Covid's endemic challenges

Public health policy must respond for the long term

The massive 30 per cent jump in Covid-19 cases in 24 hours on April 13 to over 10,000 cases from 7,800-odd the day before, the highest in 223 days, is a potent reminder of the deeply infectious nature of this virus that has afflicted the world since the end of 2019. As on April 13, the health ministry has recorded 44,998 active cases. As before, Kerala, Maharashtra, Delhi, and Uttar Pradesh have recorded the heaviest case-loads, suggesting a heavy incidence of reinfection. Though the medical fraternity has underlined the mild nature of the current XBB.1.16 variant, also known as Arcturus, which is a sub-variant of Omicron, with far fewer hospitalisations or fatalities, the case to impose robust Covid protocols in public places remains compelling. Given the new virus’ ability to “escape” the immune system, it has been the primary cause of Covid among children and the elderly. Omicron, which has over 50 mutations, has been responsible for the largest surge in Covid cases since 2019 and has been designated a “variant of concern”, which means it can cause infections in those who have been vaccinated or previously infected. In that context, the government has done well to conduct mock Covid protocol drills in hospitals. The bigger question is the long-term public-health responses.

It is being argued that the surge suggests Covid is becoming endemic in India and that the number of cases will continue to rise rapidly over the next 10 or 12 days before subsiding. Even if this were correct, health administrations need to stay on high alert. If Covid is here to stay, the government urgently needs to consider a permanent strategy rather than one-off diktats to deal with the virus. Given India’s congested cities and the high proportion of diabetic and heart patients and undernourished people in the country, the population’s vulnerability to the virus will always be high. Reinfections, even if not fatal, can progressively weaken immune and respiratory systems. These imply undesirable public-health outcomes with implications of economic prospects.

There are several easy steps that could work towards minimising propagation. For instance, it is worth noting that this surge in case-loads is on account of greater testing, highlighting a strong case for mandatory testing for any patient showing flu-like symptoms. Since a large proportion of the population will likely lack the ability to pay for such tests, free or subsidised testing facilities could be made available at public-health centres for poorer patients. At the same time, the burden of medical opinion weighs towards advising those who are eligible for Covid boosters to take them as an added layer of protection. Though the medical jury in India is still out on the wisdom of a fourth booster dose, a large number of Indians, especially from the economically weaker sections, are yet to take the third dose. Identifying and vaccinating these cohorts should be undertaken on an urgent footing, and should not be a challenge, given the Aadhaar linkages to vaccination certificates. At the very minimum, masking in public places should be made mandatory. In short, the mildness of the variant should not be cause for relaxation in public-health protocols.