Is India prepared for Omicron?
MANY INDIANS would have loved to slam the door on 2021 with a loud bang of good riddance. Instead, celebrations for this new year proved muted. As the highly contagious Omicron variant of covid-19 started spreading in late December police in Mumbai, the country’s commercial hub, banned public gatherings. Half a dozen states, along with Delhi, the national capital, ordered night curfews. But it was not just government-imposed social distancing that dampened revelry. Barely seven months have passed since a ferocious wave of the Delta variant. Covid has left some 5m Indians dead, according to The Economist’s excess-death tracker (see chart 1), the world’s highest toll. Memories of loved ones gasping for breath, of overwhelmed hospitals turning away the dying and of the choking stench of mass cremations remain all too sharp. It was fear of a reprise of such terrors, more than fear of police lathis, that kept fireworks dry.There is no doubt that India is in for another massive wave. Paul Kattuman of Cambridge University, one of the creators of an India covid tracker that correctly predicted last year’s peak, describes the current growth trend as “super-exponential”. The reproduction rate of the virus, or R, which largely remained below the replacement level of 1.0 since last June, has since mid-December ticked inexorably upward, reaching 1.37 on January 1st. In the same period the national tally of daily cases quadrupled to just over 27,000. That is still a far cry from the 400,000 new cases a day reported when the second wave crested last May, but it is a matter of time before India scales this height again, and this is likely to be far below the true number. Systemic undercounting of cases and a pattern of spread from big cities mean that a better measure may be the proportion of PCR tests returning positive results. During last year’s peak this briefly topped 25% across India, but by December 27th had fallen to a low of 0.5%. In the days since, test positivity in Mumbai has shot up to 17% (see chart 2). In Kolkata, India’s third-biggest city, it has also passed 12%. In both Mumbai and Delhi (where positivity is also surging), Omicron is already the dominant strain. However ominous the new wave, India is now much better prepared. Last April the country’s vaccination campaign had scarcely begun; now, with around 1.45bn doses delivered, 44% of the population has been double-jabbed. Millions more have gained some resistance due to previous infection. A national sero-survey conducted in June and July found that 68% already carried covid antibodies. More recent antibody surveys revealed even higher levels of exposure: 87% in Mumbai in August and 97% in October in Delhi. Such studies cannot tell whether the antibodies came via vaccination or via previous infection. But 80% of children in the Delhi study were found to be carrying antibodies. Since under-18s have so far not been eligible for vaccination, this suggests that exposure to the virus has been extremely widespread. In other words, despite a failure to provide booster shots—the government belatedly declared it would start supplying what it quaintly calls “precautionary doses” only on January 10th—Indians may enjoy a level of “hybrid immunity” comparable to countries with higher vaccination rates. This profile is similar to South Africa, where Omicron was first detected and where the wave is now declining. Epidemiologists are hoping that in India, too, the variant may prove to be much less deadly than was at first feared. There are other reasons for cautious optimism. India’s medical system is relatively well prepared. Last year’s nightmare provided valuable lessons. Doctors say their teams are now more efficient as well as better equipped. Disgraced by catastrophic shortfalls in medical oxygen, the government has massively ramped up supply and streamlined distribution. Dozens of hospitals now have their own production units, and the country’s overall capacity is said to have grown by 50%. The impressive network of private relief groups that sprang into action last year, providing everything from free meals to ambulance services to oxygen concentrators, is also ready for redeployment. But even as evidence grows that Omicron is indeed less likely to cause severe disease or death than other covid variants, doctors also warn of dangers. The sheer size of India’s population, combined with crowded living conditions and the prevalence of exacerbating factors such as high rates of malnutrition, diabetes and tuberculosis could still place millions at high risk. As yet unprotected by booster shots, front-line workers are particularly exposed. At the best of times India has too few doctors, and too many concentrated in big cities. Even with milder symptoms and quicker recoveries there is a danger that a flood of infections among medical staff could cripple health care. “Getting reports of more and more health-care workers testing positive,” tweets a doctor messaging from one rapidly filling covid unit. “We needed boosters much before this wave started…Nobody listens or understands.” This doctor is not the only medical professional concerned about inadequate or misguided government policy. Last year’s wave left bureaucrats and politicians red-faced. They boasted about Indian-made vaccines while failing to supply enough to Indian citizens, and dawdled over crucial needs such as oxygen or the release of data about the virus. Most egregiously Narendra Modi, the prime minister, and other top members of his party encouraged huge religious gatherings and campaigned vigorously in state elections, holding giant public rallies in spite of the obviously spreading virus. This year’s rising wave again coincides with heated election battles in several Indian states. Even as politicians ordered schools shut and shops closed, their own mass roadshows and rallies have gone ahead. Pandemic be damned, it seems: India’s political show must go on.Dig deeperAll our stories relating to the pandemic can be found on our coronavirus hub. You can also find trackers showing the global roll-out of vaccines, excess deaths by country and the virus’s spread across Europe.