GUWAHATI – Amid sharply falling COVID-19 cases, the streets in the largest city in north eastern India have started to resemble pre-pandemic days, crowded with pedestrians, vehicles, roadside vendors and hawkers jostling for space with scarcely anyone wearing masks.

This follows the decision by Assam state to lift all restrictions from 15 February, removing curfews and  restrictions on public gathering of people, and even mandatory testing for passengers at airports and railway stations, according to the chief minister of the state, Himanta Biswa Sarma. 

#AssamCovidUpdate

GoA shall withdraw all #COVID19 compulsory testing facilities at airports, rly stations and hospitals wef Feb 15. Also, all restrictions incl night curfew, social-religious gatherings including other curbs shall stand withdrawn. Detailed notification on Feb 14

— Himanta Biswa Sarma (Modi Ka Parivar) (@himantabiswa) February 13, 2022

Across the rest of the country other states have followed Assam’s lead, by easing restrictions. The Delhi Disaster Management Authority (DDMA) has allowed schools and gyms to reopen in the national capital. In Andhra Pradesh, Meghalaya, Rajasthan, the night curfews imposed to check the spread of coronavirus, have been lifted. 

India’s surge in coronavirus surge began on 27 December, and peaked in mid-January with more than 340,000 daily cases. But by 13 February, that number had dipped to 44,877 cases, according to India’s health ministry. Across south Asia, cases are also falling including in Nepal and Bangladesh. 

Cases subsiding rapidly

Dr Abhijit Sarma, superintendent at the Gauhati Medical College Hospital (GMCH), the largest government hospital in Assam state, said there has been a sharp decline in daily cases and the positivity rate shows that the wave is “subsiding and retreating”. “It is coming down,” he said. 

This surge, fueled by the highly transmissible Omicron variant, was termed the third wave of the pandemic in India by experts. It was predicted that the wave will be short-lived and its impact will not be as severe as that of the first and the second waves. 

“The symptoms for Omicron stay for three days and by the fifth day, it usually goes down. So, the severity is less compared to Delta,” Dr Sarma said, but added that it had been more serious for those who were unvaccinated or partially, and senior citizens with comorbidities.  

The country has so far given more than 1.7 billion doses of vaccines and about 76% of eligible adults have been fully vaccinated. In reaction to the third wave, the country began administering a precautionary booster dose of vaccine to healthcare workers, frontline workers including personnel deployed for election duty and those aged 60 and above with comorbidities from 10 January onwards. It also started vaccinating 15-18-year-olds from January.

Professor K Srinath Reddy, president of the Public Health Foundation of India (PHFI), said that the vaccination drive in India is going “fairly well in terms of intended coverage from whatever has been reported in the media.” 

India’s battle with the Omicron variant was surely aided by the large scale vaccination programme, which reduced the severity of the disease, along with apparently milder Omicron symptoms. “Two doses of the vaccine is highly effective,” Chennai-based virologist Dr Jacob T John said.

“We must recognise another fact that vaccines are meant only to protect against severe illness and death, not against infections, per se,” Reddy explained. “The Omicron wave has resulted in not as much severe infection and illness, partly because the virus itself appears to be milder and partly because a lot of our population has acquired immunity through natural infection, vaccines or both.” 

For its vaccination drive, although India has approved seven vaccines it is currently using only three – Covishield (AstraZeneca), Covaxin (Bharat Biotech) and Sputnik V (Russia), with  Covishield accounting for more than 85% of the doses administered so far.

When asked which of these vaccines was functioning well, Reddy explained that there are two ways of assessing whether the vaccines performed well or not. One is through lab tests by studying T cell immunity and the other way of assessing is by identifying how many breakthrough infections are occurring. 

“We do not have adequate data to analyze what the amount of breakthrough infections or the amount of hospitalization in vaccinated people are,” said Reddy, but added that the National Institute of Virology in Pune had demonstrated that both Covishield and Covaxin had continued protection against even the Omicron variant. 

Lack of testing and underreporting confound diagnoses 

Dr Angkita Barman, a Guwahati-based doctor who specialises in anesthesiology, and works at a private hospital in the city, said that in smaller cities such as Guwahati it had been difficult to determine whether a person is infected by Omicron or Delta . “An assumption is made based on the symptoms of a patient as we don’t have a proper lab here which will suggest what variant it is,” she said. 

To confirm whether a suspected case is Omicron requires a full genetic analysis, which can take between four and five days. 

“We have come across severe cases in this third wave as well and that could be due to Delta as well but we do not know. We are not investigating on that front due to lack of a proper lab,” Barman explained. 

Virologist John said most current cases are Omicron and that although official case figures for the Delta wave appeared higher than the Omicron wave, this was contrary to international trends and due to an “undercount”.

“Everybody knew that this disease did not cause pneumonia and hypoxemia, therefore a lot of people did not bother to get themselves tested,” said John, adding that the government was also not enthusiastic about following up on cases due to the state elections in five Indian states. 

Death toll may be six or seven times higher

India also reported a surge in the use of home testing kits with 200,000 home tests used in the first 20 days of January in comparison to 3,000 in all of 2021, the director general of the Indian Council of Medical Research, Balram Bhargava said on 20 January.

In Mumbai, the sale of self-testing kits also rose but the municipality made it compulsory for purchasers to provide their individual identification number when buying kits in an attempt to keep track of cases.

 Six to seven times more people could have died of COVID-19 in the first and second waves of the pandemic than officially reported in India, according to a study published in Science last month. 

The study estimates that as many as 3.2 million people could have died from the disease, whereas the government-recorded number is 419,000 deaths between June 2020 and July 2021. 

“India’s reported COVID death totals are widely believed to be under-reports,” the authors wrote in the study, “because of incomplete certification of COVID deaths and misattribution to chronic diseases and because most deaths occur in rural areas, often without medical attention”.

Reddy urged people not to abandon masks, noting that the virus “could still mutate to a more virulent form particularly if it mixes up with other viruses in what’s called an antigenic shift”.

Image Credits: Deepak Choudhary/ Unsplash, Govind Krishnan/ Unsplash.