For the week ended April 4, on average there were 3,206 new cases of Covid-19 across India every day, according to HT’s Covid-19 dashboard. Exactly a week before that, this number was 1,603. This means that the average rate of new infections in the country has almost doubled in the past week. Here’s why this is not a cause for immediate alarm.
The first reason is the context.
The size of the Indian Covid-19 outbreak has varied vastly over the three years of the pandemic. For instance, during the first wave (which peaked in September 2020), the seven-day average of daily cases peaked at around 94,000 infections a day, while this number came close to touching 400,000 during the brutal second wave that peaked in May 2021. During the third wave, or the Omicron wave, this number touched a peak of around 315,000.
Keeping this in mind, the 3,000 or so new cases that India has seen over the past week appear minuscule. The current outbreak only appears significant because the past two months have seen numbers that are largely negligible – in the first week of February, average daily cases dropped to under 100 for the first time since the pandemic broke.
In fact, current numbers are considerably lower than even levels seen during lulls between waves. In mid-2022, for instance, India’s average case rate jumped to around 20,000 a day, but that period was not even considered a full-blown wave.
The second reason is the evolving nature of pandemic management and the data we’ve relied on.
It has now been more than three years since India went on a nationwide lockdown on March 25, 2020, to contain what was the start of the pandemic in the country. And throughout that time, the pandemic management has evolved significantly.
At the start of the Covid-19 pandemic in early 2020, countries across the world started their battle against the outbreak by implementing strict lockdowns and travel restrictions in an effort to slow the spread of the virus. While these measures were effective then, they also had significant economic and social costs, and could obviously not be sustained in the long term. As a result, towards mid-2021, countries started shifting their energies towards other strategies – testing, contact tracing, and vaccination. Billions of people were able to resume their lives because of the onset of robust vaccines delivered at a historic pace over 2022.
But vaccines (along with relatively milder variants of the virus) have also led to a skewing of metrics that scientists the world over used to track the outbreak.
Let’s take a look at the positivity rate as an example. In the week leading to April 4, around 2.4% of the around 861,000 samples tested across India were positive for Covid-19. In the week before that, the same figure was 1.5%. When looked at in isolation, it appears to be rising fast. But what needs to be kept in mind is that the testing strategy today is very different from what it was at the start of the pandemic.
In the first two years of the outbreak, all contacts of Covid-19 patients were encouraged to get themselves tested for the virus, irrespective of whether they exhibited symptoms or not. It was with this pandemic management strategy in mind that the World Health Organization recommended that the positivity rate should be below 5%. While it was a sound strategy then, the onset of vaccination and milder variants have made it largely redundant. Now only people who exhibit clear symptoms are encouraged to get tested, thus reducing the testing numbers drastically. For instance, during the peak of the second wave, India was conducting around 3 million Covid-19 tests a day. This has dropped to around 123,000 samples tested on average in the past week (see chart).
This means that the positivity rate [the number of positives per 100 tests], will tend to be on the higher side even when there isn’t a massive spike in infections. Keeping this in mind, 2.4% of people testing positive for Covid in the past week appears rather benign as it means that only 2.4% of people who are likely exhibiting clear Covid-19 symptoms are currently returning positive for the virus.
Furthermore, there have also been improvements in the treatment of the disease. In the early days of the pandemic, as doctors grappled to treat a new disease, they had little experience with the the complications it could throw and few treatment options. However, as more data has become available and with the onset of robust vaccines, doctors have been able to develop far more effective treatments, which has drastically improved case outcomes.
This means that the low base of infections being reported right now makes the weekly case growth rate (of 100%) appear far more alarming than it is.
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