Maharashtra and Delhi have unveiled their plans for graduated release from lockdown. Wanting to restore momentum to the economy while keeping the pandemic under strict control, their governments propose to shift gears progressively while watching the road ahead. As any good driver should.
The national lockdown in 2020 was intended to prepare the healthcare, administrative and social systems for effectively responding to an apprehended surge. It succeeded in keeping the human toll comparatively low. The lockdowns in 2021 came as state initiatives, after a ferocious second wave caught an unwary nation off guard. These lockdowns were to stall the surging levels of transmission so that heavily burdened health services could recoup to cope with a manageable caseload.
Indicators of this are explicitly incorporated into Maharashtra’s plan, which has level 1 as the least restrictive and level 5 as the most. Test positivity rate (TPR) and hospital occupancy of oxygen-equipped beds by Covid-19 patients are taken as guides to determine the permitted levels of people mobility and function of different occupational groups.
TPR, by itself, is fallible because considerable variations may result from the daily total number of tests performed, repeat tests performed in previously tested individuals, ratio of RT-PCR to the less sensitive Rapid Antigen Tests, and mix of indications for testing. Occupancy rate of oxygen-equipped beds gives a good measure of the serious cases that health services have to care for. Together, these measures can track the direction of the pandemic and distance to full recovery.
Delhi’s plan is less structured, though a low TPR is cited to justify opening. Pressure on hospital beds has also eased. While these signs are propitious, the stages of unlock are not presented with the clarity that Maharashtra provides. Why should malls be permitted to operate early, when risk of aerosol transmission there is higher than in open markets? What is the rationale of selectively permitting markets and malls to function on odd and even days, when that will force people to commute far and crowd into a few open malls or markets rather than disperse them across the city?
Some observers question the wisdom of unlocking even partially before a large part of the population is vaccinated. They advocate continued lockdown till the end of July. However, our vaccination rates cannot be ramped up to reach escape velocity from the pandemic in just two months. Even with Sputnik V joining Covishield and Covaxin, it is unlikely that more than a third of the adult population would be vaccinated by July end.
What is the threshold for vaccine-induced epidemic end? Can we additionally depend on immunity provided by natural infection, to judge whether we have moved out of the danger zone? Answers are not readily available. Neutralising antibody levels are variable in strength and duration after infection, depending on the dose of viral exposure, age and nutritional status of the infected person. Also, their efficacy appears diminished against currently circulating virus variants.
Immunity conferred by the vaccines too is reduced against the Delta variant, now dominant in India. A recent report from Public Health England and a Lancet publication (June 3, 2021) examined the numbers of symptomatic Covid occurring in vaccinated persons and the levels of neutralising antibodies. On both measures, the Delta variant evaded vaccine-induced immunity more than the Alpha variant or the wild virus.
Two reports from Brazil offer interesting contrast. In January 2021, it was reported that the epidemic raged in the city of Manaus, despite 76% of the population testing positive for antibodies. While the P.1 variant was incriminated, the study suggested that depending on ‘herd immunity’ conferred by natural infection is foolhardy. A recent study from Serrana revealed that deaths were reduced by 95% and infections by 86%, when 60% of the population was vaccinated. On June 1, 2021, Britain reported zero Covid-19 deaths for the first time since March 2020, after 59% of the British adult population were vaccinated.
If we conclude that we too must achieve 60% vaccination coverage to attain such safety, despite differences in the nature of circulating variants, we have several months to go. We cannot remain in lockdown till then. That will cripple the economy, increase poverty levels and deprive children of education. We must indeed accelerate vaccination, through increased domestic production and international procurement. While doing so, we must release ourselves from the stranglehold of the lockdown by adopting all other measures shown to be effective against viral transmission.
Whether it is the wild virus or the Alpha variant or the Delta variant that we may be exposed to in any part of India, properly wearing a mask will protect us from the virus entering our nose or mouth through droplets or aerosol. We must also maintain physical distancing, wherever possible. Moving and meeting others in well-ventilated places helps to reduce the risk of exposure to viral clouds that linger in closed, ill-ventilated places. Only essential travel must be undertaken. All superspreader events must be forbidden till we can gauge the likelihood of the next wave by November-December. By then, the government expects to complete adult vaccination.
Freedom from lockdown comes with the price of diligent discipline. Searing images of devastation and distress we witnessed during the second wave, and the sense of personal loss most of us experienced in the death of someone close, must steel us in our resolve to be disciplined. Only then will the release from lockdown set us on the path to recovery.
Views expressed above are the author’s own.
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