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COVID-19: Are We in the Midst of a Fourth Wave?

On January 30, 2020, India recorded its first COVID-19 case when a medical student who returned from Wuhan city of China tested positive. A little over two years later the country has reported the second-highest number of confirmed cases in the world after the United States of America with 43,082,345 reported cases of COVID-19. It also has the third-highest number of COVID-19 deaths after the United States and Brazil standing at 5,23,869 deaths since the pandemic started in January 2020. According to experts, so far the country has witnessed three waves of the COVID-19 disease. 

While the country has witnessed three COVID-19 waves so far with the second wave that peaked in May 2021 being the deadliest, the recent rise in COVID-19 cases across the country is raising fears of the emergence of a fourth wave. According to experts, due to a robust vaccination drive coupled with strict implementation of COVID-19 appropriate behavior the third COVID-19 wave, more popularly known as the Omicron wave, witnessed both a low positivity rate and fewer deaths and hospitalisations. It passed somewhere around mid-March 2022 as the COVID-19 cases in India dropped to 2,500. However, in India and world over, there has been a recent spike in COVID-19 cases since the last week of April 2022. 

India has currently adopted the five fold strategy of Test-Track-Treat-Vaccination and adherence to COVID-appropriate behavior. Most states in India removed measures such as compulsorily wearing masks in public places in the start of April 2022, however the same was brought back within a few weeks as daily new cases, positivity rate, and deaths have started to rise again. 

Expert Speak

The Indian Council of Medical Research (ICMR), the leading scientific body in matters of COVID-19 in India, has rejected the occurrence of a fourth COVID wave in the country calling the current surge in cases local in nature and largely concentrated in a few districts of the country. As of May 3, 2022 India's active caseload stood at 19,137 marked by a decline of 363 such cases in a span of 24 hours. Active cases at present constitute a mere 0.04% of the total COVID cases in the country. Moreover, the recovery rate has been recorded at 98.74% with 2,911 fresh recoveries in the last 24 hours leading up to May 3rd. The daily positivity rate was recorded at 0.61 per cent with the weekly positivity higher at 0.71 per cent, as per the Ministry of Health and Family Welfare (MoHFW) Bulletin. The MoHFW has called this rise  "early hints of a fourth wave", in contrast to the ICMR’s stand. 

Muted Rise in Cases or A Cause of Concern?

According to experts, the current rate of COVID-19 cases is likely a result of under-reporting of cases, reduced testing and increased immunity levels due to previous waves and the COVID-19 vaccination drive. The vaccination program in India has reached a record high with nearly 63% of India’s population fully vaccinated and 73% having received at least one dose. According to the MoHFW data, a total of 189.17 crore vaccine doses have been administered in India as of May 1, 2022 under nationwide vaccination drive. 

In Spite of the measures, the recent emergence of cases has led the 7-day moving average of daily cases to rise to 2,800 per day as on April 29 from less than 1,000 in mid-April. In mid March 2022 when India reported the lowest single-day COVID tally in 680 days, with only 2,503 new cases in the entire country, doctors had cautioned against being complacent as the virus was witnessing a resurgence in many countries in Europe and Asia. Even as countries across the globe relaxed COVID-related norms, scientists, including the World Health Organisation (WHO), warned of the possibility of another global surge. This appears to have come true with the recent rise in cases across several districts in India. 

Preventing a Fourth Wave

With an economy riddled with inflation, reduced demand, and unused capacity, India relaxed several COVID-19 related norms, including opening up of schools, workplaces, and airports, over the past year and a half. Another worrying feature with the rise in COVID-19 cases is the asymptomatic nature of the disease, given that a large number across the world have gained antibodies and immunity against the virus. It is noteworthy that even when asymptomatic, the COVID-19 diseases can be transmitted to other people.  

Experts have called for continued implementation of testing and tracking, strict enforcement of COVID-19 appropriate behaviour and enhanced immunity through expanded vaccinations and booster doses. The success in vaccination of front-line workers, senior citizens, and the adult population of India has led to the government opening up vaccination for children between 12 to 14 years on 16th March 2022. To further expand the vaccine coverage, the central government also allowed for booster doses to be administered from 10th April 2022 to any adult above 18 years of age (at least 9 months after the second dose was administered) in private hospitals in the country. To deal with the current rise in cases, states across the country have brought back mask mandates in public places. However, enforcement on the ground and proactiveness in preparing for a rise in cases and hospitalisations will be key to preventing a deadly repeat of the second wave, which devastated India around the same time last year.

Damini Mehta