No surge in Covid-19 cases, but vulnerable lag in full vaccination

Omicron is proving to be more resistant to vaccines than its predecessors.

Over 150 cases of the Omicron variant of the Sars-CoV-2 have been detected in India so far. However, unlike the surge seen in South Africa after detection of the more infectious variant, there is no rapid rise in Omicron cases in India yet. But we have to keep in mind that India’s population is about 20 times that of South Africa. Are there local outbreaks in the country already? More importantly, how protected is India should an outbreak occur? Apart from transmissibility, Omicron is proving to be more resistant to vaccines than its predecessors. It means at least two doses of a Covid-19 vaccine, if not a booster dose, might turn out to be a necessary tool in keeping the share of severe cases low and reducing hospitalizations. Here are four charts that explain how India is doing on these fronts.

Apart from transmissibility, Omicron is proving to be more resistant to vaccines than its predecessors. (Representational image) (Sunil Ghosh/HT photo)

Currently no surge in cases and positivity rate, even at the district level

The weekly average of daily Covid-19 cases was 7,117 on December 18, down from 8,673 on December 6 and 8,048 on December 12, and the lowest since the week ended May 31, 2020. There is, therefore, no surge in cases. However, as India is a large country, a rise in cases in one place can be offset by a larger decline in another. District data compiled by How India Lives shows that even such local outbreaks are not taking place currently. HT analysed the growth rate of cases at the district level between three dates, each two weeks apart, between November 16 and November 30, and between November 30 and December 14. The weekly average of cases grew in both fortnights for only 13 of the 707 districts for which data is available. Despite growth in cases over the past month, the seven-day average was less than 50 in all these 11 of the 13 districts. In Hyderabad and Bangalore, cases have grown and are more than 50. Last week’s average was 78 cases in Hyderabad and 187 cases in Karnataka.

Is the low number of cases because of low testing? Cumulative tests have indeed fallen since the peak of the second wave but have not caused a high positivity rate. Positivity rate averaged 0.59% nationwide in the week ended December 15. The health ministry releases a list of districts with high weekly positivity rates. 25 districts had positivity rate above 5% in the week to December 15. 15 of these were from Arunachal Pradesh, Mizoram, Nagaland and Sikkim, where cases are declining in all districts. Nine districts are from Kerala. In three of them – Pathanamthita, Kannuar and Kottayam – cases have increased in the past fortnight by 2%-10% after declining around 40%-50% the fortnight before. In Kolkata, where positivity rate was 5.9%, cases have declined 22% in the past fortnight.

Second dose coverage is still low in about a third of districts

India is, however, ill-prepared in case there is a surge. Early studies suggest the Omicron variant might be more resistant to vaccines, HT reported on December 12 (https://bit.ly/3GIeNYS). Late last week, the first real-world evidence arrived of how vaccine efficacy against symptomatic Covid-19 all but erodes in case of an infection with the Omicron variant, suggesting that boosters might be needed for those who have received Covishield jabs. This makes for speeding up full vaccination all the more necessary. 36% districts (229 of 628) are still lagging on this metric, with less than 50% adults fully vaccinated. Since official population projections are not available at the district level, HT has used the number of electors in the district at the time of the 2019 Lok Sabha elections as a proxy for the adult population.

A third of 45+ age group, half of rural India not fully vaccinated

Covid-19 vaccinations for those at 45 years and above, who are more vulnerable to severe disease and death, started on April 1, a month before those in the 18-45 years old age group began receiving jabs. Those with co-morbidities in the older age group were being jabbed even before April. Yet, 34% of the 45+ age group is not yet fully vaccinated, according to age-wise vaccination update of the health ministry on December 18. On the other hand, while there is only an eight percentage point difference in first dose coverage between the older and younger age groups, the gap in second dose coverage is wider at 17.2 percentage points. It means the young will also be vulnerable if Omicron proves to be more severe than its predecessors.

The 45+ age group needs full vaccination and possibly boosters because they are vulnerable to severe disease. Rural India, on the other hand, is vulnerable because it lacks health facilities. While scaling up health infrastructure is a time-consuming and expensive exercise, vaccinations, which have to be inevitably given to every person, can be a pre-emptive tool against catastrophes. However, this group is also not sufficiently covered with full vaccination. Only 55% of the population in rural districts is fully vaccinated, compared to 60% in mixed districts, and 73% in urban areas. Districts with the share of rural population below 40% in the 2011 census are considered urban, those with more than 60% rural population are considered rural, and the rest are considered mixed. While rural areas are indeed getting more doses per million population now than urban areas, this reversal has happened only in late October.

Past vaccination rates suggest we can speed up to cover the vulnerable

There is no reason why these vulnerable groups cannot be vaccinated at a faster rate. India administered over 236 million doses in September. In October and November, only 173 and 178 million doses were administered. While the speed in December so far looks to surpass the rate of the past two months – 135 million doses have been administered so far – it will be important to keep this rate up, possibly by reaching out to the elderly, and those in remote and rural areas.