Avoid complacency

Threat of devastating third wave is real

The number of confirmed Covid-19 infections in India has been steadily declining since a peak in early May. Many cities, including Delhi, are gradually reopening, driven in part by a fear of lost income and livelihoods. While there are sections of the country where the test positivity rate is still quite high, the average for India overall has been below 5 for most of June. It might thus be tempting to assume the second wave of the pandemic, devastating though it was, is over.

Yet India cannot afford to repeat the mistakes it made last year after reopening. In spite of a draconian national lockdown and gradual “unlocking”, by the end of 2020 most precautions had been thrown to the wind. Social distancing was barely being enforced, and mobility was almost back to pre-pandemic levels. It would be foolish to repeat that error, since that would be asking for a third wave to hit India, which might be even more overwhelming than the last. The second wave was in a large measure a product of complacency, which should not be repeated. It is also worth noting that the presence of the new and more transmissible Delta variant of the virus, which was first detected in Maharashtra, means that even measures that seemed reasonable last year to deal with the original variant must be tightened. Government, at both Union and state level, must also work to augment medical capacity and ensure that recent capacity increases are not mothballed. Mumbai did better than many other jurisdictions in the recent wave precisely because it did not shut down all its Covid facilities even when cases declined last year. Delhi’s chief minister has said that additional intensive-care and oxygen facilities will be built, in preparation for a possible third wave. Other state and local governments must do the same.

The government must also work on awareness — both of the disease, of basic counter-measures to prevent the spread of infection, and of the right therapies if an infection becomes severe. In the second wave, reporting from some rural areas suggested people were not even aware that the fever hitting their communities was Covid-19. The science of Covid-19 has also been updated over the past months, with a new understanding that surface sanitisation is less important in controlling the spread than ensuring distancing and ventilation — since the virus is more airborne than was earlier believed. High-quality masks, not simple cloth face coverings, are needed for indoors. Another problem during this past wave was the demand for medical therapies and drugs that are largely unproven and might be harmful. The Union health ministry has now released an evidence-based set of guidelines for treating the disease. Doctors and hospitals must be encouraged to follow this strictly, even if patients and their families expect otherwise.

The threat of a third wave will be removed only when vaccinations pick up. India is closing in on 250 million doses being administered, but that is a far cry from the two billion-plus that will eventually be needed. The rate of vaccination, of 3-4 million shots delivered a day, will need to be at least doubled. The priority must be to bring more vaccine supply online. Finally, despite demands for a “stimulus”, the government must recognise that the pandemic is far from over for India, and even more calls on the treasury — whether for relief or for health — can be expected. It must thus preserve fiscal firepower rather than spending it on a premature stimulus.