Here’s why Covid cases in Maharashtra are declining
Experts cite the receding second wave, widespread infection in the population and the overall coverage of vaccination of Maharashtra
Easing of restrictions, opening up of public transport, schools and colleges, overcrowding in public places such as markets, and a precipitous fall in vaccination numbers in October led policymakers to worry about a third Covid-19 wave in Maharashtra, with the state task force repeatedly issuing warnings. Yet, Maharashtra has been recording a steady decline in both daily fresh cases as well as fatalities.
Public health experts attribute this trend to a combination of multiple factors – the receding second wave, widespread infection in the population and the overall coverage of vaccination. Virologist Dr T Jacob John from Christian Medical College in Vellore believes that Maharashtra and many other Indian states surpassed the herd immunity threshold at the end of June. “Maharashtra is now in the endemic phase,” Dr John said. The US-based Centers for Disease Control and Prevention (CDC) define endemic as “the constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area”.
Until November 4, Maharashtra recorded 6,615,299 cases and 140,325 deaths, making it the worst-affected state in India. The state with the next highest number of cases is Kerala with over 4.9 million, with nearly 33,000 deaths. Karnataka has nearly three million cases and over 38,000 deaths.
In October, Maharashtra saw an average of 1922 new cases daily, down from 3424 cases per day in September. The first four days of November averaged just 1055 new cases.
“Vaccinations are a recent addition to tackle the pandemic,” Dr John said. “The virus moved much faster and a large majority of the people were already infected and had antibodies due to the infection. This phenomenon has been the same in urban and rural areas as well as the adult and children population. Therefore, despite overcrowding and mingling of the population, we are not seeing a spike, as almost everyone has some level of immunity.” He added that the herd immunity threshold to the initial Wuhan strain of SARS-CoV-2 was surpassed in the end of 2020 and to the more infectious Delta strain by end of June.
There are nearly 92 million people in the state eligible for vaccination. As of November 4, 34% of this population was fully vaccinated. However, the number of vaccinations slowed down in October with a 41% decline in daily average doses administered through the month as compared to September. From a daily average of 760,955 doses administered in September, vaccination dropped to 536,704 daily doses in October. State health officials have attributed the decline to the Navaratri festival and the harvesting season.
“Maharashtra resembles the national scenario, barring Kerala, Mizoram, Sikkim and Meghalaya where the decline in cases has been slow,” Dr John said.
But medical experts warn that a new variant of the SARS-CoV-2 may still shock the system. “Caution is therefore extremely necessary,” said Dr Shashank Joshi, a member of Maharashtra’s Covid-19 task force.
According to Dr Joshi, the second wave is receding in the state and there has been substantial vaccination coverage, which has helped in keeping the numbers low. “Largely, our population has antibodies against the Delta variant and its derivatives as it was the most dominant strain through the second wave. But if the variant changes, we may be back to square one,” he said.
Serological surveillance studies carried out in congested cities such as Mumbai have shown that more than 85% of the population have antibodies. A serosurvey conducted in Pune showed 51.55% seroprevalence in August. Even as the overall cases are on the decline, there has been no corresponding decline in daily cases in Mumbai and Pune. Nearly half of Maharashtra’s 15,062 active cases are currently in Mumbai (4160) and Pune (3190) as of Thursday, November 4.
“The virus continues to be around and a lot of cases in the endemic phase are re-infections,” said Dr John. Doctors treating Covid-19 patients also said that hospitalisations have reduced considerably and they are mostly seeing mild infections.
Some health experts also cautioned about the reduced testing in districts. For instance, the Pune district has been carrying out 15,000 Covid-19 tests over the past two to three weeks. Prior to that, its daily testing numbers had touched 35,000. “People are not willing to test if they don’t have symptoms,” said Dr Bhagwan Pawar, Pune’s district health officer. “We have therefore started concentrated testing in areas where positive cases are coming from,” he said.