The story of India's fight against coronavirus for over a year is remarkable. On September 16 last year, India had reported a record 97,894 coronavirus cases. Fast forward to February 2, the country registered 8,635 new cases. The declining trajectory, not only of fresh cases but also of the death count due to the virus, is no flash in the pan for the simple reason that it has been sustained over the last four to five months, during which India has gradually reopened almost all areas of economic activities. The school, college and university campuses too are going to reopen soon. Go to any city and you will find restaurants, malls and markets brimming with people. Clearly, India has travelled a long way since the first case was detected in the southernmost state of Kerala on January 30 last year when a student from Wuhan, China, returned home.
As of February 7, 2020, India's total virus caseload stands at 1,08,27,314 and the death toll at 155,032. The steep fall in the number of cases and fatalities over the last five months has led to a drastic decline in hospital ICU use, so much so that hospitals in some cities including Delhi have even withdrawn the quota of beds for Covid-19 patients.
When India launched its Covid-19 vaccination programme on January 16, the world's biggest inoculation drive in a country of 1.35 billion people, with two home-manufactured vaccines—Covishield, developed by Oxford-AstraZeneca, and indigenously-developed Covaxin by Bharat Biotech—all eyes were on how such a gigantic task against a new disease would be implemented. The government put in place digital technology by setting up the portal COWIN as the nodal point for planning, implementing and monitoring the drive and creating a countrywide network of cold storages for the vaccines. Overcoming vaccine vacillations, which were largely fuelled by rumours and fears about the jabs' possible side-effects, the inoculation campaign began on a slow note but picked up speed as the days went by.
And on February 5, India became the fastest country in the world to vaccinate more than five million people—all health and other frontline workers—in just three weeks. The same milestone was reached by the US in 24 days and by Britain and Israel in 43 and 45 days respectively. India was also the fastest to race to the four-million vaccination mark. No wonder the Indian health ministry has lost no opportunity to take credit for these achievements.
What has helped people largely shed their vaccine hesitancy is the extensive media campaign about the efficacy of the jabs and their side-effects. To further drive the point home, a number of senior and eminent doctors were brought up-front to take the shots across India. A study published in a prestigious British medical journal about the efficacy and safety of Covaxin also gave a big boost to the inoculation drive. Add to this the fact that a total of 27 persons out of more than five million people vaccinated have so far been hospitalised and 0.0005 percent people needed hospitalisation against vaccinations.
There have been questions about the pace of India's vaccination drive considering its huge population and the fact that the government is aiming to inoculate an estimated 300 million people by July this year. Responding to questions from social media users, Dr NK Arora of the Indian Council of Medical Research said on February 5 that the speed, albeit the fastest in the world, "has been kept deliberately slow as the Health Ministry wanted to take stock of the hiccups and gradually iron them out." According to him, India has the capacity of immunising five to eight million people per day. After all, the country did inoculate over 17 crore children in a week several times a year during its anti-polio drive, he pointed out. However, there are concerns in certain quarters that India needs to push up the pace several times over as the falling number of active coronavirus cases should not lead to any complacency if one is to go by how the virus showed up again in Europe for a second or even third wave.
In fact, it is not only the progress of the vaccination programme but also the declining number of virus cases in most parts of the country—barring Kerala and Maharashtra, the two states that have so far defied the national trend and reported a disconcertingly much higher number of cases and fatalities—that have become subjects of discussion in the national and international media, a section of which tended to focus on the "mystery" behind the dramatic fall in number of cases. And that brings one to the challenges India faces in the battle against the virus. Is India already witnessing herd immunity against the disease? Have a sizable section of Indians already been infected by Covid-19 and developed antibodies? Has the virus mutated into a much milder form? These are questions that are coming up as India readies itself for injecting the second Covid-19 vaccine shot from February 13.
Speculation is swirling and umpteen theories have mushroomed to explain the sharp fall in Covid-19 cases. Led by Prime Minister Narendra Modi, the government had all through the last one year conducted a sustained awareness campaign through the media about Covid-19 safety protocols like washing hands, wearing masks and maintaining social distancing in crowded places. The government imposed fines for not wearing masks, and free masks were distributed.
It has also been suggested that the country's hot and humid climate proved to be unconducive to the coronavirus which requires low temperature and dry climate to flourish. It has been argued by some doctors that droplets of cough and sneeze letting out the virus remain in the air for a longer time in cold, dry climate but fall on the ground in humid and warmer air, making its spread a little more difficult. Another theory doing the rounds is that since Indians are exposed to diseases like malaria, dengue and typhoid in a less hygienic atmosphere, their immunity to Covid-19 is stronger. Some studies by scientists find that Covid-19 deaths per capita are lower in countries where people are exposed to a diverse range of microbes and bacteria. Besides, only six percent of India's population is older than 65 and over half the population is below 25 and therefore less vulnerable to the virus.
There is no unanimity about whether herd immunity can be attained when around 60 or 70 percent of the population has been vaccinated or has developed antibodies and become potentially immune to Covid-19. India's latest official serological survey—the third since the virus appeared first, made public on February 4—shows that more than one fifth of the country's population, which translates to about 270 million of the total 1.35 billion, has already been exposed to the virus with or without developing symptoms by the middle of December last year. The survey by the Indian Council of Medical Research finds the presence of antibodies in 21.4 percent of the population, up from 7.1 percent revealed by the previous survey conducted in August and just 0.7 percent in the first survey in April. Compare the figure of 270 million to India's actual confirmed Covid-19 cases of 10.8 million and it leads to the conclusion that many cases have gone unreported by individuals who opted for home quarantine and consulted family or local physicians for recovering.
A separate sero-survey conducted in Delhi found that about 56 percent of its estimated two crore population had coronavirus antibodies, said Delhi Health Minister Satyendar Jain last Tuesday. So, some experts say that although the virus will continue to spread in India, the extent of that spread may be increasingly limited.
In order to take the virus head-on, India has, according to the health ministry statistics released on February 6, registered an "unprecedented record" in the number of Covid-19 cumulative tests by crossing the figure of 20 crores (20,06,72,589). The calibrated countrywide expansion in testing infrastructure has played a crucial role in the steep rise in testing numbers. There are 2,369 testing labs in the country—1,214 in government and 1,155 private sectors.
Experts do not agree on whether those who have already had Covid-19 need vaccination. "It has been found out in India that one third of those who have contracted Covid-19 do not develop the antibodies required. And even if one does, no one knows how long those antibodies are going to protect you," according to Indian Council of Medical Research's NK Arora. Asked about the possibility of herd immunity in Delhi, he said, "nothing can be said with certainty on herd immunity and so this can't be an excuse to skip vaccination."
Pallab Bhattacharya is a special correspondent for The Daily Star. He writes from New Delhi, India.