Step up testing, tracing and genomic analysis

The Centre did well to allow Covid-19 vaccination for everybody above the age of 45 years from April 1. This can help mop up vaccines available for inoculation in the existing distribution set-up in greater numbers; for various reasons, including inefficiency of the distribution channels, there has been significant wastage. The more efficient solution would have been to allow sale in the open market, but, pending that, the dropping of the ‘co-morbidities only’ criterion for the 45-59 years age group is welcome. That said, the government needs to pay heed to what Dr Devi Shetty of Narayana Hrudayalaya has called for, in the pages of The Times of India; he has urged the Centre to allow vaccination for the 20-45 year age group as well, terming them ‘super-spreaders’—likely talking of the higher mobility exhibited by this group. The detection by the INSACOG (a grouping of 10 laboratories in the country that are carrying out genomic sequencing and analysis of circulating SARS CoV-2 strains) of 771 variants of concern (VoCs), including a novel double-mutation variant, the UK, South African and Brazilian variants, as well as the variants that had been circulating earlier in the country, makes increasing vaccine coverage an imperative. While the INSACOG maintains that none of the VoCs have been detected in sufficient enough numbers “to either establish a direct relationship (with) or explain the rapid increase in cases in some of the states”, India must preempt this since many variants are known to show increased infectivity. Increased vaccination will prevent the spread of strains against which the vaccines are effective—Punjab has reported 81% incidence of the UK strain, against which Covaxin has been shown to be effective, in 401 samples from new cases. This will also prevent evolution of new strains in immuno-compromised people.

While a Telangana needs to get its act together on vaccination-pace—on March 23, the seven-day rolling average of vaccine doses administered per 100 people in India stood at 0.16 versus the UK’s 0.88 and the US’s 0.75—states also must intensify testing and contact tracing efforts. It is therefore a big positive that, over the past 10 days, the daily testing has gone up considerably even as positivity rate has been near constant. However, this progress is not uniform—for perspective, in Haridwar, Uttarakhand, where the Kumbh Mela is to start mid-next month, nearly 75% of the tests conducted are rapid antigen tests, which have a higher chance of returning a false negative result. The Centre has done well to advise states to ensure at least 70% of their testing is accounted for by the higher-accuracy RT-PCR. States have also dropped the ball on contact-tracing—while Punjab, which the Centre has termed ‘a state of grave concern’, was tracing only as many as 15.5 contacts per positive case two weeks back, its health authorities had urged district administrations to trace at least 10. Close to a third of its districts couldn’t even match this minimum standard. The Centre, on its part, needs to step on the gas on getting people to use the Aarogya Setu; while there were roughly 70 crore smartphone users in India in 2020, the app has seen only 17 crore downloads.

With VoCs detected in 18 states, the pool of genomic analysis needs to be widened to stay on top of VoC spread. Given how many of them can also escape the immune system, a possible second wave in the country will only get exacerbated if a significant number of cases can’t be prevented by increasing vaccine cover; the threat of vaccines proving a weak shield because of rapid spread of VoCs also needs to be borne in mind.