India is still a few weeks away from a nationwide peak, as the virus continues to spread in rural areas and smaller cities, according to doctors and public-health experts, who also warn that daily hospitalizations and deaths will likely continue climbing even as infections slow down.
Even so, they say the early signs point to a less severe wave than last year’s, when India’s hospitals ran out of beds, oxygen and medical supplies, leaving many people to die at home, and forcing crematoriums to work around the clock.
In New Delhi—India’s second biggest city—new cases have dropped for five days straight after hitting a high of 28,867 last Thursday. In Mumbai, the financial capital and most populous city, 6,149 new daily infections were reported on Tuesday, after a peak of 20,971 cases on Jan. 7. Officials in both cities say that about 80% of hospital beds are empty.
A swift decline of cases following a huge surge is a pattern seen with the Omicron variant in other countries such as South Africa, epidemiologists say. But they are watching India especially closely because of its large population, its relatively low vaccination rate and the severity of last year’s wave—factors which led public-health experts to warn the country’s hospitals could be overwhelmed by Omicron.
“The virus is meeting up with a whole population of people already previously infected and immune or vaccinated and immune,” said T. Jacob John, a retired professor of virology at the Christian Medical College in India’s southern city of Vellore. “That adds to the mildness of the disease.”
Gautam Menon, professor of physics and biology at Ashoka University, said his modeling shows that all parts of India will peak by Feb. 10. Given the low rates of testing, the model has assumed that actual infections are 15 times higher than the official tally—although it is possible the true count could be 20 to 25 times, he said.
“Overall, the impact of Omicron on India has been milder” compared with last year, he said. “That’s something really to celebrate.”
Delhi and Mumbai were ravaged by the wave last April and May. Now, about 97% of Delhi residents and 87% of Mumbai residents have antibodies against Covid-19, which could be a result of prior infections or vaccinations, according to government serological surveys. Both cities have a higher portion of their population fully vaccinated compared with the nationwide rate of 47.7%.
The Ministry of Health and Family Welfare didn’t respond to a request for comment.
Doctors in India have reported that recent Covid-19 patients are generally less-severely ill than during last year’s wave—in line with some early studies indicating that Omicron cases tend to be milder than the Delta variant.
Public-health experts warn it is too early to say India is over the worst of Omicron, noting that hundreds of millions of children are ineligible for vaccination, and that the elderly and immunocompromised remain vulnerable. Even if a fraction of India’s nearly 1.4 billion people fall seriously ill, its hospitals could still be overwhelmed, they say.
They also point out that daily hospitalizations and deaths are better indicators of the variant’s seriousness. On Wednesday, India reported 441 deaths from Covid-19 in the last 24 hours, an increase over recent days but down from 534 on Jan 5. That is still far below the second wave, when the official tally recorded deaths reaching almost 4,500 a day in May. Hospitalizations are also about 75% lower than last year, said Lalit Kant, former head of the Division of Epidemiology and Communicable Diseases at the Indian Council of Medical Research.
“The wave arrives first and recedes first in metropolitans,” said
K. Srinath Reddy,
president of Public Health Foundation of India. “A peak in Delhi and Mumbai doesn’t mean an end of the third wave in India.”
R.K. Mani, director of clinical services at Yashoda Super Specialty Hospital in a suburb of Delhi, said the hospital is now admitting about 10 patients a day, up from two daily two weeks ago. “We can’t jump to the conclusion that all is benign,” he said.
But Covid-19 patients who died in recent weeks all had underlying health conditions like cancer, and most others had relatively mild symptoms like blocked noses, sore throats and low fevers, he said. Many can be discharged after five days, compared with at least 10 days last year.
Other important indicators in determining the peak are the positivity rate—the percentage of Covid-19 tests that are positive—and the reproduction rate of the virus, which is the number of people a single contagious person can infect.
The reproduction rate nearly halved to 2.2 in the week ended Jan. 13 compared with the first week of 2022, according to a study by the Indian Institute of Technology Madras.
The national positivity rate also fell slightly to 15.13% on Wednesday after reaching nearly 20% on Monday. Both Delhi and Mumbai have reported dropping positivity rates in recent days.
But pinpointing the timing of the peak is complicated by a lack of testing data, as most people are now testing at home, and results might not be registered in the official database, said Arun K. Sharma, director of the National Institute for Implementation Research on Noncommunicable Diseases in India’s western city of Jodhpur.
“The time of the peak will be difficult to determine since we are not testing, tracking and tracing enough,” he said. “If the decline continues for a week, then we can say we are close to the peak.”
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