Experts urge continued vigilance despite falling Covid-19 cases in India

NEW DELHI - Daily fresh cases of Covid-19 have dropped to less than 2,000 in nearly two years in India but experts have advised continued vigilance to track potentially dangerous new variants.

This warning comes as the country prepares to open itself up to regular international passenger fights on March 27 for the first time since the pandemic began and when cases have surged in different parts of the world.

India, however, reported 1,778 fresh cases on Wednesday (March 23), the lowest daily count since April 30, 2020. This figure has been declining steadily this year after peaking at 347,245 cases on Jan 21 during the third wave. There has also been a sustained fall in the weekly proportion of positive tests, which currently stands at 0.39 per cent.

But as cases dip, along with daily tests, there are concerns around a slackened pace of genomic sequencing in India. No figures have been released but the centre last week wrote to states urging them to maintain "aggressive and sustained genome sequencing" along with "intensified surveillance" to guard against a fourth wave.

"Whenever the numbers go down, people become relaxed and this is dangerous because then we are setting ourselves up for surprises," Dr Rakesh Mishra, the former director of the Hyderabad-based Centre for Cellular and Molecular Biology (CCMB), told The Straits Times, noting that the number of samples being sent in by states for sequencing had fallen.

CCMB is one of the 35-plus participating institutions in the Indian Sars-CoV-2 Genomics Consortium (Insacog), a network appointed by the government to track coronavirus variants.

"In fact this is the time we can expect something more interesting to come at least, if not dangerous," Dr Mishra added, referring to how Sars-CoV-2 could now be evolving in its effort to breach human immunity with new variants. "If they are not there, then you are done with the pandemic, which is really not the case."

He suggested enhancing the number of daily tests for the next few months and expanding genomic sequencing, besides regularly testing sewage samples, even if they are negative, to ensure adequate surveillance.

India's large vaccination coverage - around 81 per cent of those above 15 are fully vaccinated - and widespread infection-induced immunity have protected the population from severe disease during the Omicron-driven third wave. The country had just 23,087 active cases at March 23.

While daily testing levels have fallen from nearly two million earlier this year to around 500,000, there are some who believe this decline is not particularly concerning as of now.

Dr Anurag Agrawal, the director of the Institute of Genomics and Integrative Biology, a government institution and also part of Insacog, said current testing is "adequate" given India's low positivity rate.

"Continue sequencing as we are now, continue watching the number of cases and test positivity rate as we are doing. That's enough," he added. "Sticking to this plan for a long time, even when people feel everything is over, is important, yet challenging. But, as of now, I have zero concern (of India's surveillance being inadequate and the situation spiralling out of control)."

Dr T. Jacob John, former head of clinical virology at the Christian Medical College, said India is in an endemic phase of Covid-19, describing it as a situation in which cases fall to less than 10 per cent of the peak and continue to reduce steadily.

"From Feb 17 to March 21, we have been steadily remaining in the endemic phase," he told ST.

Dr John, however, stressed that focus should remain on sequencing, tracking hospitalisations and taking a bird's eye view on cases across the country.

"A lot of people are talking about a fourth wave coming. That is putting fear into people's minds, asking them to be cautious. I don't think that is the right way. Be cautious anyway; however, don't live in fear," he added, urging people to continue wearing masks whenever necessary such as in crowded locations.

There has also been a growing demand to open up booster shots for everyone above 45, which is presently restricted to those more than 60. Noting that by May 20, around 53 per cent of 345 million people above the age of 45 will have completed six months since receiving their second dose, The Times of India said in an editorial comment on Monday that greenlighting boosters for all above 45 and reducing the mandated gap between the second and third doses from nine months to six is essential.