Medical workers attend to patients at the ICU of a hospital in Beijing, amid the COVID-19 outbreak in China, December 27, 2022. Photo: China Daily via Reuters
- The ongoing outbreak in China was bound to happen for a very long time, deferred only due to continued restrictions and zero tolerance against even a single case of COVID-19.
- The threat of developing a more infectious, immune-evasive, or virulent form of SARS-CoV-2 is real and necessitates a proactive approach. Planning for a newer variant will require several measures.
- India must prepare to act based on epidemiological and sequencing data, study how the variant responds, and surge response capabilities.
Human coronaviruses cause common colds, and reinfections occur frequently but rarely were a cause of worry as they don’t usually result in fatalities. SARS-CoV-2, the coronavirus that causes COVID-19, is an exception since it has stayed around and has evolved more than what experts could expect, leading to several waves in each country. In most countriess, COVID-19 is reaching the endemic phase, characterised by continued infections but few hospitalisations. China is going through a rapid spread of infections and is probably the last country to see massive cases ahead of the globe reaching an endemic phase.
The ongoing outbreak in China was bound to happen for a very long time, deferred only due to continued restrictions and zero tolerance against even a single case of COVID-19. The prolonged, most unscrupulous, and often excessive strategy resulted in greater distress to Chinese citizens and has resulted in global panic.
It is not that the strategy itself can be held wrong; key is when to exit and switch strategies. The measures associated with Zero Covid Strategy (ZCS) offered successful outcomes in a few countries, including New Zealand, Australia, Singapore, and South Korea. These countries lost far fewer lives and successfully kept cases largely at bay until effective vaccinations were made available to a larger proportion of people. Continuing the ZCS without an efficient exit plan has led to the current outbreak; the hospitalisation demand in China over the next few months can be 1.5-2.5 times higher than the surge in hospital capacity and up to 1.5 million deaths.
For a long time, leading journals and organisations kept showcasing China’s model as successful and urged many countries to emulate its features. Little did they realise that the vast populace was uninfected for three years, and the outbreaks were bound to happen sooner than later. The good news is that XBB and other Omicron lineages may not result in a surge in hospitalisations in India. This is mainly because of widely prevalent Omicron infections, which have been at an endemic level for several months. Also, 93% of Indians have received two doses, and 25% of eligible adults have received their booster shot. Therefore, there is no need for panic at this stage.
Also Read: COVID-19: What We Know About New Omicron Variant BF.7
A proactive approach
The threat of developing a more infectious, immune-evasive, or virulent form of SARS-CoV-2 is real and necessitates a proactive approach. Planning for a newer variant will require several measures. India must prepare to act based on epidemiological and sequencing data, study how the variant responds, and surge response capabilities.
As newer variants appear, the current standard operating procedures (SOPs) can be transformed based on evidence of how a new variant will affect our testing and hospital capacity, vaccines and treatments. For quick implementation and scale-up, the deployment of the tools, personnel, and resources must be planned. India should prepare to assemble an arsenal of vaccines, drugs and logistics to fight emerging variants and other contagious diseases. Procuring or manufacturing generic versions of newer antiviral pills should be considered. Pfizer claims that its COVID-19 antiviral pill reduces hospitalisation or death by 89%. A reliable and consistent pace of testing is needed to assess the changing trajectory in COVID-19 cases.
Surveillance is data collection for action. The government needs to prioritise expanding data collection, sequencing, and sewage surveillance capabilities to quickly identify and detect new and emerging variants. This is essential component of pandemic preparedness. The National Centre for Disease Control (NCDC), the nodal agency for surveillance, has shown exemplary leadership in tackling COVID-19 in India. Resources should be made available to NCDC to strengthen and handhold the state and district-level surveillance cells; to analyse and initiate actions.
Capacity building at the district level can aid in detecting, managing, and tracking a range of real-time response metrics, including cases, tests, vaccinations, and hospital admissions. States should establish and strengthen sequencing facilities to detect variants reliably. The INSACOG should facilitate and strengthen decentralised coalitions, mostly at the sub-state levels, bringing together researchers, academicians, and organisations to study the sequence and assess mutations rapidly.
Some states, including Karnataka, have started sewage surveillance to track the presence of SARS-COV-2 in wastewater samples. This can be strengthened and integrated at the national level to track several pathogens. Concerted actions at the district and state levels can aid in responding quickly to outbreaks due to new pathogens, including SARS-CoV2 variants.
It is important to remove the phobia of impending lockdowns and severe restrictions. To prevent adversities on the economy and social fabric, proactive efforts to set up permanent logistics and operational mechanisms for fighting future variants. This includes investing in research and partnering with industry for fast-tracked development, production, and delivery of COVID-19 vaccines and treatments. Without these preparations, communities cannot function normally: the loss of education and community connections due to the closure of schools should not recur. A simple but profound step towards minimising the spread of infectious diseases is to improve ventilation and air filtration in closed spaces of schools and workplaces.
The repeated waves of COVID-19 test global health and collective leadership. In order to control future waves or outbreaks of any infectious disease, equity must be a core element of the public health response. Vaccination, testing, and treatment efforts should be prioritised in vulnerable groups to achieve this. While addressing this internally is extremely vital, India should take the lead in promoting vaccination programmes for the underprivileged and vulnerable in other nations. The WHO can work with India and other countries to establish financial intermediaries to leverage India’s stockpile of medications and vaccines to share vaccines, drugs and logistics around the globe and save lives. What happens in China matters for rest of the world and necessitates fostering global health security as an urgent priority.
Giridhara R. Babu is a Professor of Epidemiology at the Public Health Foundation of India, Bengaluru.