Covid-19: The last thing India needs in 2021 is to repeat disasters of 2020

How we deal with the new strain of coronavirus will show whether we have learnt the right lessons from the initial response to the coronavirus

In the dying moments of the year 2019, the country office of the World Health Organization (WHO) in the People’s Republic of China was officially informed that a “pneumonia of unknown cause” was sweeping through the city of Wuhan, apparently centred on a seafood market. On January 4, the WHO first tweeted about the pneumonia, claiming that nobody had as yet died from the illness.

The year to come would be dominated by this one single event as no year has been since the last world war. And, like world wars, this one too has waves and false victories.

We are living through one of those false victories at the moment. The euphoria engendered in both the markets and among regular people by good news on vaccine development and approval obscures the fact that the pandemic is at a particularly critical stage. It has spread widely enough and found enough hosts that it has begun to throw out problematic mutations. Two are particularly concerning, from South Africa and England; both of these appear to spread more rapidly than the standard strains of the novel coronavirus.

Over the past week, some academic research has emerged on the England strain in particular. The consensus is that it raises the infection rate, or R, of the virus by between 50 and 70 per cent. This is particularly problematic, as R determines the speed of transmission of the virus. An R of one means that each infected person infects one other on average. An R above one means that cases are increasing; an R less than one means that the number of active cases is going down.

In the last week of December, India’s R was about 0.9 — reflecting the fact that the total active case numbers have been decreasing for some time. For whatever reason, in spite of the festive season and resumption of near-normal activity in many parts of the country, R has not headed back up above one. But if one of these new strains manages to replace the regular coronavirus in circulation in the country, then India’s R will shoot up to 1.4 or even higher. This would be calamitous. Remember we are talking about exponential values here; an R of 1.4 could produce a fairly steep upward curve, reminiscent of the months of July and August this year — only worse, since the temperatures are lower and the virus would survive for longer on surfaces and in the air.

The question is: Have we learned the right lessons from the initial response to the coronavirus? What we should have learned is that speed is essential. Countries like Taiwan and South Korea took the virus seriously early, in January and February of 2020, and successfully contained its spread. In India, the government was warned — including by opposition leaders — in February but even so it was not till the second week of March that it began to act seriously. I flew into India in that week, and aside from a cursory temperature check at Delhi airport, there was little or no follow-up. I quarantined myself as best I could for a week, but that was purely voluntary: There was no institutional enforcement of quarantines, even though I was flying in from areas where Covid-19 was already raging.

As a result, when the government did move, it felt the need to take draconian steps. The lockdown of late March came perhaps later than it should have, but it was the right step and properly publicised.

The fear that many countries are feeling right now is that a more infectious strain of the virus will race through still vulnerable populations even before vaccinations have a chance of taking hold.  Indian regulators have now approved the AstraZeneca vaccine, but our best guess for the standard course of that vaccine remains that it provides 60-70 per cent protection. This is good enough in normal times. But these are not normal times; if transmission goes back above R, then a vaccine with “only” 60 to 70 per cent protection will have to be rolled out much, much quicker than planned in order to have a proper protective effect. Even countries using the Pfizer and Moderna vaccines, which have a higher protection rate, have altered their rollout schedules to ensure that more people receive the first jab of the vaccine as quickly as possible.

The government must be prepared for three things. First, it must accept that a new strain of the virus might force severe lockdowns once again — locally, if not nationally. Second, track-and-trace efforts that were allowed to die down as the virus reached “community spread” levels will have to be revived, this time chasing the new strains. And finally, it will need to be transparent in terms of its monthly targets for the vaccination programme. So far it has gotten away just by talking up its expectations of India’s installed manufacturing capacity. Now it needs to give us numbers, and allow statisticians to model the interaction of the vaccination programme and the infection rate. The last thing that 2021 needs is a repeat of the disasters of 2020.