A motorist passes by a mural of frontline workers against coronavirus at RK Puram in New Delhi on July 25. (Sanchit Khanna / HT Photo)
A motorist passes by a mural of frontline workers against coronavirus at RK Puram in New Delhi on July 25. (Sanchit Khanna / HT Photo)

What led to a dramatic fall in Covid-19 cases in India? Experts debate

In whatever direction India has moved, it is clear that the country's once sinking health care system has reported grasp over the disease as reports of burdened and overstretched hospitals have not surfaced from any part of the country.
By hindustantimes.com | Written by Arpan Rai
UPDATED ON FEB 16, 2021 01:43 PM IST

The trajectory of coronavirus disease (Covid-19) cases in India has left open a gamut of theories for experts. What seemed like an inevitable escalation in the cases, rising at a pace quick enough to overtake the United States, fizzled out within three months and displayed India as an interesting case study.

Are the natural factors like innate human immunity and the country's topography at play or did the stringent measures of compulsory use of mask and hefty fines for breaking the rule prevent deaths from Covid-19 large scale? Or has the urban India secured herd immunity which is controlling the tally from again touching a red mark?

In whatever direction India has moved, it is clear that the country's once sinking health care system has reported a grasp over the disease as reports of burdened and overstretched hospitals have not surfaced from any part of the country.

Daily new cases being reported in India at present are only around 12% of the country’s peak. India has so far not seen a second wave of infections, unlike most other big countries. New cases in the US stopped dropping after the first wave when the new cases were 64% of the first peak (and the second wave began).

Among the top explanations lies - preexisting immunity from previous similar viral infections.

Experts suggest that Indians may have some preexisting protection from the virus.

Dr Daksha Shah, a government epidemiologist explained NPR how Malaria, typhoid, dengue fever are all endemic in India. "People with robust immune systems are more likely to survive here in the first place, Shah said.

Also read | Covid-19: Why India is on the right track now

"Plus, more than half of the population is under age 25. They're less likely to die of Covid-19 and more likely to get it asymptomatically," Shah said.

“If the Covid virus can be controlled in the nose and throat, before it reaches the lungs, it doesn’t become as serious. Innate immunity works at this level, by trying to reduce the viral infection and stop it from getting to the lungs,” said Jameel, of Ashoka University.

This is especially true because new research suggests that people who got sick with one form of the virus may be able to get infected again with a new version. For instance, Vineeta Bal, who studies immune systems at India’s National Institute of Immunology, pointed to a recent survey in Manaus, Brazil, that estimated that over 75% of people there had antibodies for the virus in October — before cases surged again in January.

India's infections began to plummet in September, shortly after India was witnessing a crippling surge in cases, as people feared the toll it was taking on the country's economy. Now, the country is reporting about 11,000 new cases a day, compared to a peak of nearly 100,000.

The second explanation by the experts points towards a dubious herd immunity claim. Some large areas have reached herd immunity — the threshold at which enough people have developed immunity to the virus, by falling sick or being vaccinated, that the spread begins to slacken, Bal said.

However, even if herd immunity in some places is partially responsible for the decline, the vast Indian population as a whole remains vulnerable — and must continue to take precautions.

Also read: The Covid-19 story across the country’s districts

“If we don’t know the reason, you could unknowingly be doing things that could lead to a flare-up,” said Dr. Shahid Jameel, who studies viruses at India’s Ashoka University told Associated Press.

The progress in combating the viral contagion in India has been worthy of study by experts to help other countries determine the methodology for bringing the cases down.

India has reported nearly 11 million cases and over 155,000 deaths. Some 2.4 million people have died worldwide.

Soon after the disease spread, India moved swiftly to bring a lockdown in place. The streets ran empty and markets once bustling with people were left deserted for weeks, except the essential stores for helping people stock up on ration.

The cases didn't go down. Only increased.

So in consultation with medical fraternity and experts, the government made the mask mandatory for people.

A report by NPR quoted health policy expert Genevie Fernandes who said mask mandates are one of the things that may have helped bring down India's Covid-19 caseload. The worst-affected states like Maharashtra, Gujarat, Karnataka, Delhi among several displayed stringency in asking people to wear masks whenever they step outside. Non-compliance with the instruction carried a hefty fine.

"...In this particular case, the police, the monitoring, enforcement, that was ramped up. Every time they fine a person 200 rupees, they also give them a mask to wear," Fernandes told NPR.

But experts have noted the situation is more complicated since the decline is uniform even though mask compliance is flagging in some areas.

Could India be underreporting the cases? Or manipulating the death toll?

The Associated Press stated that India, like other countries, misses many infections, and there are questions about how it’s counting virus deaths. But the strain on the country's hospitals has also declined in recent weeks, a further indication the virus's spread is slowing.

When recorded cases crossed 9 million in November, official figures showed nearly 90% of all critical care beds with ventilators in New Delhi were full. On Thursday, 16% of these beds were occupied.

That success can't be attributed to vaccinations since India only began administering shots in January — but as more people get a vaccine, the outlook should look even better, though experts are also concerned about variants identified in many countries that appear to be more contagious and render some treatments and vaccines less effective.

According to the serosurvey - a nationwide screening for antibodies by Indian health agencies - estimated that about 270 million, or one in five Indians, had been infected by the virus before vaccinations started — that’s far below the rate of 70% or higher that experts say might be the threshold for the coronavirus, though even that is not certain.

“The message is that a large proportion of the population remains vulnerable,” said Dr. Balram Bhargava, Indian Council of Medical Research chief said.

The urban city sphere versus rural hinterlands diagnosis by the experts tells an interesting tale, backing the plummeting cases with reason.

The screening showed that more people had been infected in India’s cities than in its villages, and that the virus was moving more slowly through the rural hinterland.

“Rural areas have lesser crowd density, people work in open spaces more and homes are much more ventilated,” said Dr. K. Srinath Reddy, president of the Public Health Foundation of India told Associated Press.

If some urban areas are moving closer to herd immunity — wherever that threshold lies — and are also limiting transmission through masks and physical distancing and thus are seeing falling cases, then maybe the low speed at which the virus is passing through rural India can help explain sinking numbers, suggested Reddy.

With the reasons behind India's success unclear, experts are concerned that people will let down their guard. Large parts of India have already returned to normal life. In many cities, markets are heaving, roads are crowded and restaurants nearly full.

Can this spark another slew of infections and mark the virus' return? Will India's second return because of the country's own lack of learning? The above-stated factors will be able to explain better.

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