Time to re-examine Covid response strategies

THERE is sufficient epidemiological evidence to argue that the ongoing Covid-19 wave in China is unlikely to trigger a fourth wave in India. The risk is not zero, but very close to negligible. In India, the authorities have held several national and state-level meetings and mock drills, which, inadvertently, fuelled rumours about the imposition of Covid restrictions. In a few states and cities, commercial establishments such as hotels and restaurants (mostly on their own and in some cases after informal instructions from the local administration) have imposed the older Covid instructions and started requesting citizens to wear face masks and maintain social distancing.

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All of this has resulted in panic and apprehensions among the citizens. People have started asking questions: Should they be wearing a face mask? Should they get a booster shot? Do they need a fourth shot? Should they go ahead or cancel a long-planned family trip?

First of all, as the world is in the middle of a pandemic, a surge in any country demands that the governments of other nations monitor the situation and be vigilant. The high-level meetings and mock drills in India are part of the standard operating procedure and should not be a reason to get worried. The wave in China has not altered anything in India; government and private establishments should refrain from enforcing past Covid guidelines. In fact, we need to remember that the situation in China is the outcome of its aggressive zero-Covid policy, which clearly did not work.

In settings such as India, which has attained hybrid immunity through natural infection and vaccination, there is almost no role of old approaches such as mask mandates, universal testing or that of enforced physical distancing or any form of restriction on public activities.

Three years after the first reports of SARS-CoV-2, the response should be guided by science, informed by evidence, modulated by the learnings from the past and need to be nuanced and setting-specific.

What should the governments do? The Central Government needs to constantly monitor the Covid situation in China and other countries. It needs to run awareness and communication campaigns to dispel rumours and misinformation. Both Central and state governments should increase wastewater genomic surveillance and review the clinical outcomes in confirmed Covid cases to pick up any change in the trends. Daily new Covid-19 cases are not a good parameter, at this point, as the testing is likely to increase, so the confirmed cases may go up. Hospitalisation due to Covid-19 should be used as a parameter of the trends.

For common citizens, there is nothing to worry about. Regarding wearing a mask — make a personal assessment and decision. You can go on your planned national or international travel without any hesitation. However, for travel outside India, a face mask would be a helpful companion, in accordance with the local level of transmission.

All those eligible should get a precaution or booster shot at the earliest possible. Now as there are vaccines available, a heterologous booster shot, which provides better immune response, can be preferred. Those who have already received two primary shots and one precaution shot do not need a fourth dose. In fact, most countries across the world are not recommending a fourth shot. Irrespective of the time elapsed since the third shot, a fourth dose of Covid-19 vaccine is not recommended in India for any age group.

A new nasal Covid-19 vaccine has been given emergency use authorisation in India as a precaution or booster shot. This would be available from January 2023. Please remember that this is recommended only for the third or booster shot. The nasal vaccine is not for the fourth shot.

Children younger than 12 years do not need a Covid vaccine. Only two shots are recommended for children aged between 12 and 17 years; a third or precaution shot is not needed for this age group. Children were and are at very low risk of Covid infection. Therefore, physical/offline schools for children of all age groups should continue.

Covid has not gone and it is unlikely to go away in future, either. However, the risk of moderate to severe infection is at the lowest possible (with the caveat of unknown probability of an emergence of a clinically significant new variant). Staying healthy, getting treatment for any chronic illness and taking basic preventive health measures will protect you from Covid illness.

The ongoing Covid-19 wave in China, majorly driven by BF.7 Omicron sub-variant, is likely to be over in the next few weeks. It is very likely that with the end of the current wave in China, the world may reach the endemic phase of Covid. However, considering that the SARS-CoV-2 would stay with humans for long, there might be fresh Covid waves and spikes (localised or nationwide) at regular but unpredictable intervals in different parts of the world.

Therefore, all countries, including India, should be prepared for such eventuality. Rather than panicking every time a wave is reported from another country, a calm, considered and evidence-guided approach is required.

It is time for the Indian Government to re-examine the strategies used for the Covid response in the last three years. India needs to develop an evidence-informed ‘Covid-19 endemic response strategy and plan’.