Once again, Maharashtra is witnessing a rise in COVID cases and the threat of another lockdown looms.
Monday, 22 February, saw 6,971 fresh COVID-19 cases and 2,417 recoveries in the last 24 hours in the state. As per the Ministry of Health and Family Welfare, the number of active cases is 54,149.
Are we in a second wave? Should we worry? We speak to virologist and former professor at the Christian Medical College, Vellore, Dr Jacob John and Maharashtra government's Technical Advisor on COVID-19, Dr Shubhash Salunkhe to break it down.
The Main Question
“The first question any epidemiologist will ask is if these are new infections - meaning in people who have never gotten infected with COVID - or reinfections in people who already had the virus.”Dr Jacob John, virologist
If it is the former, the rise could be due to a “relaxation in discipline, meaning more gatherings, not masking or maintaining hygiene,” but if it is the latter, “we must be careful and alert because this could mean a new variant has escaped from the immunity net and this may be the cause.”
We would only know this in a few days once we follow the World health Organisation’s initial maxim of ‘test, test, test!’
What’s more worrying? “Reinfections,” says Dr John. “If there are fresh infections, we must be alert as well, but it can be controlled through certain curbs. In re-infections, we have more to worry about.” We would need more tests to determine if it is a more infectious variant, the UK or South African variant or if it is an indigenous variant.
Dr Shubhash Salunke adds, “Every virus, particularly pandemic prone viruses have their mutations - this is nothing unusual. Even our Indian indigenous virus has many mutations - virologists say we’ve had up to 3-4000 mutations and this will go on. Some will increase the transmissibility, some the virulence.”
Now in these situations, there are epidemiological tests in communities and virological tests in labs that need to be done to get the whole picture.
“Virological tests are being done in NIV, ICMR and we will get those results in a few days and then we can comment with confidence,” says Dr Salunke.
“From the epidemiological tests we are seeing an increase in transmission in certain districts. Earlier, in each family we would see 1 or 2 cases, now we are seeing the whole family affected which indicates some change in the viral activity in these pockets (or areas). But what that is and what that implies will take some testing to figure out.”Dr Shubhash Salunke, Maharashtra COVID Technical Advisor
Dr John adds that we have several labs that can conduct quick genomic analysis and we need data on the virus' patterns such as the age groups affected, specific regions, etc.
Will There Be Another Lockdown?
Maharashtra CM Uddhav Thackeray said that he was worried about the situation and would be monitoring residents behaviour for the next 10-15 days to see if norms were being followed. If not, he said he would be forced to reimpose a lockdown in the state. For now, Amravati district in Maharashtra’s Vidarbha region will be placed under a week-long lockdown from 8 pm on 22 February, said minister Yashomati Thakur on Sunday. The lockdown will be in force till 8 am on 1 March, Thakur added.
The good news is that if it is a new variant, Dr John still doesn't expect a new wave in all of India. “Our house is not on fire anymore, we are not starting from scratch, we have some knowledge and people are also aware.”
He adds that the “virus makes use of peoples behaviour - so overcrowding, large gatherings, going out maskless and all will worsen things.”
“Its a virus, it propagates in its own way. It’s up to us to change our behaviour and decide how much we want to welcome or not welcome this in our homes. It depends on the people.”Dr Shubhash Salunke, Maharashtra COVID Technical Advisor
Dr Salunke reminds us of our privilege and says that while a 10-15 day lockdown is seen as ‘not as bad’ for some of us, it can be devastating for daily wagers and other lower-income workers. “Keeping this perspective in mind, we need to be taking precautions because we can avoid a lockdown. ”
Why Are Smaller Districts Seeing a Sudden Rise?
For the past week, more than 200 cases are being reported in Maharashtra and six districts — Ratnagiri, Beed, Sindhudurg, Raigad, Satara and Amravati — are seeing a marked spike in average daily deaths.
“The number of cases doubling has become 8 days which is most unusual. The doubling time used to be 1 or 2 months, and here it’s literally in a week. Secondly, the number is huge. In the city of Amravati, we tested nearly 700 people who were not necessarily showing symptoms, but 350 people turned out to be positive, which is nearly a 50 per cent positivity rate which is very high. Both of these things indicates the transmission is taking place in a very rapid fashion.”Dr Shubhash Salunke, Maharashtra COVID Technical Advisor
He adds of his field observations from Nagpur to Aurangabad, “While the transmission has increased, perhaps the virulence has not as we have not seen the number of deaths go up significantly. This is a very positive sign.”
Dr Salunke adds that this might spread to other parts of Maharashtra. “The situation in Marathwada or Vidharbha is expected, the virus is behaving how we thought it would. Pandemic or outbreak prone viruses don't come and go in a day. If we look at history, look at the Spanish flu, which stayed for 3 years. Even now we will have to live with this, we will keep seeing waves. This can be the initial phase of a wave. It depends on us, if we make that true or not.”
But why the sudden change? The lockdown was lifted in October and restaurants, malls and cinemas re-opened to great crowds - but we are only seeing a significant in numbers within the past week or few days.
Dr Salunke explains,
- “One, there definitely seems to be a change in the agent, meaning the virus itself.
- Two, we have marriage season with more than 100 marriages within one city where government protocols of 50 people are flouted. No one uses masks or hand hygiene. We have consciously decided to insult the virus and it is giving us a response.
- Three, a slightly less significant factor is seasonal changes, where the temperatures are fluctuating although not as severely. This variation is known to help the virus multiply.”
All these factors interplay to cause the rising cases in Maharastra and unless we break the chain consciously, “it can go to explosive levels. We have to take action or face the music.”
Dr John adds, “We could be seeing micro-waves in smaller regions.”
“We know what we have to do. Imagine knowing you are going to fall in a ditch, the decision is on us.”Dr Shubhash Salunke, Maharashtra COVID Technical Advisor
He adds that the northern states need to take a lesson from this - they are not immune.
The Other States to Watch Out For
Across the country, five states - Maharashtra, Kerala, Punjab, Chhattisgarh, and Madhya Pradesh - are seeing a rise in the number of COVID cases and fresh infections despite having a dip in November and December, said the Centre on Saturday, 20 February.
Dr Jacob tells me that while Kerala also has a high number of cases, “it is on the downward trend since their peak in November, which was later than the national peak of September. They have had their second wave too and are on the decline.”
“We don’t need to worry about Kerala, they have been managing very well. India’s national average death rate is 1.4 percent while Kerala’s is 0.039 percent- this is huge. ”Dr Jacob John, epidemiologist
Kerala is most transparent about data and most efficient in testing adds Dr John, who says that testing is the key to solving this as we need to gather data.
Punjab and Maharashtra are seeing small rises, but their slow rise still mean things are not that tense yet. “It is a signal to be careful,” he adds but we need weekly averages to ascertain the rate as “numbers are not that high yet.”
(This article was first published on FIT.)
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