than 15 months. The state of Punjab resumed in-person classes for all age groups this week.
Rajendra Bhosale, an official in the district of Ahmednagar in Maharashtra, said that in May, nearly 9,000 coronavirus cases were detectedamong children, or 10 percent of all cases. But the majority of the cases were asymptomatic, he said.
In Karnataka, people younger than 20 accounted for nearly 12 percent of the coronavirus infections in the past five months, a marginal increase from earlier, according to an analysis from the state’s coronavirus data management team. Few deaths were reported.
These numbers are on par with data shared by UNICEF on infection rates among children: Fourteen percent of all coronavirus infections in 103 countries were made up of people younger than 20. The mortality rate for the age group was less than 1 percent.
Ashish Jha, dean of the Brown University School of Public Health, who has been following the situation in India closely, said it is difficult to predict when and how the next wave will land. The delta variant appears to be so infectious that another wave can be prevented only if 80 to 90 percent of the population is vaccinated, he estimated.
Hundreds of millions of Indians have not been inoculated, Jha added.
“Much of India is still vulnerable,” he said. “That’s what keeps me awake at night when I think about the coming weeks and months.”
This article was originally published on Website: www.washingtonpost.com
Author is: Niha Masih and Gerry Shih
Mohit Rao in Bangalore contributed to this report.