2nd wave coming: Serosurveys had raised crimson flags — however little else

IT doesn’t want a galaxy of consultants to checklist what’s wanted: boosting Covid vaccination, augmenting oxygen and beds, increasing genome sequencing, ramping up testing and tracing, bringing down the an infection degree — all of this double fast.
But because the second wave climbs increased every day, each in instances and deaths and the Centre and states scramble to reply, there’s a rising — and grudging — acceptance that one apparent reality eluded many. That, in a inhabitants of a billion plus, a pandemic doesn’t vanish because it appeared to do barely a few months in the past. That a second wave was going to return.
“We were quite lucky to have this wonderful window of opportunity between November and January when the curve was falling across India,” mentioned Virander Singh Chauhan, former director of the International Centre for Genetic Engineering Biotechnology.
“Unfortunately, it served to instill a false sense of security. Everyone thought the virus had magically disappeared when anyone with a basic idea of infectious diseases knew it was lurking very much within us and could strike anytime…There are several things we should have done during this time but, I have to say it, we messed it up big time,” Chauhan mentioned.

To ensure, a falling Covid curve, a low fatality ratio, a big younger and asymptomatic inhabitants and the financial and social imperatives of opening up, meant that the second wave was inevitable. But the four-month lull, consultants agree, might have been used to not solely anticipate this wave however design coverage interventions. Instead, guards had been lowered, important indicators ignored.
Beginning with serosurveys – that important indicator of illness prevalence. These contain blood checks to verify whether or not an individual has been contaminated with a illness within the latest previous. They assist monitor the geography of the illness, its age-wise or gender-wise break-up and ranges to which testing must be ramped up.
The Indian Express spoke to a number of officers and consultants on the Centre and the states and located that in state after state, serosurveys underlined that the second Covid wave was coming (see chart) and but little was achieved with the information or as follow-up.
Indeed, in January, when nearly each state was reporting a decline in case numbers, Kerala was witnessing a surge — contributing nearly half of all instances within the nation. By mid- February, the confirmed instances within the state had crossed 10 lakh, second solely to Maharashtra.
This “outlier” pattern in Kerala was not very effectively understood till the state did a serosurvey in January-February in all its 14 districts. It revealed that solely about 10% of the state’s inhabitants had been contaminated. In different phrases, a majority was nonetheless vulnerable.
Importantly, the survey provided clues to the state’s excessive case rely. For, Kerala had recognized and examined at the least considered one of each 4 contaminated people. In the nation as complete, this quantity, estimated from a previous serosurvey, was only one in about 30.
Another perception the state gleaned from the serosurvey was that the danger of an infection amongst these 70 years or above was considerably much less, indicating that reverse quarantine – the place the weak are remoted – was efficient.
Such granular element was not captured in lots of states. At the nationwide degree, the Indian Council of Medical Research has carried out three serosurveys, the final one in December. Serosurveys have been achieved in at the least 10 states and plenty of cities, together with Delhi, Mumbai, Pune, Ahmedabad, and Chennai, however few have achieved it at common intervals.
The WHO listed a complete of 37 serosurveys in India till March 10. It consists of the three nationwide serosurveys, 14 regional and metropolis degree workout routines, and 20 others at a extra native degree by medical and well being establishments.
However, many states at the moment witnessing a serious surge in instances together with Chhattisgarh, Bihar and Punjab, don’t seem on this checklist compiled by the WHO.

But serosurveys usually are not a one-off train. As the character and behavior of the virus modifications continuously, scientists say, there’s a want for normal monitoring and surveillance via serosurveys in numerous inhabitants teams. This has hardly occurred.
More regarding has been how the information was interpreted. The December serosurvey, whose outcomes had been introduced in early February, for instance, confirmed that hardly 20 per cent of India’s inhabitants had been contaminated by then. That was a crimson flag: it meant a contemporary wave was attainable despite the fact that one couldn’t predict when.
However, some small very localised clusters in Delhi, Mumbai and Pune displaying greater than 50 per cent seropositivity acquired far higher prominence, and had been used to clarify why the numbers had been falling.
“It was a classic case of cognitive bias,” mentioned an official who didn’t wish to be named. “We wanted to believe that the Covid is on its way out and so we interpret data to reinforce that belief. We were even talking about herd immunity for an entire city based on a serosurvey in a few neighbourhoods of a small sample.”
That’s why the present wave of infections requires extra common, and geographically spread-out serosurveys. “The second wave is very different from the first and we do not fully understand why or in what manner. There is anecdotal evidence of this being less deadly, or affecting a different age-group but in the absence of scientific data, the policy responses are likely to bring less than optimum results,” mentioned a scientist monitoring these surveys.
There is another excuse why serosurveys have grow to be essential. There is a rising variety of instances that may probably be labeled as re-infections. The most sturdy means of confirming reinfections is thru gene evaluation however that takes money and time. Cases of reinfections will be flagged very simply via these serosurveys. A superb estimate for reinfection price would have implications for quite a lot of responses, together with the deployment of vaccines.

Niti Aayog member Dr V Ok Paul, head of India’s Covid19 process drive, admits there’s a want for extra sturdy information. “We know from local serosurveys that in densely populated areas, the virus has gone deeper. However, the overall picture shows that… (people) can still get infected. Therefore, we should not have large gatherings. Only then, will the situation be under control…In our country, there is still a very large population that continues to be vulnerable,” he mentioned.
Giridhara R Babu, a member of Karnataka’s COVID-19 Technical Advisory Committee, mentioned the panel, on the idea of a serosurvey, had in November itself flagged {that a} second wave would hit the state late February.
“In Karnataka, there was no confusion; they knew a second wave is coming,” mentioned Babu. However, he underlined that the serosurvey is barely one of many instruments. “Using serosurveys to prepare for the second wave is just one part of the story. You need to have the intent to prepare for the second wave….Now there is enough evidence that the third wave will also come,” Babu mentioned.
(Tomorrow: First pressure of concern in January however why genome research delayed)