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Covid-19: Should India start opening up?

The second wave of Covid-19 infections in India is slowing down. The seven-day moving average of daily cases peaked on May 9, 2021. On May 27, this number was 56% of the peak of 392,000 cases. To be sure, the daily caseload is still much higher than what it was even at the peak of the first wave. This number was 93,617 on September 16, 2020, which is when the first wave peaked. India is also leading the pack as far as international caseload is concerned.

This brings up an important policy dilemma? Should governments start easing lockdown restrictions? Lockdowns inflict a huge collateral damage on the economic front. An Azim Premji University Study released earlier this month has estimated that a 10% decline in mobility was associated with a 7.5% decline in income. There are no easy answers to the opening up question. Sajjid Chinoy, chief India economist at JP Morgan, has argued that scars of the second wave could manifest themselves in policymakers becoming more conservative on restrictions.

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A recap of India’s trajectory of lockdowns and Covid-19 infections might throw some light on the issue.

First lockdown perhaps postponed the Covid-19 infection curve

India detected its first confirmed case of Covid-19 on January 30, 2020. The World Health Organisation (WHO) declared Covid-19 as a pandemic on March 11, 2020. The government of India imposed a nation-wide lockdown, among the most stringent in the world, from March 25, 2020. The lockdown was the most severe in the first two months. Both stringency Index from Oxford University and Google Mobility Indices corroborate this.

But it did control infections. The infection curve started rising along with mobility and peaked in mid-September. Even though infections were rising, there was no re-imposition of restrictions. Daily cases started falling from September onwards and mobility kept on increasing. This was true until February 2021. Then there was a sharp spike in cases.

Higher mobility levels might have acted as a catalyst for the second wave

The first wave of Covid-19 infections in India reached its trough on February 11. The seven-day average of daily cases was 10,988 on that date. The second wave reached its peak 87 days later. Daily cases increased by a multiple of 36 during this period. The first wave did not have such intensity. Daily cases increased by a multiple of just seven times from 87 days before the peak – the time it took for the second wave to begin and peak – to the day of the peak.

What explains the sharp spike in the daily infection curve during the second wave? Mutation of the virus could have played a role. People could have given up on practices such as use of masks and social distancing. But mobility is also likely to have played a big role. Mobility levels were much higher in the months of March and April than they were a couple of months before the peak of the first wave. So even if all things were the same – no mutation or letdown in use of masks etc. – the chances of infection spreading far and wide were significantly higher during the second wave.

The role of long-distance travel is especially important. Mobility at transit stations was significantly below overall mobility levels before the peak of the first wave due to restrictions on use of public transport. That was not the case during the second wave. This is one of the important reasons why the pandemic has proliferated to rural areas this time.

Headline case and mobility numbers vary across states

A state-wise analysis of daily cases and mobility levels shows that a decentralised approach might work better. The second wave (fourth wave in Delhi) reached its peak in Delhi on April 23, 2021 with a seven-day average of 25,294 daily cases. The number was just 1,800 on May 27, 2021. Mobility levels have not changed much. The seven-day average of Google Mobility Index was 52.5 on 23 April (peak of second wave) and it is 49.9 right now, which is lower than what it was at the peak of each of the past four waves in the city-state.

In other states, the second wave has not flattened to the extent seen in Delhi. For example, the seven-day average of daily cases is yet to sufficiently decline in major states like West Bengal, Tamil Nadu, Andhra Pradesh, and Assam to declare that the second wave has peaked in these states.

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Then there are testing issues. Delhi conducted an average of 68,067 tests in the week ending May 27, which means a testing rate of 3,309 per million people, according to projected population for March 2021. This number was just 636 per million in Rajasthan and 685 per million in West Bengal. To be sure, ranking high on tests per million alone isn’t sufficient. Kerala, for instance, has tested even more than Delhi in the past week – 3,553 per million – but the average positivity rate there was 21% compared to 3% in Delhi. This means that not enough people with infection are getting tested, so they can be isolated and stopped from spreading the infection.

What is to be done, now?

Easing of restrictions did not lead to a reversal in falling trend of Covid-19 cases after September 2020 until the second wave in March 2021. Can this be taken for granted? Everybody is being cautious. The central government advised states on Thursday to continue with restrictions on movement imposed to curb Covid-19.

Vaccination is yet to reach a critical mass. Just a little over 3% people have received both doses so far. The majority of those vaccinated are in the 60 years and above cohort, who are not very likely to venture out in any case. On May 28, Union minister Prakash Jadavekar said that India will vaccinate its entire adult population by December 2021. The best case scenario will be a synchronised opening up along with a concrete plan of vaccinations, if there is one, at the moment.

Experts say easing restrictions depends on the administration’s ability to prevent infections when people move. “It all depends on the ability of the administration to keep people from infecting each other: to what extent people are masking up, to what extent they maintain social distance, and in this period, how many people are being vaccinated,” said Dr Lalit Kant, former head of the department of epidemiology at the Indian Council of Medical Research (ICMR). “Closed places, where people would get together, sing, speak loudly – now we understand that it (the infection) can spread through aerosols — we need to be very careful,” he added.

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