Dinesh C Sharma

Science Commentator

The second wave of Covid-19 in India is on a steady decline after causing far greater devastation than the first one. In a few weeks, the number of new infections and mortality figures may reach levels similar to those in January. The unlocking process has begun in most states. In metropolitan cities and towns, the process has been rather swift. Industrial and commercial activities have resumed. People are flocking to malls and shopping districts in large numbers, and restaurants are reporting rising footfalls. Fruits, vegetable and other retail markets are crowded once again. Traffic on the city roads is chock-a-block like before. Metro services, too, have restarted though with occupancy limitations. Highways from metro cities leading to hill stations and other tourist destinations are reporting long traffic snarls. Barring educational institutions, bars, gyms and public parks, most activities are back to the pre-second wave level.

The situation raises some pertinent questions: Have any lessons been learnt from the experience of unlocking after the first wave? Are we committing the same mistakes and risk entering a perpetual cycle of waves and lockdowns? The answers to such questions are not encouraging at this point, for the following reasons.

First, we are unlocking the wrong way and hardly any lessons have been learnt from the experience after the first wave. The only difference is that the process of unlocking after the 2020 lockdown was national, and now it is state-wise since the duration and intensity of lockdown was left to the discretion of states based on the pandemic curve in each state.

The process of unlocking should be guided by now clearly laid-down epidemiological parameters — test positivity rate, change in cases (measured by percentage growth on a weekly basis) and oxygen/ICU bed occupancy. Data on these parameters at the district level should guide decisions relating to lockdowns and unlocking. The National Institute of Epidemiology has developed a four-level alert system for implementing control measures at the district level. It has listed activities that can be allowed and those that need to be restricted in each level. Such a calibrated approach is missing in the current phase of unlocking. In Delhi, for instance, shopping malls have been allowed to reopen while public parks remain shut ignoring the fact that ventilation is a key factor to reduce the risk of spreading Covid-19.

Second, the period of unlocking is not being used for strategically increasing the vaccination coverage. The availability of vaccines continues to be less than required, and the pace of vaccination is way below the daily target needed to achieve the goal of vaccinating all adult Indian population by December 31. Given the continued shortfall in vaccine supplies, the effort should be to vaccinate more and more people in identified districts having susceptible population groups and high transmission areas. This was not done in January-March 2021 — vaccines were allocated to states based on their population and other factors — and is not being done now. Vaccine requirements should be assessed in each city ward and at the village level for preparing micro plans. The emphasis should be on achieving coverage of fully vaccinated individuals. There is no point in touting large figures of those who have got one dose. For speedier coverage, vaccination centres should not restrict themselves to one vaccine. Both Covaxin and Covishield — and Sputnik when it is ready — should be made available at all centres.

Third, the window of opportunity before the next wave is not being fully utilised to identify and bridge critical gaps in the health system — infrastructure and manpower at all levels. Creating additional capacity for oxygen production and supply as well as ICU beds is just one aspect of preparedness at the tertiary level. We need to strengthen district hospitals and primary care facilities to ensure that big hospitals don’t get overburdened in times of an outbreak or surge. Incidents of fire were reported from many ICU wards, indicating the lack of mandatory fire testing. District hospitals don’t have paediatric ICU beds, in case children get affected in the next wave as widely speculated. Doctors and paramedical staff in government hospitals lack proper facilities for themselves and often complain of delay in getting salaries. ASHA workers — who are the backbone of the health system in rural areas — are poorly paid and are on strike in Maharashtra seeking higher wages. In May, health workers went on a day’s national strike. Doctors have been agitating over the incidence of violence against them. Along with all these concerns, hangs the question of the likely shortage of health manpower.

Fourth, India needs to learn from the pandemic surge being reported from many countries in Europe and elsewhere. The third wave has hit some countries, while others are experiencing increased hospitalisation due to the Delta variant. Amidst all this, large events like football matches and election campaigns are taking place, and tourist destinations have been thrown open. In America, masking is no more mandatory for those fully vaccinated. To facilitate travel, vaccine passports are in the offing. It would be of interest to see if countries with a substantially high number of vaccinated are able to duck the next wave. A careful study of the mistakes and successes of others, be it lockdowns, unlocking or vaccination, can help India calibrate its strategies. After all, elections are due in Uttar Pradesh, Punjab and other states early next year and political activity may begin there in a few months.

Above all, the need is for transparent and open Covid control policies, based on science and data. The pandemic is not yet over. The virus is still circulating and mutating. The Delta variant is not the last deadly one we have seen. The period of respite is an opportunity for enhancing preparedness for the future. Sustained efforts can yield results, as demonstrated twice in the recent case of cyclones where the loss of life could be minimised due to community awareness and mobilisation backed by accurate warning systems. This is the only way to break the vicious cycle of pandemic waves and lockdowns.