there is A fresh spike in COVID-19 cases in India, a surge that is attributable to at least three reasons. One, the XBB.1.16 recombinant variant that has higher transmissibility than other circulating variants. Second, the recent increase in viral flu (H1N1 and H3N2 subtypes) resulted in health care providers recommending higher COVID-19 testing. Three, the availability of COVID-19 testing at low cost and the COVID-19 surge which is making those suffering from cough and cold to volunteer to get tested. This has sparked buzz that a new wave is imminent in India. In fact, since the last and third national COVID-19 wave in January 2022, there have been some spikes each time, with each episode creating fears of a new wave (fortunately, these fears have not come true).
effect of uneducated speech
In the last three years, there has been another development which has become a cause for concern. Some groups have emerged which continue to argue very vociferously COVID-19 is very dangerous and has not gone, These groups, or ‘Covid-forever’, bear an uncanny resemblance to two-century-old anti-vaccination groups, calling themselves ‘post-Covid’ and ‘long Covid’, arguing that even if infections are mild, COVID-19 remains a serious disease. His signature mark is that he does not want to discuss anything other than COVID-19. Largely based in the West, the ‘membership’ of these groups is increasing in India.
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There is every epidemiological evidence to show that COVID-19 has become endemic in India. However, being endemic for a disease does not mean zero cases or no seasonal increase. The last pandemic before COVID-19 was the 2009–10 swine flu (H1N1) pandemic. It was caused by the new subtype H1N1 of influenza A virus. It was an epidemic that ended in 2010. Since then, the H1N1 subtype has been causing seasonal increases in flu cases, and is the most prevalent influenza A virus subtype. There has been a lot of news about H3N2 flu in India in the last two months, but the other and more prevalent subtype of flu is H1N1. However, and rightly so, we have not responded to H1N1 in the same way that we did in 2009-10. And we should have the same response for the SARS-CoV-2 variant.
We need to be mindful that the public discourse on fresh waves is not entirely innocuous. Although the medical implications have been blunted, any discussion about a recent surge is likely to generate panic and fear, apprehension among parents about sending their children to school (thus, loss of learning) and There is a social impact on livelihood. The burden of these indirect effects falls heavily on the poor, the marginalized and those whose voices rarely matter.
Discard old parameters to track disease
One of the reasons for the new discourse on One Wave is the new sub-version XBB.1.16 (which is essentially a recompiler of the Omicron version). It is one of more than 100 recombinant variants and one of more than 700 SARS-CoV-2 variants that have been reported in the last three years. It is not a concern like Alpha, Beta, Gamma, Delta and Omicron. On average, about four to five new variants of SARS-CoV-2 have been detected every week over the past three years. Variants will continue to emerge, and thus we must embrace the rise and fall of COVID-19 cases.
For a country with a population of 1.4 billion and with SARS-CoV-2, a certain number of cases will be reported on an ongoing basis. Let us understand this with the example of another respiratory disease Tuberculosis (TB). An estimated 7,000 new TB cases are reported every day in India. The bacterium for TB is far more stable, while SARS-CoV-2 is prone to mutations and variants. Therefore, the first step for experts in India is to reach a consensus on the number of COVID-19 cases to be expected even if the disease becomes endemic. This can be in terms of absolute numbers or new cases per 1,00,000 people per week or month.
Another important reason why every spike in cases fuels talk of a new wave is the continued use of old parameters of daily new COVID-19 cases. However, since the emergence of the Omicron variant, there is a clear separation between infection and disease.
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Over the past eight weeks, although the number of daily new COVID-19 cases has increased nearly 55-fold, from a very low base, there has been little change in the number of hospitalizations and deaths. This is why focusing on daily new cases has very limited public health relevance, if any, right now.
A more objective approach is needed to define parameters to track COVID-19 conditions. In public health, the approach must be to gather information in order to intervene. With targeted and voluntary testing, daily COVID-19 cases and test positivity rates are a very vulnerable parameter as well as a flawed approach – it is influenced by prescriber and citizen care-seeking behaviour. Therefore, a better parameter would be to focus on and track moderate to severe illnesses and hospitalizations.
This needs to be made more comprehensive by further disaggregation of data by those admitted after COVID-19 infection and those who were already in hospitals and incidentally tested positive. At this stage when COVID-19 is endemic in India, the dashboard parameters of cumulative cases, cumulative hospitalizations and cumulative deaths are also not relevant.
It is time we start tracking, comparing and analyzing COVID-19 data on a monthly and weekly basis for the calendar year. The new dashboard indicators should start tracking from the year 2023 onwards, which will give us an idea of the trends – these were wiped out by the cumulative data of the previous three years.
Various forms of surveillance (genomic, wastewater, influenza-like illness and severe acute respiratory illness) are going to be integral tools for response over the long term. However, some of these datasets need to be linked to clinical outcomes. The multiple agencies operating in these systems must work with physicians, data and public health experts to draw conclusions in real time. The government should also put this data in the public domain so that independent researchers and academics can analyze and support the response process.
COVID-19 has become endemic in India and the medical impact of the disease is low. But viruses are ubiquitous.
At this stage, India’s response should be calm and evidence-guided. Public to encourage governments to implement new parameters to track disease, develop strategies to fight misinformation and ‘Covid-forever’, and launch sustained health communication messages about preventing all respiratory illnesses Health aspects should be taken care of. There is no role for any specific targeted intervention only for COVID-19. It is important for citizens not to panic with every spike, not to be swayed by unverified social media messages, and learn to do personal self-assessment of risk and take preventive measures as per health risk.
ECG approach to COVID-19 data response
Looking ahead, the response to the emerging COVID-19 situation needs to be determined by an overall assessment of the situation through careful examination and interpretation of ECG data: epidemiology (tendency to moderate to severe cases); clinical (change in symptoms, hospitalizations and outcomes), and genomic and other surveillance (variants, etc.) data. Most importantly, our selection of data for decision making should be objective, keeping in view the emerging epidemiology of COVID-19 and should be solution oriented.
Dr. Chandrakant Lahariya is Consultant Physician and Epidemiologist. He is the founder-director of the Foundation for People-Centric Health Systems, New Delhi