On Wednesday, 15 June, Maharashtra reported 4,024 new COVID cases — nearly twice the number of cases reported on the previous day. It also makes up almost a third of the country's total new cases in 24 hours.
Nearly half the cases come from Mumbai, where 2293 new COVID cases were reported in the last 24 hours.
The steady rise in COVID cases in the state over the course of the last 2 weeks has prompted the question, are we staring at a potential 4th wave in India?
Is it safe to travel to Maharashtra?
Can more people taking booster shots help curb the spread of infections?
Are the vaccines still working?
FIT speaks to experts.
What the Data Says
According to a statement released by the State Public Health Department, Maharashtra currently has a test positivity rate of 9.74 percent. This means that nearly 10 in every 100 people that are tested for COVID turn out positive.
Currently, Mumbai accounts for 70.51 percent of the active cases in the city as of 6 June. This is followed by Pune, which makes up 7.19 percent of the currently active cases in Maharashtra.
It's not just Maharashtra though, cases of COVID have been rising in other parts of the country as well, albeit at different paces.
According to Kerala's Health Ministry, the state currently has a test positivity rate of over 10 percent, and a seven day average of 9.39 percent.
Karnataka, too, has been seeing a slight uptick in cases, with the state reporting over 200 new cases every day this week. In response to rising cases in the city, the Bengaluru civic agency has reinstated mandatory masking in public places.
As of 15 June, Delhi has a case positivity rate of 7.09 percent.
Why Are Cases Surging Now?
The surge isn't really out of nowhere because "COVID had never really gone away," Dr Bharat Agarwal, Internal medicine specialist, Apollo hospitals Navi Mumbai, tells FIT.
And it's true. Other parts of the country, including Delhi, have been seeing a periodic rise and fall of COVID cases in the last few months.
"We should also keep in mind that, since testing and reporting is now even less systematic and more variable across the country, 'case numbers' and 'test positivity rates' are harder to interpret," says immunologist, Dr Satyajit Rath.
As a rule of thumb, COVID cases are interpreted to be higher than the recorded numbers.
Speaking to the press, Maharashtra State Health Minister, Rajesh Tope said that the rise in cases is likely due to a combination of Omicron subvariants BA4, BA5, a low uptick of boosters, and a slack in masking habits.
It's difficult at this point to say which subvariant is really causing the surge, but they're all offshoots of Omicron, which remains a highly infectious variant, says Dr Vineeta Bal, an immunologist and scientist at IISER-Pune.
While BA1, BA2, and XE have been detected in Mumbai, BA.4 and BA.5 have been detected in Pune.
Add to that a lax in precautionary measures like masking, and waning immunity, and it is no wonder infections are going up.
"I suspect that immunity is partly waning, and the immunity always would need a booster. But its also the case that people have become lackadaisical and they don’t really want to think about COVID any longer."Dr Vineeta Bal, Immunologist, and researcher at the Indian Institute of Science Education and Research (IISER Pune)
Can Booster Doses Help Curb Infections?
According to experts that FIT has spoken to, COVID vaccines have not been very effective in keeping people from getting infected with Omicron and its subvariants, and a third shot may not make a significant difference.
This is where we have to draw a distinction between infection and illness, says Dr Bal.
"What we are seeing here is mostly infection. Most people are either asymptomatic or mildly symptomatic, and few are actually reaching a stage where they are needing hospitalisation. That hospitalisation is the illness that we are worried about."Dr Vineeta Bal, Immunologist, and researcher at the Indian Institute of Science Education and Research (IISER Pune)
The reason why our current vaccines – boosters included – are not great at keeping out infections is because these don't create a massive wall of immunity at the site of entry to stop the virus from entering the body.
"It is impossible to stop the infection of a virus that is as infectious as sars COV2," says Dr Bal
"But once it gets in, whatever immunity we have as T cells, B cells, antibodies, all of it comes together so that further spread – which is responsible for illness – is decreased."Dr Vineeta Bal, Immunologist, and researcher at the Indian Institute of Science Education and Research (IISER Pune)
"All in all, the infection is likely to continue to spread" adds Dr Rath.
"So-called 'booster' vaccine doses will reduce the likelihood of infection somewhat for a while, and enough booster dose uptake would therefore help slow down rates of spread."Dr Satyajit Rath, Immunologist, National Institute of Immunology
Dr Rath goes on to add, "I am doubtful if we can achieve sufficiently large scale 'booster' vaccination to make a major difference given that even our vaccination campaign seems to have gotten bogged down in loss of urgency and focus."
But the good news is that most people are getting away with just mild illness or asymptomatic infection, which means the vaccines are still working.
The Vaccines Are Still Working
Speaking of the situation on ground and in the hospitals, Dr Sanjith Saseedharan, Consultant & Head Critical Care, SL Raheja Hospital, Mahim, tells FIT that although cases are going up, hospital admissions remain low.
"The severity of these cases are very mild. In fact, we had only one or two hospitalisations in the last 3 or 4 days. None of these have been ICU admissions."Dr Sanjith Saseedharan, Consultant & Head Critical Care, SL Raheja Hospital, Mahim
According to data released by the BMC, only 223 of the 24,601 available hospital beds in the city are currently occupied, and 45 of the 1531 available ICU beds in the city are currently occupied.
Moreover, only 3 patients out of the 4,880 active cases of COVID in the city are currently in a critical condition.
When COVID cases previously surged in the country after a period of lull, experts have on occasion noticed a lag between when cases first start rising and severe cases and deaths start being reported.
Could this be a similar situation? Is the worst of it still ahead of us?
Dr Sadeedharan is of the opinion that it isn't, adding that the lag was more variant specific.
"That lag was when the virus was very aggressive, like in the case of delta," he says, explaining it further. "At that time what was happening was that the virus itself was creating such bad pathology that the virus was infecting but then 10 or 12 days later they were getting worse. That’s why you had that lag at that time."
"Now we have seen omicron and its sub variants have been around for around 4 months and we aren’t seeing that kind of a lag period."Dr Sanjith Saseedharan, Consultant & Head Critical Care, SL Raheja Hospital, Mahim
‘It’s Kind of Like the Flu'
"Most people are not seriously coming down with illness, so its alright. We come down with flu, we take it in our own stride and we continue moving on after 3 or 4 days. So I think that is the situation that we are reaching."Dr Vineeta Bal, Immunologist, and researcher at the Indian Institute of Science Education and Research (IISER Pune)
Ripples and waves of infections are likely to continue, and "this will remain the case only so long as no newer virus variants emerge that by chance end up causing severe illness as well," according to Dr Rath.
"If there is a low level infection, that will also trigger a new wave of immune response, and function like another booster. Which is good,"adds Dr Bal.
However, this doesn't mean that everyone is equally likely to get just mild infection, and there are some who remain more vulnerable than others.
"When numbers go up, chances of severe illness in people who are already at risk, like immunocompromised people and the elderly, will also go up."Dr Sanjith Saseedharan, Consultant & Head Critical Care, SL Raheja Hospital, Mahim
Moreover, "we do not even seem to have completed coverage of our adult population for the basic two-dose schedule, and the majority of children are still unvaccinated," points out Dr Rath.
Given all of this, experts, including health authorities, have been pushing the public to keep up COVID appropriate behaviour of masking, handwashing and maintaining a physical distance.
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