Excerpts from “MedPage: India’s COVID Spike and Plummet. What Have We Learned?”

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Vaccines and face masks rank first and second in Covid-19 prevention. There is no mention of Ivermectin.

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India’s COVID Spike and Plummet. What Have We Learned?

— Experts discuss the country’s second deadly wave

by Shannon Firth, Washington Correspondent, MedPage Today October 29, 2021

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All of the physicians and public health experts who responded to our inquiries agreed that one of the primary reasons the virus dissipated so quickly after the second wave was that it simply had nowhere left to go.

Not a Wave but a ‘Sharp Spike’

The “virus inferno” is how Bhramar Mukherjee, PhD, of the University of Michigan School of Public Health in Ann Arbor, refers to India’s second wave, which hit before the country had a chance to fully roll out vaccination.

Seroprevalence surveys at the end of June found that roughly 70% of the Indian population had SARS-CoV-2 antibodies, said Mukherjee, which can only mean that those antibodies were the result of past infection. At that time, India had vaccinated only about 2% of its population. In the U.S., seroprevalence rates were closer to about one in three Americans prior to vaccination, she noted.

During the second wave, the country witnessed a “very sharp spike and fall,” which, as seen in other outbreaks, often occurs after the virus returns with a mutation that is more transmissible, in this case, of course, being the Delta variant, she continued.

At the same time, human behavior grew more lax, said Mukherjee.

Gagandeep Kang, MD, PhD, of the Wellcome Trust Research Laboratory at the Christian Medical College in Vellore, India, and an adjunct professor at Tufts University in Massachusetts, agreed, noting that by January and February of this year, “you could see that the masks were coming off or were inappropriately used.”

When Delta arrived, “hardly any household was spared,” said Arvinder Singh Soin, MD, of the Institute of Liver Transplantation and Regenerative Medicine in Medanta, India, in an email.

At this point, people weren’t as willing to stay home. Some were in denial and others simply had pandemic fatigue, Mukherjee said.

Kang recalled the “tens of thousands of people” at election rallies and the millions who took part in festivals and pilgrimages across the country, who then brought the virus back to their communities.

“So … the virus is coming back with [a] vengeance and the human beings are letting their guards down. [The] juxtaposition of these two forces often leads to this huge spike that we see … and I think that’s exactly what happened,” Mukherjee noted.

Once people “exhausted” their networks — meaning the infected people had exposed every person they could among friends, family, and colleagues — then cases began to fall, Kang explained.

By then the “sheer devastation,” the fact that so many people lost loved ones, hit a nerve, Mukherjee said. “I think the proximity to death really scared them.”

How long that fear will last is unclear, she added, noting that one of the biggest Indian festivals, Diwali, is set for next week.
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Lessons Learned

If India has learned nothing else from the pandemic, the importance of syndromic surveillance has been made crystal clear, according to Kang. “Because if you understand what you’re dealing with, then it becomes much easier to develop a strategy.”

She also noted the importance of developing pandemic protocols. Southern states had lower mortality rates among similar patients in Northern states because the South was more prepared, she said.

Second to vaccines, distributing free masks is probably the “best intervention” the country can invest in, she added, noting her strong support for mask mandates.
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A Third Wave

Despite “hysteria” over a possible surge in July and August, “our models actually never projected the third wave,” Mukherjee said; however, just because a “huge, towering wave” isn’t expected in the next 4 to 6 weeks doesn’t mean that people shouldn’t remain vigilant.

“Unless we’re careful in the festival season and get fully vaccinated, we could be staring at a third wave soon,” Soin said, noting that uptake of second doses of the vaccine has been lagging.

He also emphasized his support for mandatory vaccination certificates for those on welfare, for domestic travel, in public spaces, and at work.

Lancelot Pinto, MD, of P.D. Hinduja National Hospital and Medical Research Centre in Mumbai, said that there are “naysayers” who don’t think India should invest in preparing for a possible third wave.

But when there’s a disease with this many unknowns, it makes sense to prepare for a worst-case scenario, he told MedPage Today on a phone call. “Nobody had predicted Delta. Right?”
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While festivals have been ongoing for the past 3 weeks, Kang said that no uptick in cases has been reported anywhere. “So, not to say that it can’t happen. But, so far, there are no huge indicators that things are going awry.”
Shannon Firth has been reporting on health policy as MedPage Today’s Washington correspondent since 2014. She is also a member of the site’s Enterprise & Investigative Reporting team. Follow


Shannon Firth has been reporting on health policy as MedPage Today’s Washington correspondent since 2014. She is also a member of the site’s Enterprise & Investigative Reporting team. Follow

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