India is in the middle of a Covid-19 surge that’s rising exponentially and can’t be reined in by booster shots at this stage, says a leading virologist. “For this wave, we are too late. Nothing will now rein it in,” says virologist T. Jacob John.

We could see the Omicron surge play out two ways. John reckons the number of Omicron cases could soar and then come down at equal speed as they appear to have done in South Africa, where the highly transmissible variant was first detected. “We could expect a fast-rising peak. I expect the peak should be reached within weeks, not months,” he says, adding: “The fall would be equally fast.”

Like India, South Africa has a large number of young people who generally suffer fewer Covid-19 symptoms than older people. Also, South Africans had built up immunity from three previous Covid-19 waves. South Africa’s fourth wave peaked in four weeks and then went into precipitous decline without causing a big increase in deaths. “(It) was a flash flood more than a wave,” tweeted Fareed Abdullah, a director at the South African Medical Research Council.

But another eminent Indian virologist, Shahid Jameel, feels that circumstances may mean Omicron may last longer. Says Jameel: “Massive election rallies, low mask compliance and business as usual tell me that we may have a more protracted course with the caseload shifting from urban to rural areas.

John believes the government should have moved more quickly when the first news about Omicron emerged from South Africa. “We were warned on November 25. We should have had a plan of action on November 27. But we waited till December 24-25.”

India’s caseload rocketed by over 93,000 in 24 hours to hit the highest level in nearly 200 days and Omicron now accounts for over 80 per cent of the Covid-19 cases emerging in Delhi and Mumbai. It’s swiftly displaced the Delta lineage that left devastation in its wake last year. The R nought value for the country as a whole that shows the spread of the infection is 2.69 – higher than the 1.69 at the peak of the devastating second wave.

“Around 80 per cent of the cases are Omicron which is accurate for both Delhi and Mumbai but it’s a lagging number. It will be even higher now,” says Anurag Agrawal who’s the director of the Institute of Genomics and Integrative Biology.

Spread: 3-5 times faster

Scientists reckon Omicron spreads three-to-five times faster than Delta. Booster shots are scheduled to commence on January 10 and John points out it will take around two weeks before they have an impact on people who have received the jab. Right now, only frontline workers and those people over 60 with comorbidities are eligible for a third injection and they must wait nine months until after their second shot to get one.

The government announced Wednesday booster shots must be administered with the same vaccine received earlier. This means most people will receive Covishield which the British government felt would not be effective as a booster and advised Pfizer or Moderna instead. The UK and other countries are allowing anyone over 18 to get booster shots two months after their second jab. Israel’s offering two boosters.

On Wednesday, West Bengal had 14,022 cases, a steep climb from the day before. Mumbai had 15,166 cases which was a 39 per cent leap from the previous day which itself was a 34 per cent rise from the day before. This is Mumbai’s highest-ever number of new cases in one day, leaving far behind the earlier high of 11,206 cases on April 4 last year. Similarly, Delhi had 249 cases on December 25 and that rose to 5,481 on January 4 and shot up to 10,665 on Wednesday, January 5 – a stunning 94 per cent rise from the day before.

Though the figures are still a long way from the 400,000 plus daily cases at the height of the catastrophic second wave, experts say it could easily hit those levels soon, given India’s population size and the “super-exponential” spread.

In the last four-five days, there has been a "galloping increase in the number of cases," says Dr N. K. Arora, who heads the National Technical Advisory Group on Immunisation, or NTAGI. (The UK, a country of 67 million, said it feared a hospital crisis as new Covid cases topped 200,000 in 24 hours. France, a country of 60 million, on Tuesday reported a new daily record of 335,000 new cases). Even the US recorded a million cases in one day.

There will be some severe cases

While Omicron appears to be milder than the Delta variant, doctors say there will be some severe Omicron cases. Early laboratory studies suggest Omicron replicates less efficiently than Delta and stays in the upper respiratory tract without entering the lung tissue. Researchers believe that if the disease can be contained in the upper airways there’s much less chance of severe disease. The studies suggest that those infected with Omicron have a 30 per cent to 70 per cent lower chance of infected people ending up in hospital. But researchers say what is also important is that the severity of disease is not determined only by virus replication but also by the host immune response to the infection.

However,.even a small percentage of 1.4 billion people will be a lot and could easily overwhelm India’s weak health care system, especially if many healthcare workers get infected as is being seen in other countries. India reported its first known Omicron death Tuesday, that of a 73-year-old man who had comorbidities.

West Bengal, Maharashtra and Delhi are the worst hit till now in terms of the numbers of cases emerging. Uttar Pradesh and Bihar are also badly hit. Also, key figures like the R rate which indicates how many people will get infected by one person who is carrying the coronavirus are alarmingly high in West Bengal, Maharashtra and Delhi.

The R rate is 2.33 in Bengal, 2.80 in Maharashtra and 4.35 in Delhi. The R rate should be under one for the epidemic to be reasonably under control. The R rate is over one in most states currently, except significantly Kerala where the number of cases stayed high throughout last year.

Bengal logs highest test positivity rate

Additionally, the test positivity rate (TPR) in Bengal is one of the highest in the country at 23.17 which means that many people out of 100 who are tested are turning out positive. Maharashtra had a seven-day average TPR of 4.99. Delhi’s 11.8 per cent positivity rate Tuesday was also sharply up from the previous day’s 8.3. The capital saw 251 hospital admissions on Wednesday.

The TPR is an indicative figure but it’s not conclusive because only people who are feeling unwell present themselves for testing. Asymptomatic people who have no symptoms do not go for testing.

Upto now, most hospitals even in cities like Delhi and Mumbai. said they have no rush for beds in their wards and even less pressure on ICU beds and oxygen. However, this could change rapidly as the number of cases climbs steeply.

Mumbai's municipal commissioner Iqbal Singh Chahal who is in charge of the city's anti-Covid battle told an online TV channel on Tuesday that the city had 47,000 active cases and only 4,000 people hospitalised. He added that only a few cases had been admitted to ICU and even fewer required oxygen. Chahal added crucially that the turnaround time for Omicron was mostly five days and therefore beds were being vacated more quickly, reducing the chances of running out of hospital beds.

'Do not drop your guard'

A look at the UK, however, indicates that this fairly comfortable picture could change rapidly. The country had over 200,000 cases on Tuesday and the National Health Service has come under intense pressure because large numbers of health workers have also been forced into quarantine by the illness. A similar situation is emerging in Delhi where over 100 doctors at top hospitals like AIIMS and Safdarjang Hospital have been forced into home quarantine.

Also, doctors and public health experts warn that people should not drop their guard. Says Jameel: "India is unfortunately stuck on Omicron being a natural vaccine. We don’t know that. It can very quickly overwhelm the healthcare system. Follow masking and avoid crowds. No unnecessary travel. Avoid crowded markets."

Adds epidemiologist Bhramar Mukherjee: “We have not achieved herd immunity through Alpha, Delta. To think that we will achieve it through Omicron is wishful thinking.”

Vaccines and masks

IGIB”s Agrawal points out on a slightly different note: "Molecular and clinical data does show that individual risk from Omicron is lower but society risk remains high. It’s not nature's vaccine and while there is no reason for panic, there’s a social responsibility to protect ourselves and others: Vaccines and masks!"

Adds Jameel on a different note: India needs to complete two doses for everyone eligible and this is already delayed based on the government’s earlier schedules. It’s another matter that the goalpost has now shifted. “The emphasis should be to quickly boost the most vulnerable. I don’t sense an urgency for that.”