COVID-19: India’s R Number Crosses 1, but Is a Third Wave Coming?

The number of districts reporting a test positivity rate greater than 10% has increased from two to eight in a week, with Kolkata among them.

A health worker wearing PPE and gloves shows her hands written 2021 and 2022 with red paint, amid rising concern over Omicron cases as the New Year approaches, in Jammu, Thursday, December 30, 2021. Photo: PTI

Banjot Kaur, The Wire, 31/DEC/2021: New Delhi: The basic reproductive number, or R number, of the novel coronavirus in the country has breached the value of 1. That is, the virus is spreading from one infected person to more than one other person – an indication that the rising number of COVID-19 cases in the country is becoming consistent.

Addressing the press at the National Media Centre on December 30, NITI Aayog member (health) Vinod K. Paul said that the R number for India is currently 1.22.

For context: if the R number is 1.1 and there are 100 cases, then the virus will spread to another 110 people, and from them to 121 more people, and so forth. But if the R number is 0.95, then the virus will spread from 100 to 95 more and from them to 90 more, and so on. In general, the fewer cases at each successive step if the R number is lower than 1. If it is greater, then the outbreak is expanding.

The Wire Science reported on December 18 that the R number had already crossed 1 for the country’s four major metropolitan cities. But the national value was 0.94, and had been for two months until then.

In February 2021, the R number had increased to more than 1 for the country and was soon followed by the second COVID-19 wave.

In the first wave, in 2020, India’s peak daily cases stood at 98,000 before declining slowly to 9,000 a day. During the second wave, the number of daily new cases peaked at 4 lakh cases a day in May, before declining to around 6,000 a day until recently.

Now, the number of cases is climbing again. Yesterday, India logged more than 13,000 cases. Could these be indications of an impending third wave? Paul didn’t say either ‘yes’ or ‘no’.

“It is an emerging situation,” he said instead. “We have no idea currently what shape this situation will take. But what we have in our hands are tools to suppress the virus transmission.”

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WHO director-general Tedros Adhanom Ghebreyesus said in a press conference on December 29 that the circulation of both the delta and the omicron variants “is leading to a tsunami of cases” that, in turn, could stress health systems and workers already on the “brink of collapse”.

Did the Indian government take anything away from this statement? “This statement is based on global trends of 3-4 weeks,” Paul said. “But the warning has a message for all of society.”

Union health ministry joint secretary Lav Agarwal also made a presentation at the presser, in which he said eight districts in India have been reporting a weekly test positivity rate (TPR) of more than 10%. In the last press conference, on December 24, health ministry officials had said only two districts were reporting a TPR in excess of 10% – both in Mizoram.

A TPR of more than 5% is considered a matter of concern. The eight are six in Mizoram and one each in Arunachal Pradesh and West Bengal. The TPR in many districts in India’s northeast has been increasing for some time now, but the one in West Bengal – Kolkata – is a new entrant to the list. Its TPR is currently 12.5%.

Local transmission of omicron

Separately, Delhi health minister Satyendra Jain admitted today that the omicron variant was spreading locally in the national capital. This is also called community transmission; it means more people are getting infected by the omicron variant because the virus is spreading within the city, instead of the people having to travel away.

According to Jain, of all the samples obtained in Delhi and subsequently found ‘positive’ for the virus, 54% had the omicron variant. Some of these samples were from people who had no recent travel history. This, Jain said, indicates that the variant is spreading locally.

Delhi is the first and only state, thus far, to have admitted on the record that the omicron variant has commenced community transmission. But this doesn’t not mean people infected by the omicron variant and have no recent travel or contact history are restricted to Delhi. The health departments of at least two other state governments, Maharashtra and Karnataka, have reported detecting the omicron variant among people with no recent travel or contact history. However, they haven’t officially said anything about local transmission.

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The Union health ministry has also admitted to detecting such cases but has stopped short of admitting to community transmission of the omicron variant.

Nonetheless, given Jain’s admission, the All India Institute of Medical Sciences in the city issued a memorandum today extending the tenure of senior residents. “During the extension period, the senior residents will be exclusively posted in COVID-19 areas,” the memorandum read.

Alert, not panic

Even though all indications are that the days ahead may not be good, Paul said there was need to be alert, not panic. He also said twice during the presser that they didn’t know enough about the omicron variant’s expected severity of the illness.

“It’s unsettled. Hopefully, it will be mild, but may not be also. The need is to be responsible and be prepared,” he said.

He also repeated the conclusions of many studies published from around the world – that although the number of hospitalisations has gone up in different countries, the death rate and severity have stayed low.

In fact, Delhi’s Jain also said none of the 200 currently hospitalised patients in Delhi have required supplemental oxygen and that most patients had relatively minor symptoms.

At the same time, Paul and other experts have cautioned that any complacency at this time could prove disastrous for the country’s health infrastructure.

A health official takes swab sample of a man at a market for COVID-19 test, amid concern over rising Omicron cases, in New Delhi, Tuesday, Dec. 28, 2021. Photo: PTI/Kamal Kishore

The other significant questions at the presser were about electoral rallies flouting COVID-appropriate behaviour, following the Election Commission’s announcement today that it wouldn’t postpone the upcoming Uttar Pradesh state elections.

Paul parried the question twice, but finally said: “This isn’t the appropriate forum to comment.”

‘Precautionary doses’

On December 25, Prime Minister Narendra Modi announced that the health ministry would roll out vaccines for those aged 15-18 years from January 3 and booster doses – or ‘precautionary doses’, as Modi called them – for frontline workers and the elderly from January 10, 2022.

But the Centre is yet to decide which vaccine should be used for the ‘precautionary doses’.

“An extensive debate is going on,” Indian Council of Medical Research (ICMR) chief Balram Bhargava said at the presser. “There are many parameters to consider. How much is the target population? Which vaccine doses are available and [in what quantity]? What is the safety and efficacy of available vaccines as additional doses?”

Bhargava also presented a slew of Indian studies, including this and this, both conducted by the body he heads, to say that people who have recovered from a novel coronavirus infection retained their natural immunity for nine months on average.

However, the first of the two ICMR studies was conducted between April 2020 and February 2021 – a period that overlapped with the first wave, caused by the ‘original’ strain of the virus. Similarly, the second study had been conducted between November 10 and December 15, 2020, when the delta was starting to spread but hadn’t yet dominated.

Bhargava didn’t say whether his conclusion would hold true for the omicron variant or even the delta, considering neither strain had become dominant when these studies were conducted.

He also invoked other studies vis-à-vis the immunity offered by vaccines in India. One, reported in early November, examined the protection offered against the delta variant and against the original strain. It found that the protection conferred by Covishield and Covaxin lasted for 10 months. Studies probing the effectiveness of these vaccines against the omicron variant are still underway.

Bhargava added that the primary purpose of vaccines remains to prevent severe disease, hospitalisation and death – and not preventing infection.