There are two ways to deal with the uncertainties arising from the Covid-19 pandemic. The first is to take them as they come, and as I wrote in an earlier column, deal with the daily developments with a Stoic mind. To play the stroke according to the ball that comes your way. The second way is to try to get a sense of how things are likely to pan out, and prepare for them in advance to the extent possible. To have a game plan, but still be Stoic about it because things might not go the way you want. Most people can choose either way. But those who have to make personal, business or policy decisions that involve a longer horizon need some way to look beyond the here and the now. In other words, we need information that helps us estimate what might happen in the future. And this is where the problem lies.
Now, like all public health problems, the Covid-19 pandemic is both an information problem and a health problem. It has been an especially difficult one because, initially at least, we didn’t know much about the disease itself and because we still do not have accurate data about how it is spreading in India. Yes, we have daily updates of new and active cases, recoveries, deaths and so on. I am personally aware of government officials, medical personnel and public-spirited data scientists going the extra mile to compile and publish data. But the overall situation is like counting potholes on the street at night. You can count them wherever you have working streetlights, but you are pretty much in the dark where there are none. Even our biggest cities don’t have streetlights everywhere, and none at all once you leave the outskirts of towns. You have little choice but to make intelligent guesses and — to really stretch this metaphor — wait for daylight. The published Covid-19 figures are just the potholes under the streetlight that we can count. There are more.
How many more? In August this year, I conservatively estimated that the actual number of coronavirus cases are 10 to 20 times higher than the recorded figure, and argued that the pandemic could taper in India as early as October 2020. My cynically optimistic back-of-the-envelope (COBOTE) model estimated that ”over 50 per cent of the population will have immunity by mid-November 2020, and the country will be at the threshold of herd immunity”. It turns out that I was far too conservative.
Nearly half of India infected
According to a paper published by the Indian Council of Medical Research (ICMR) last month, based on a sero-survey conducted in May-June 2020, the actual prevalence of Covid-19 might be 80 to 100 times higher. For every pothole that we observe, there are 80 to 100 more that we do not. So, if the cumulative positive cases in India officially stand at 6.7 million (or 67 lakh) today, in reality, there probably are between 536 million (53.6 crore) to 670 million (67 crore) people who have already been infected. That’s between 39 per cent and 48 per cent of India’s population, and approaching herd immunity levels.
The slowdown in the number of new cases since 17 September, despite higher levels of testing, supports the argument that the coronavirus has run through half the population of the country. Indeed, professors T. Jacob John and M.S. Seshadri are “confident that India indeed has reached the peak of the COVID-19 epidemic.” This doesn’t mean that the pandemic is over and we can let down our guard. As John and Seshadri, both formerly with Vellore-based Christian Medical College, point out, the epidemic ends when around 70 per cent of the population has antibodies, which means another 303 million (30.3 crore) to 427 million (42.7 crore) people remain vulnerable to the disease over the next six months. John and Seshadri predict that the pandemic will end by mid-March 2021, more or less consistent with my COBOTE estimate of end-February 2021. In any case, the Narendra Modi government estimates that 250 million (25 crore) people will be vaccinated by July next year.
Increase the level of caution
The upshot is that while the end of the Covid-19 pandemic might now well be in sight, we must raise the level of caution to minimise the new infections and deaths until then. The reopening of schools, cinema halls, religious places and public transport under progressive “Unlocks” can cause a resurgence in the number of cases.
Recent findings in India (see data journalist Rukmini Srinivasan’s analysis in Mint) and in other countries show that the risk is particularly high where, as professor Zeynep Tufekci puts it in an essay in The Atlantic, “the three C’s come together—crowds in closed spaces in close contact, especially if there’s talking or singing.”
This does not call for the continuation of a national closure of schools and cinemas — rather, to reiterate what I have argued from the outset, local authorities must decide whether or not to reopen places where large numbers of people congregate. With hospitals and health care facilities already maxed out, the next few months can portend greater human tragedy than we have so far seen. The need for caution, for stricter adherence to masking and social distancing, and for avoiding non-essential gatherings is as great as ever.
In the case of Covid-19, it will be darkest before dawn.
The author is the director of the Takshashila Institution, an independent centre for research and education in public policy. Views are personal.