India’s first Covid-19 wave finally recedes

The first wave of the coronavirus disease (Covid-19) appears to be receding for the first time across the country, with cases seeing a steady drop for three consecutive weeks now. Experts warn that with the festive season coming up, the curve may rise again if people let their guard down during the celebrations.

The seven-day average of daily cases in India touched 93,617 on September 16, the highest till date. In the three weeks since, this number (also referred to as the daily case trajectory) has dropped every single day and stands at 74,623 on Wednesday — down around 20% from the peak.

This has meant that India's doubling rate — the number of days it takes for the number of infections to double — has seen a drastic improvement in the past month. On Wednesday, it stood at 60 days, as against 32.6 days on September 7.

This drop is also mirrored in the death trajectory. The seven-day average of daily deaths in the country was at its highest on September 15, when it touched 1,169. This number has dropped near consistently since then, and as on Wednesday, it stands at 977 — a drop of 16% from the peak.

This is the first time a drop of this magnitude and consistency has been recorded in the Covid-19 case and death trajectories in India. Across the world, there have been fluctuations and waves in the case (and death) trajectories — the US, for instance, is on its third wave currently — but India's trajectory has been climbing throughout till mid-September.

This reversal in trajectory has been led by the some of the states that have so far caused the national spike in cases — Maharashtra, Tamil Nadu, Andhra Pradesh and Delhi. Together, these four states have been responsible for 46% of all infections in the country.

In Maharashtra, India's worst-hit state responsible for a little under a quarter of all infections in the country, daily cases peaked at 22,149 on September 17, a day after the peak in the national trajectory. The trajectory in Delhi also peaked the same day, although Delhi is the only major region in the country that has seen a distinct second wave of infections. Cases in Tamil Nadu and Andhra Pradesh, meanwhile, have been dropping since the start of September — their respective peaks were on September 2 and 1 respectively.

A handful of states, particularly Kerala and Karnataka, however, appear to be defying the larger trend and cases there remain currently at peak levels and appear to be rising .

"Even though cases have started dropping, we are nowhere close to the end of the first wave. We are still reporting close to 75,000 cases a day, which is by no means a small number. However, it is still a significant drop, especially if it is not artificially influenced by a change in testing strategy. But if our testing strategy is the same as it was in August and early September, then this is a very good sign," said Dr Shahid Jameel, virologist and director of Trivedi School of Biosciences at Ashoka University.

The threat of a festive resurgence, however, is very real, as India's own experience shows.

In Kerala, festivities for Onam (celebrated between August 22 and September 2) appear to have caused a spike in cases. While the trajectory in the state was largely in control through much of the pandemic, it has seen a huge spike from the start of September — average daily cases have increased from around 2,000 in the start of September to nearly 8,000 in the last week of the month.

Union health secretary Rajesh Bhushan identified Onam as the key factor that caused the spike in the state. "The highest increase in active cases in the country has been seen in Kerala and the surge is possibly due to the Onam festivities," he said in Tuesday's health briefing.

Dr VK Paul, member of Niti Aayog, stressed last Tuesday that the coming festive season will be all about masks — "mask wali Chhath, mask wali Eid, mask wala Dussehra aur mask wali Diwali". Dussehra will be celebrated on October 25, Eid Milad-un-Nabi on October 28-29, while Diwali will be on November 14 and Chhath on November 20.

"This is all for our own good; and needs to be promoted big time. Community heads should ensure and appeal that festivals should be celebrated with caution; not in large groups but smaller groups. Large gatherings, especially in marketplaces, could be detrimental, so we have to be careful," he said, during the government's weekly Covid-19 media briefing.

On Tuesday, the Union health ministry issued standard operating procedures (SOPs) ahead of the festive season to curtail the spread of the infection. These included a cap on the number of people at events and gatherings, staggered timings and restricted entry during fairs, Puja pandals, Ramlila pandals or concerts and plays.

"The next few weeks will be extremely crucial because quite a few factors will be at play that can cause a rise in cases. With the festive season here, people need to develop a sense of individual responsibility when they visit temples, pandals or family gatherings. Add to this the fact that in winter people tend to stay indoor with shut windows, creating ideal conditions for viruses to thrive. Wearing masks, observing hand hygiene and social distancing become even more important now, and I hope people don't forget this," Dr Jameel said.

"During the festive season people will be visiting relatives, and since it will be cold, they may gather indoors with windows shut. All of this ends up creating ideal conditions for the spread of infections. In the festive spirit, people also tend to talk louder or they end up singing — studies have also shown that viral particles tend to travel larger distances in such circumstances. All of this increases the chances of infections rising," said Dr Lalit Kant, former head of the department of epidemiology at the Indian Council of Medical Research (ICMR).