Have We Passed the Peak?
India has been recording a 7-day moving average of 74,000 cases daily in October, down its peak of 97,000 cases in September. Our death rate has been declining in most states, and testing levels have remained mostly consistent.
This a big drop, prompting many to optimistically announce that we are passed our peak.
But have we? FIT speaks to Dr Shahid Jameel, a Virologist & CEO of Wellcome Trust DBT India Alliance said and Dr Sumit Ray, Head of Department, Critical Care Medicine at Holy Family Hospital, Delhi to break it down.
“India went on highest in mid-September - 93,000-94,000 reported cases on an average, today on a 7-day moving average its 74,000, so there is a consistent down trend but we don’t know if testing based on rapid antigen has increased. Because if the testing strategy has increased to include more antigen tests, then these are artificially low numbers, we may have a false downward trend.”Dr Shahid Jameel
There has also been an Indian Council of Medical Research guideline for states in September on increased testing on demand of rapid antigen testing (RAT) kits, especially in the cities that are severely affected by the coronavirus outbreak.
For a recap, rapid antigen tests are cheap and quick - but they are not always accurate. "They only have about a 50 per cent sensitivity, so you are actually missing half the cases,” says Dr Jameel. RT-PCR tests, on the other hand, take longer to show results and are more expensive but have increased accuracy.
“In September, we had more RT-PCR than antigen tests, and if the situation is reversed now then that could lead to this false downturn,” says Dr Jameel, adding,
“We need more granular data and more data on testing to say with certainly if we are past our peak.”Dr Shahid Jameel
Dr Ray agrees and says that the type of testing will determine if we are out of the woods. “There may be a brief decline, but there are still many urban conglomerations which have large percentages of population that are still vulnerable, so we can't yet be sure it is coming down.”
‘Don’t Get Complacent'
“Now, if we assume the testing proportion not changed, then yes, it can be a downturn and it appears that we may have crossed a peak. However, it is still not the time for complacency as 75,000 cases daily is not a small number at all.”Dr Shahid Jameel
We have been in lockdown for 7 months now, and as states prepare various levels of unlock, we will see a spike. “As time passes, there will be a slackening. There is fatigue setting in, and we do have to open up for our economy. There is a phrase, ‘Pandemics end when people lose fear not when infections end,’ and we need to be careful of this.”
“The US is reporting on a 7-day average about 44,000 cases, so we are still putting out a little less than twice the number of cases of the US on a daily basis - by whatever means we might be testing. So it is definitely not the time for complacency. Yes it would be very good news if the daily case load is coming down but its the time to wait and watch - and be careful.”Dr Shahid Jameel
At the government’s level, the Health Ministry has been clear that we are still in the throes of a pandemic, and we must wear our masks properly - not on the chin, but covering the nose and mouth tightly - wash our hands frequently and maintain social distance.
“The state and central governments have been actively saying we need to be careful and stay vigilant. Now, the central government needs to keep its focus and coordinate medical and relief equipment, funding, organising etc. with state governments,” adds Dr Ray.
Will We See a Surge in Winter?
“It is a known fact that in the winter, the flu spreads better as the coronaviruses are more stable at colder temperatures. Besides, in winters, one tends to stay indoors and this can increase the circulation of the virus if infected,” says Dr Jameel.
“Yes, we can expect a surge. It was always predicted that like all coronaviruses COVID-19 will see a spike in colder months and that expectation still remains.”Dr Sumit Ray
Dr Ray adds that the way things are going, we may not reach a level of seropositivity by winter where we can be lax.
“We can extrapolate from the situation in Delhi - which was the same as New York - as soon as things open up there is a spike. Now, we have to open up eventually but we cannot be lax.”
However, Dr Jameel added that this year in Southern Australia’s winter and flu season, the flu didn't spread as much because people were masked up due to COVID-19. So in effect, both infections were curbed. “It’s our responsibility to wear a mask properly, that’s the only way we can stop the spread. That, and proper hand hygiene and social distancing.”
Festival Season May Bring in More Cases
We are entering India’s busiest festival season with Dussherra, Durga Puja, Diwali and more in the coming months. The increase in social gatherings, aided by the unlock, could increase cases say experts.
“We are coming to a season where we have to be careful. We need to stress the use of masks and distancing. We also need to remind people on the correct way to wear masks - without gaps and covering both nose and mouth,” says Dr Jameel.
Recovery Can Be Difficult
It’s important to remember that when we talk about spikes and dips, we are counting the cases and recoveries and deaths. But as COVID-19 has shown us, it’s a complicated disease, and even when people do recover, they often suffer long-term effects and prolonged symptoms, colloquially called ‘long COVID’. These can include mild symptoms like mild, persistent fevers, coughs and mild body ache to more severe symptoms like liver, kidney and cardiac issues, severe fatigue and even neurological issues.
“We are discovering that this disease is not just for 2 weeks or 14 days. We see the effects lingering for 4-6 weeks to more in some patients, and the severe cases can go up to 4 months.”Dr Suranjit Chatterjee, a senior consultant of internal medicine at Indraprastha Apollo Hospitals,
This is to say that the disease does not end at recovery. However, Dr Ray adds that what is considered long or post COVID is in reality a part of COVID. “Physical and psychological symptoms of severe COVID and the subsequent ICU stay can lead to a long recovery period. This happens in other severe diseases that lead to ICU stays, but of course, COVID-19 is a new disease and we are discovering new things about it every day.”