India may witness 1,750 coronavirus-related deaths per day, surging to around 2,320 by the first week of June, according to a report of the Lancet COVID-19 Commission by India Task Force members.
The report, titled "Managing India's second COVID-19 wave: Urgent steps", underlines the key elements of the second COVID-19 wave. It also suggests measures that should be taken now to help mitigate the spread of infection.
Coronavirus glut concentrated in few districts, less scattered
As per the preliminary review of the report, "while the pandemic has spread, the geographic contours of the second wave closely mirror those of the first wave, though with a deeper penetration into tier-2 and tier-3 cities."
The study also indicates that the second wave has been more geographically bundled so far.
The tally of districts constituting the top 50% of the cases has fallen from over 40 at the time of the first peak to less than 20 presently.
As a matter of fact, at the time of the first surge of the novel coronavirus cases during August-September 2020, the count of districts contributing to 75% of the total COVID-19 cases was 60-100, whereas it has been approx. 20-40 districts during the second wave.
It took 40 days to go from 10K-80K in COVID-19 second wave
The second wave is unlike the first in two significant ways. Firstly, the rate of increase in fresh coronavirus cases is substantially higher.
The surge from 10,000 to 80,000 fresh cases per day from February to April has taken less than 40 days. It was 83 days in September last year. Secondly, more coronavirus cases are asymptomatic or mildly symptomatic, causing relatively low rates of hospitalisation and mortality.
It is not completely clear whether the higher proportions of asymptomatic cases are solely due to better contact tracing, more family members, for example, being tested.
Case fatality may rise with surge in COVID-19 cases
The overall Case Fatality Ratio (CFR) since the outset of the coronavirus pandemic in March 2020 has been reported to be around 1.3%.
The CFR among COVID-19 patients who have contracted the infection since the beginning of 2021 is considerably less at 0.87%.
Tentatively, it appears that CFR is lower in the second wave of COVID-19. Yet India is registering 664 fatalities per day across the country (seven-day moving average as of April 10, 2021). Furthermore, disruptions to regular health services, for instance, regular inoculation and delivery care, could have catastrophic implications for maternal and child survival.
Fiscal health burden
In financial terms, India may need to expend over $7.8 billion on testing and $1.7 billion on healthcare usage because of COVID-19 by September 2021.
The report also recommended following solutions to check the further spread of coronavirus in India:
Vaccination: Cover younger populace based on supplies- As of April 11, 2021, 29.6% of people above 45 years have been administered one or both doses of a vaccine. The Lancet report suggests including all adults, comprising those below 45, with severe co-morbidities into the priority group.
Ramp up vaccine production - The report notes, "today Indian manufacturers are producing approximately 70-80 million doses of vaccines per month (Covaxin and Covishield). Even if 100% of this supply was for domestic use, at a target of 5 million doses a day, the monthly supplies would fall short by half."
More COVID-19 vaccines needed- India currently uses two coronavirus vaccines - Covishield and Covaxin. As of April 13, 2021, the Centre has given its nod for emergency approval for other jabs that have met efficacy and safety standards as well as received regulatory green signals in other markets. These comprise Pfizer-BioNTech, Moderna, and Johnson and Johnson.
Address vaccine hesitancy - Despite high rates of inoculations, several surveys demonstrate that although acceptance is increasing, only 57% of respondents stated that they are now ready to get vaccinated.
No blanket lockdowns - The report doesn't propose a blanket national or state lockdown. Indicating that economic closures are most disruptive to the poorest sections of society, it proposes a middle-ground approach in India, comprising phased, localised closures or curbs.
Step up genome sequencing - The report recommends widening of genome sequencing of the coronavirus to figure out if variants or mutants are responsible for the current spike, and if so, then what's the nature and type of such variants.
Travel - The report suggests a mandatory seven-day institutional quarantine for all visitors arriving from other nations, along with an RT-PCR test conducted on Day 8. It also recommends the option of completing another week in home isolation if the test comes negative.
Ban on assembly of groups of over 10- The report suggests an interim ban on assembly of groups larger than 10 for the next two months to control the spread of COVID-19.
Inform if those testing for coronavirus were vaccinated or not - The report proposed that the coronavirus test registration form be promptly amended to comprise information on whether the person getting tested has been administered one or both doses of the vaccine, along with details of the type of vaccine. This information can help trail the spread of post-vaccination infections and the spread of potential variants.