New Delhi: Maharashtra has rarely fallen off the list of Indian states worst hit by Covid-19 since April 2020, and now, another recent surge is causing grave worry.
The state accounts for 56 per cent of all active cases in India currently, with eight of the top 10 districts in the country. In the last one month, in fact, Maharashtra has shown an explosive spurt in active cases from 36,917 on 11 February to 1,00,240 on 11 March.
However, Maharashtra’s vaccination data stands in sharp contrast — the state accounts for just 7 per cent of fully vaccinated people in India. Of the 35,73,489 vaccine doses administered in the country last Friday and Saturday, just 3,84,922 or 10 per cent were administered in Maharashtra.
This has now prompted experts to call for targeted vaccinations in high-burden districts to achieve herd immunity faster.
Another one of Maharashtra’s problems has also been chronic under-testing. Despite the fact that the state is now testing close to 1 lakh samples a day (97,918 last Friday), the state has achieved a tests-per-million figure of 1,42,513.9 against a national average of 1,63,160. The case fatality rate too continues to remain almost one percentage point above the national average.
Subhash Salunkhe, technical advisor to the state government on Covid control, told ThePrint: “Maharashtra is on an upward trajectory of the second wave, and this is likely to continue for 15 days or so till the state government’s measures to actively control the situation start showing some results. We have just started taking these steps, such as increasing testing, being more vigilant about contact-tracing, quarantine of high-risk contacts.”
Salunkhe added: “District and civic administrators need to implement these four or five measures very strictly. If these things are done properly, we will start seeing an improvement in the situation by 15 April.”
Lagging behind in vaccinations
Expressing his concern about the situation in Maharashtra at the weekly Covid briefing last Thursday, NITI Aayog’s Member (Health) Dr V.K. Paul had said: “We are very worried about Maharashtra. Across several districts of Maharashtra — there is a strict lockdown in Nagpur — we are reaching a situation where those approaches are being brought back. It’s a very serious matter.”
Paul added that the lesson was not to take the virus for granted. “If we have to remain free of it, it is very important that all our armamentarium such as Covid-appropriate behaviour, health system readiness etc. is brought into facing this pandemic. Our suggestion in all states where the virus is on the rise is that vaccinations of eligible individuals should be prioritised.”
But despite this, vaccinations in Maharashtra have not really picked up. Of the total 2,97,38,409 vaccine doses administered in the country, only 27,83,323 — about 9.3 per cent — were given in Maharashtra.
Maharashtra’s surge has left public health professionals flummoxed because the measures for disease control are the same — testing, tracking, containment. As Union Health Secretary Rajesh Bhushan put it, “more of the same, but more efficiently”. But after months of “practice”, the state still does not seem to have quite perfected it.
But at the same time, not everybody is convinced by the Government of India’s stance that new variants of the SARS-CoV-2 are not to be blamed for the increase in the number of cases.
“One thing is clear — part of the problem is the new variant that developed in Vidarbha. But I cannot understand why there is such a lot of difference between Gujarat and Maharashtra, for example. Gujarat has a population of 6.5 crore, Maharashtra about 10-11 crore, but in almost every Covid parameter, Maharashtra’s figures are 10 times higher than Gujarat,” said Dr Dileep Mavlankar, director, Indian Institute of Public Health, Gandhinagar.
“That is why I think a better way to go about vaccinations is to prioritise high-burden districts. The top 50 districts in the country account for 50 per cent cases currently. If we start vaccinating the general population, concentrating on these districts rather than the whole country, we may be able to achieve herd immunity faster. We need clarity on how much vaccine is available and then apportion it by disease burden rather than just the eligible population. Also, I think vaccinations have to be 24/7,” Mavlankar said, adding that the public health question really is whether the goal is to reduce mortalities or to reduce cases.
States currently do not administer the vaccine on Sundays, the Ministry of Health said in a brief update Sunday evening. Fresh lockdowns in Maharashtra may further impede the pace of vaccination, experts fear.
The Vidarbha variant
In the Covid briefing on 23 February, Dr V.K. Paul had said while mutant strains have been found in Maharashtra, they cannot be causally linked to the increase in cases.
“Mutations are the nature of the virus. So, there are other variables… I would like to confirm that the N440K (one of the strains found in India, especially southern states) and E484K (UK) variants have been detected in Maharashtra and Kerala. But mere detection is not enough. To relate occurrence of virus to a change in disease pattern, epidemiological and clinical information have to be linked,” he had said.
The Government of India reiterated its position last Thursday too that new variants are not responsible.
The Vidarbha strain is a unique mutation that was first found in Amravati district. This mutation has been termed E484Q, which has similarities to the UK strain, and like that strain, is more transmissible.
E484Q is one of more than 7,000 Covid variants in India. Amravati has been recording one of the highest test positivity rates in the state.
(With inputs from Manasi Phadke)
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