New Delhi: With the daily total number of cases fewer than 20,000, the Covid situation in the country seems to be improving. The number of Covid deaths is also decreasing. According to reports, daily new cases have seen a fall of over 80% since September. This declining figure may seem like a relief, but several doctors and health experts told The Sunday Guardian that the possibility of another wave hitting India cannot be discounted.

According to Dr Suri Raju from Regal Multi-Specialty Hospital, “Though we say it is less likely that India will be hit by another wave, we cannot ignore such chances. In the case of the UK, for example, it was thought Covid was under control, but it has been hit by a new wave. There has been an increase in Covid cases amid vaccination.”

“However, India is well prepared to fight in any such unlikely instances. With vaccines being rolled out, we are more prepared to handle the crisis in case there is any rise in Covid cases. In fact, healthcare workers being vaccinated on priority has made them more confident and they are ready to serve patients in a better way now,” he added.

Dr Sanjeev Bagai, MD and Chairman of Nephron Clinic, told The Sunday Guardian: “There is always a possibility of getting hit by another wave. Mask, hygiene, social distancing, and precaution are important for the better part of 2021. The drop in Covid cases is due to the good management by the government, good medical response, extremely good quarantine and isolation facilities, early lockdown, which helped in containing the spread, and probably the innate immunity of the Indian subcontinent. Genetic mutation can definitely be the cause if we get hit by another wave. We have already seen 30-40 odd patients of UK mutation. But mutations are a part of the RNA virus evolution and we have gazillion strains floating around the world.”

As per data from ICMR, almost 30% of the population has antibodies due to exposure to Covid, though they haven’t suffered the disease.

Dr Jagadish Hiremath, CEO of Ace Multi-Specialty Hospital, told The Sunday Guardian: “The majority of healthcare workers who have been exposed to Covid, either while treating the patients or in daily life, might possibly be immune to the disease already. Still, there is a significant vulnerable population without antibodies in them. So, the possibility of another wave is always there. That is the reason we want early immunization with vaccination for all so that we cross the 70% threshold required for herd immunity to develop in the population.”

Dr Trupti Gilada, Infectious Disease Specialist, Masina Hospital, said that the SARS CoV-2 virus has undergone over 4,000 mutations around the world, but most of these have made little difference to how the virus functions. “It is normal for viruses to undergo mutations as they replicate. A few recent strains have caused some concern though. The UK strain has mutations that make it more transmissible but with this variant, there is no evidence that it will evade the vaccination or human immune response. Also, there is no evidence that it makes people sicker or kills more people. The South African variant has been worrisome too because of its unusually large number of mutations that have changed the shape of the spike protein, which the virus uses to attach to and infect human cells. It is believed that the mutations in this strain make it harder for some antibodies (formed in response to either a Covid-19 infection or a vaccine) to get a good grip and neutralize the virus. This makes the virus much more infectious or transmissible. Over the last three months in India, we are all already witnessing increasing complacency in the behaviour of people, with inconsistent masking and small and large social gatherings without any distancing norm. These already existing variants definitely raise concerns about newer strains in the future that may be more transmissible and/or more dangerous. In the background of our dropping our guard, if these variants also evade people’s immunity, either acquired naturally or through vaccination, we are definitely in for a second wave,” Dr Gilada said.

Maharashtra, which was the worst affected state in India, may witness stability and a steady fall in terms of the number of Covid cases. Meanwhile, several doctors maintain that the country has developed some percentage of herd immunity and this has led to a drop in Covid cases.

Dr Hemalata Arora, Senior Consultant, Infectious Diseases & Internal Medicine, Nanavati Super Specialty Hospital, said: “It seems that we have developed some amount of herd immunity. But it’s difficult to estimate the exact percentage as it varies with the location, based on multiple factors such as active and past patient count, people movement, access to timely healthcare, infection awareness, etc. Multiple surveys of the Indian Council of Medical Research (ICMR) have yielded similar results. Moreover, herd immunity is determined by studying the antibody count of a group of individuals and while at times the antibody test may not detect enough antibodies for a ‘positive’ result, the person may have sufficient antibodies to fight off the infection. Thus, the concept of herd immunity in Covid infection is not very clearly understood, but it’s likely to be the reason for the drop in new cases.”

“The percentage or levels of herd immunity is different in different parts of the country or even a state. As we speak, Telangana is witnessing a rise in positive cases. On the other hand, densely populated areas such as Mumbai, which reported a large number of cases in the early stages of the pandemic have a low fresh case count. Most crowded areas of Mumbai like Dharavi haven’t reported a fresh case for several days. However, the levels of herd immunity may substantially rise as the Covid vaccination drive takes off. The vaccine will be effective against all the strains and help us gain the much-needed immunity to end this prolonged pandemic,” Dr Arora added.

“India is moving towards herd immunity. The ratio of people who have tested positive versus the people who are asymptomatic carriers probably will be 1:80. That’s the projected ratio. I think a large number of people would have gained sub-clinical infection and immunity. Over a period of time, the virus load in the country is also decreasing. People need to understand vaccines are important. Serum Institute’s Oxford-AstraZeneca Covid-19 vaccine is vector-based. It is announced to be safe with a good efficacy of around 70%. Bharat Biotech’s vaccine is also vector-based, which is made from a rabies vector virus. The advantage is it doesn’t only target the S-protein, but it also targets the N part of the protein. So, it has better coverage as far as the mutants are concerned. The vaccine program should be widely accepted. Wide acceptance is very important,” Dr Bagai said.