Between the first and second waves, several modelled predictions told us that there would not be a second wave because of ‘herd immunity’ that draped itself around India as a protective cloak.
Between the second and third waves, several experts asserted that ‘hybrid immunity’ acquired through large-scale viral exposure in the second wave and the increasing population coverage of the vaccination programme would give the country an impenetrable armour against a third wave.
The latter assessment would have possibly held true if it were only Delta that existed as the circulating variant.
However, the bets were off when a new variant emerged. Omicron is now rapidly spreading across the country, creating a dramatic daily rise in the number of infections.
The response has been varied, across different sections of experts, people, and policymakers. While some experts welcome Omicron as a “gentleman virus” that can confer widespread immunity, while causing very little threat to health, others caution that even a small fraction of serious illness in a huge surge of infected persons can storm our hospitals and strain our social systems.
Others remind us that Delta is still around to pose danger in a scenario of unmasked persons, mingling crowds, unrestricted travel, and uninhibited mass gatherings in yet another election season. Certainly, care is warranted and we need to stretch this wave to keep it low and prevent a sharp skyward surge.
States vary in their policy response.
Some have imposed night curfews, some are implementing weekend curfews, and a few are proposing both measures.
There is apprehension that if these measures do not succeed in slowing down the spread, there may be more rigorous lockdowns. This fear has started the trek back of migrants from cities to their villages.
The Science Behind Night Curfew
How far are such measures justified? If I were to be a lawyer arguing the case for the night curfew, I can provide several theoretical grounds for justification. It prevents crowded indoor gatherings for celebration, revelry, entertainment, or late-night shopping, which are happy hunting grounds for the virus.
The cold night air also tends to form low-hanging, slow-moving viral clouds, unlike the warmer daytime air, which lifts the virus clouds higher and drifts them away faster. The colder temperature in the night constricts the blood vessels and lowers the early immune response to viral invasion.
A night curfew also gives respite to security personnel who are intensely occupied with crowd control during the day.
However, all of these are partial measures that will be of no avail if the daytime crowds flout masking regulations and invite the virus into their bodies. There is a cognitive dissonance between leaders announcing the need for masking and physical distancing in the evening and addressing unmasked crowds during the day.
Similarly, weekend curfews amount to tokenism if the weekday crowds are unrestricted. Indeed, the evening markets will be even more crowded on working days, if weekend curfews and night curfews restrict people’s time for marketing. Weekend curfews will also affect the lives of many daily wage workers and street vendors.
Surely, the virus is not just a weekend visitor out to inspect how well people are observing Sabbath!
A complete lockdown will also serve little purpose. In 2020, it served to curb the speed of transmission while health and social systems geared up to meet the challenge of a new viral pandemic.
Repeated lockdowns are not effective in shutting out the sneaky virus, as China is discovering in its doctrinaire pursuit of a ‘zero COVID’ policy.
The disruption of many lives, especially of the poor and the very young, is not worth the price of a lockdown. Especially when the release from lockdown is followed by laxity in controlling the uninhibited exuberance of movement and mingling.
So, What Will Be Effective?
What is needed is a consistent commitment to controlling transmission by employing as many of the measures, which we know to be effective, for as much as practically feasible.
These are:
Wearing protective face masks properly everywhere out of the home;
Wearing them even at home if any member of the household has symptoms of COVID or any respiratory infection, or has had recent contact with an active COVID case;
Keeping physical distancing as far as feasible;
Moving in well-ventilated places, as much as possible;
Hand hygiene;
Isolating oneself if symptoms of COVID develop;
Getting tested but relying more on clinical recovery to end isolation, as a variable fraction of the tests can be false negative;
Working from home to the extent feasible and using staggered shift systems for reducing crowding in classrooms and workplaces.
We need to do this for several weeks more, without sliding back to reckless behaviour when the wave begins to ebb. The chief minister of Maharashtra has rightly appealed to all political, religious, and social organisations to avoid events that lead to crowding and endanger the lives of the public.
Governments too must enable and enforce COVID-appropriate behaviours. They must freely distribute good-quality face masks to all low-income families while communicating their importance. Supported home care must be provided to persons who isolate themselves for mild to moderate illness while ensuring prompt transfer to assured hospital care if serious illness develops.
Poor families, which are dependent on daily wages, must be provided essential supplies, including food and medicines, for the period of isolation.
In a situation of rapid community spread, symptom-based isolation and supported home care are even more important than testing and contact tracing. Even when restrictions are imposed, stepwise relaxation is best guided by the hospital load of serious ‘cases’ than by daily counts of infections.
This is especially so in the case of Omicron, where mild infections may facilitate an early transition to an endemic state of co-existence where we will have periodic rises and falls which are not alarmingly dangerous to the population or call for draconian measures of control.
(Prof K Srinath Reddy, a cardiologist and epidemiologist, is President of the Public Health Foundation of India (PHFI). The views expressed are personal.This is an opinion piece and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for the same.)
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