2022: When India learnt to live with Covid as the virus eased its grip

The health sector returned to the old normal; the advice for 2023 is 'watchfulness and appropriate response'

India scored high in tackling the spread of the Covid-19 virus amongst its population in 2022, but experts caution that it’s not the time to let one’s guard down. “Watchfulness and appropriate response” would hold the key to 2023, they say. That’s because while India seems to be managing the Covid-19 situation well, several countries across the world, including China, Japan and South Korea, are struggling against a massive surge in fresh cases, with increased hospitalisations and deaths. 

The year began with a roaring third wave of infections as the highly transmissible Omicron variant replaced the Delta strain. From a peak of close to 350,000 daily fresh cases in the third week of January, the count has dropped to around 150-200 now. In comparison, a million deaths are estimated in China alone.

Taking a proactive approach, the government ran a mock drill across Covid-19 facilities on December 27 to assess preparedness. It has also mandated random testing of 2 per cent international arrivals. Mandatory pre-departure RT-PCR tests for people arriving in India from China, Hong Kong, Japan, South Korea, Singapore and Thailand will also begin from January 1, 2023. 

That’s the latest situation, after months of the return to the ‘old normal’ – the high point of 2022. Experts say that as long as Omicron and its sub-variants are in circulation, there’s not much to worry about. As senior virologist Jacob John puts it: “We are keeping a watch, and it's necessary to do so. Omicron and its sub-variants are the dominant strains globally. It is not causing severe hypoxia.”
 

He agrees that India let the virus run free among its population, and thus most of its citizens now have hybrid immunity from the virus and the infection.
 

India hit the two-billion vaccine dose milestone in July and has given at least one dose of the Covid-19 vaccine to practically its entire eligible population. However, the country lags in booster dose coverage. Till the end of November, India had covered around 27 per cent of its eligible population as against the world average of 33 per cent. The US and EU have over 45 per cent coverage for booster doses.
 

Gagandeep Kang, microbiologist and professor at Christian Medical College, Vellore, says, “We got lucky with Omicron being a relatively mild disease and in having had our population well vaccinated by the start of 2022.” She adds that India pushed vaccination to high levels right. “What India got wrong was keeping schools closed for far too long,” she says.
 

“Watchfulness and appropriate response” is key, in India and elsewhere, Kang adds.
 

There was, however, a flip side of the entire public health infrastructure going on an overdrive to tame the pandemic: the focus shifted from other infectious diseases. The measles outbreak in different parts of the country is an indication of missed routine vaccine doses during the pandemic.
 

Thus, experts feel that it is time to consolidate our surveillance systems, but at the same time also work on a pandemic policy for the future.
 

Anish T S, associate professor of community medicine at Government Medical College, Manjeri in Kerala, says, “The next pandemic could be in 25 or 30 years – no one knows. It could even be a bacterial pandemic, and that could be more difficult to handle, as we cannot make vaccines easily for bacteria and many antibiotics don’t work against drug-resistant bacteria.”

‘Old normal’ at hospitals
 

Year 2022 has also been one of many firsts for the Indian pharma industry. Among others, the country got its first and the world’s second intranasal vaccine from Bharat Biotech; a temperature-stable, indigenously developed mRNA vaccine from Gennova Biopharmaceuticals; it kickstarted projects to develop pan-coronavirus vaccines; and indigenously developed the first HPV vaccine from Serum Institute of India.
 

Vaccine makers, who emerged heroes of 2021, have now largely moved away from Covid-19 vaccines. As the CEO of a leading vaccine firm put it, “Covid-19 vaccines are no longer a ‘hot’ opportunity unless the virus mutates into a form that again causes serious disease.” He adds that even exports are not a great opportunity anymore. “Africa has started believing that it has developed infection-led immunity, and these nations are not keen to receive millions of doses anymore,” he said, requesting not to be named.
 

Drug firms, too, have adjusted their strategies accordingly – refocusing on chronic ailments, and chasing the off-patent opportunities in cardiac and diabetic therapies. Most of them had to write off their Covid-19 drug inventories by the beginning of the first quarter of 2022-23.
 

Also, most of the excess capacity created to cater to Covid requirements by local medical device players is either lying idle or is now being re-deployed. The same is true of the excess oxygen capacity created – India had ramped up its liquid medical oxygen and pressure swing adsorption (PSA) plants by almost 20-fold during 2020 and 2021. Right before the Omicron wave, India had an overall oxygen capacity of 20,000 tonnes per day – the country now uses only 1,200-1,300 tonnes per day.

At hospitals, meanwhile, pent-up demand for elective surgeries is back and so are overseas medical tourists.
 

“In retrospect, 2022 was a mixed bag for the hospital sector,” says Dilip Jose, MD and CEO of Manipal Hospitals. “The year began with us being in the grip of the Omicron spike. However, once the third wave eased, there was a rapid bounceback. especially from April-May onwards that saw many such postponed instances accessing care.”

International patients, too, started returning to the country, and now as we stand at the end of 2022, the number of such patients is at pre-Covid levels or even higher, Jose says.

For India and its healthcare sector, it has clearly been a year of returning to the ‘old normal’ – with an eye on global developments.