Rise in Covid-19 cases no cause for concern

Chandrakant Lahariya

Physician-Epidemiologist

THE daily new Covid-19 cases in India are showing an upward trend. This is being driven by a rise in select states, such as Delhi, Haryana and Kerala. There are a few reports of confirmed Covid cases in schoolchildren. These developments have raised some concerns and face masks have again been made mandatory in Chandigarh and some districts of Uttar Pradesh and Haryana.

Is this increase in the cases a reason for worry and the start of the fourth wave in India? Are children at risk of Covid again and should schools be moved to the hybrid mode? Should masks be made mandatory again? Let’s discuss.

The rise in Covid cases in Delhi and Haryana can largely be attributed to the removal of Covid-related restrictions and increased social mobility and travel. Most of those tested positive are asymptomatic or mild symptomatic and had got themselves tested voluntarily for travel or other reasons. There is a very marginal or no increase in hospitalisation or the need for ICU beds.

The Covid cases are at a two-year low and with the experience of last year, even a slight increase is seen with a lot of caution and alert.

However, learning from the pandemic indicates that SARS CoV-2 will stay with humanity for long. The rise and fall in Covid cases at regular intervals is going to be a normal phenomenon. But scientific and epidemiological evidence points that in any future rise, because of natural infection in the second and third waves in India and high adult vaccine coverage, the severity of infection would remain low. In this backdrop, there is no reason for an immediate worry about the increase in Covid cases.

Currently, the Omicron and its sub-lineage BA.1, BA.2 and recombinant XE (mix of BA.1 and BA.2) are circulating in India. A few confirmed cases due to XE are not a cause of worry as it is not a new variant but just a subtype of Omicron, which caused the third wave in January-February 2022 in India. Considering that India’s third wave was caused by Omicron, there is no scientific reason to believe that XE, BA.2 or another Omicron sub-lineage will cause fresh waves in the country. Since there is no new variant, this is not the start of the fourth wave in India.

The masks are proven tools in reducing Covid transmission. However, in the early part of the pandemic, when the entire population was susceptible and vaccination had not started, universal masking had clear-cut benefits. Omicron and its sub-variants have indicated that cloth masks have a limited role in the prevention of its transmission.

Now, with natural infection and vaccine-induced immunity, the risk of severe disease has drastically come down. The way we do not boil the entire overhead water tank in our house to prepare two cups of tea, we should not make face masks mandatory for everyone when the risk is differential. The new approach has to be ‘protect the vulnerable’ and mask-wearing and other Covid-appropriate behaviour (CAB) should be and continue to be voluntary. This is likely to increase willingness and adherence to the following of these behaviours by the citizens.

Government policy decisions should not be ‘knee-jerk’ but determined by a calm assessment of the situation and evidence. The current upward trend in cases is not a justification to rush to making face masks mandatory again. With the hybrid immunity in India, the societal risk is low and individual risk needs to be assessed. Therefore, a differential and voluntary approach for CAB needs to be followed. The fully vaccinated adults and all healthy children can live a normal life, the elderly and other high-risk adults should follow mask-wearing more diligently, specially in indoor and crowded spaces and when meeting non-family members. These behaviours have to be suitably adjusted to local transmission dynamics, but still be voluntary.

The children reported to have tested positive are all asymptomatic or mildly symptomatic. There is no evidence that children were infected from schools. Rather, more likely from other family members.

The successive sero-surveys have pointed out that 70-90 per cent of all children in India had already developed infection, when schools were closed. The studies have reported that children do get infection at the same rate as adults; however, most remain asymptomatic.

In this backdrop, children being tested positive is not a reason to worry or close schools. In fact, the schools should not be closed, irrespective of the increase in Covid cases in the community. The issue of a partial closure of schools should come up for discussion only if evidence emerges that children are developing severe disease or there are reports of a new variant which affects kids predominantly. In Indian states, the schools should be continued for fully offline classes.

Now, the number of the daily new Covid cases is not the right parameter to track the pandemic. Policy decisions should be taken based upon trends in clinically confirmed cases, hospitalisation and the ICU admissions. The genomic sequencing needs to be increased.

There is an urgent need to increase public communication for voluntary adherence to mask-wearing, specially by vulnerable populations. At the individual level, people need to do self-assessment of risk and follow Covid-appropriate behaviour accordingly. All those eligible should get a Covid booster shot.

There is no reason to worry and get concerned about the rise in Covid cases. The rise and fall in Covid cases will be a reality for many months ahead. This is not the start of the fourth wave, and we should continue all economic, social and educational activities without any restrictions but with individual precautions. All pandemic-related measures should be voluntary. The schools should continue to be fully open for offline classes.

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