MUMBAI: After three years into the worst-ever pandemic since the Spanish Flu of 1919-1921, we are in a comfortable position to rejoice in freedom from the Covid pandemic, orchestrated by the SARS-CoV-2 virus. With weekly Covid numbers hovering below 1,500 and average daily Covid deaths at 3, India is in a comfortable position to declare Covid as an endemic and say goodbye to the pandemic. Covid now is just like a seasonal flu. I have no other disclosures than my national interest, guided by public health knowledge, in saying so.
India remained unaffected by BF.7 (China and the East) or BQ.1, BQ.1.1 (USA and the West)—both are sub-lineages of the Omicron sub-variant BA.5. It will continue to be so, as ever since Omicron entered India, it became a Variant of Support (VoS), rather than a Variant of Concern (VoC). India’s BA.2 and its sub-lineage XBB, a
recombinant of BA.2.10.1 and BA.2.75, did not allow entry to BA.5 or its sub-lineages. Conversely, countries affected by Omicron’s BA.1, BA.4 and BA.5 sub-variants allowed entry to BA.2 and its sub-lineage XBB.
The credit for India’s uniquely safer position goes to our excellent Covid management strategies, natural infection among over 90% of the population and excellent vaccination coverage with potent vaccines. We are a nation with highest percentage of hybrid immunity. A Malaysian study compared deaths among breakthrough infections following Astra-Zeneca (Covishield in India), Pfizer mRNA (USA) and Sinovac (China). For one death after Astra-Zeneca, there were 2.5 with Pfizer, and 9.5 with Sinovac. This proved supremacy of Covishied that dominated vaccination in India with 90% of 220 crore doses used. Similarly, the longevity of vaccine efficacy is over 10 months with Covishield, double than that of mRNA vaccines.
As everyone, we too were ignorant on how to handle the pandemic and looked to the east and to the west for guidance as well as help. Having realised that we would have to fend for ourselves, India undertook massive capacity-building exercises. Not only did we succeed to overcome the shortages in armamentarium to confront the pandemic, but Covid-19 has helped position India as a powerful and formidable country. Amazingly, our country under Prime Minister Narendra Modi has vanquished the pandemic and proved to the world how an adversary has been turned into an opportunity and that is despite the worst ever phase of morbidity and mortality during the Delta-wave when we lost 5 million lives. Not only we look after ourselves but helped several countries globally with our “Vaccine-Maitri” initiative.
In 2020, we said, “look to the east and do our best”. In 2021 we modified it to “look to the west and do our best”. But in 2022 we zeroed down to “look to the east, look to the west, but India is the best”. It is time to reassert India’s authority and supremacy in tackling the pandemic and not get distracted by what is happening in China or elsewhere.
Barring a few instances, all along the pandemic science, sanity and support of people prevailed, and India always overcomes scaremongering with a short passage of time, compared to elsewhere. Our vaccine hesitancy was lowest globally. People cooperated with the authorities without much outrage that we noticed elsewhere.
Surprisingly, a well-intentioned letter of 20 December 2022, from the Union Health Secretary, meant for internal circulation among top health officials at the Centre and the States, seeking preparedness and heightened genome sequencing went viral, playing a spoilsport. Several contradictory health advisories followed, fuelling several scary opinions and predictions of even BF.7-driven fourth wave, giving a 40-day timeline. We are thus faced with a pandemic of guidelines and confusion, not Covid. Creating panic is the task of our enemies; let us not become our own enemies and create scaremongering based on hypothetical situations. Let us be guided by science and real-life situations and learn lessons from the recent past when certain “National Covid Projection Council or SUTRA model” had even given a date of 21 June 2022 for the fourth wave peak after its previous faux-pass with its dangerous advice to the government that the second wave was not forthcoming just prior to the Delta-wave in April 2022.
Current travel restrictions are futile and ground realities also proved that there is no let-up in Covid cases in last two weeks. The current Covid Test Positivity Rate (TPR) remains abysmally low at 0.1%. Even the random testing deployed at airports has yielded less than 1% positivity.
By subjecting fully vaccinated Indians to take an RT-PCR test amounts to doubting efficacy of our vaccines. Anyone vaccinated in India or with India-approved vaccines should be spared of RT-PCR, as has been the practice over the last several months. Respecting vaccination certificates will bring faith in the vaccines and reduce the relative vaccine hesitancy. It will end unscrupulous practices. It is important to relieve people from unnecessary distress and undue financial burden as people are being fleeced in different countries, with RT-PCR being charged up to Rs 15,000. People are forced to shell out a bomb even to file an Air Suvidha form at several airports globally. People guiding the health ministry have no idea how people suffer due to their whimsical non-scientific advices. Many of them may not have seen a single Covid case. This warrants the Health Ministry and states to revamp Covid-related committees and downsize them, as some of the members have scant public health expertise.
Highly technical agencies like INSACOG, that scared people with detection of India’s first case of Omicron’s XBB.1.5 sub-variant, shouldn’t hurry to ring the alarm bell on every development in the laboratory without carrying out appropriate studies in our population.
Severe travel restrictions are no more considered useful in arresting the spread of Covid-19 infections and are in fact detrimental to the economy and development. Science, sanity and support to the people should prevail over scaremongering.
Akin to Seebeck’s principle, we should “see back and move forward” comparing different timelines for our right and wrong policies. What is required now?
1. Though we are in the safe zone, knowing the erratic behaviour of SARS-CoV-2, it is prudent to take precautionary measures like using the mask in overcrowded public places.
2. Those eligible, should take the booster dose in their interest and in the interest of their aged relatives. It may become the prerequisite for travel soon. Free booster for the 18-59 age bracket is back in India, with even intra-nasal vaccine on CoWin app.
3. Do not panic and do not forward scary messages, a fresh Covid-wave is not round the corner. We are practically in the endemic stage and we will be the first nation if we announce the same.
4. Focus on possible solutions and not problems vis-à-vis the current Covid scenario in China or elsewhere. India should offer help to China with its Covid-management protocol, Covid vaccines expanding its Vaccine-Maitri and medicines including generic Paxlovid. This will make its stature taller whether or not China accepts our help.
5. Reverse travel restrictions and spare vaccinated people from pre-boarding RT-PCR tests. It is prudent to exempt those who have taken the booster.
6. It’s time to make testing only targeted for symptomatic patients. Whole genome sequencing and pandemic preparedness should continue. Unless and until a totally new variant comes that is equal to more potent than Delta, we have nothing to worry.
7. Our focus should continue to remain on those health problems that are prevalent, to avoid any more collateral damage. We lost 5 lakh people to tuberculosis alone during 2021, as opposed to 5 lakh to Covid in three years.
Dr Ishwar Gilada is Consultant in HIV and Infectious Diseases, www.UnisonMedicare.com; Secretary General, Organised Medicine Academic Guild (OMAG); President, AIDS Society of India (ASI); and Governing Council Member, International AIDS Society (IAS); email@example.com