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Opinion

An Unending & Uncertain Battle Against the Covid

NEW DELHI, Feb 7 2022 (IPS) - The year 2021 began with several new vaccines showing efficacy in randomized trials, but despite 26 authorised Covid-19 vaccines globally, and at least another 200 in development (The Lancet, 2021), the first few weeks of year 2022 brought a sense of uncertainty.

Nearly 2 years after the first Covid-19 case was registered in India, the country ranked third globally in terms of total deaths due to coronavirus, and second in terms of total number of cases. More than six and a half million cases and fifteen thousand deaths were added to India’s tally in January 2022 alone. The increased detection of the Omicron variant in the initial weeks of the year raised concerns whether we will see another deadly wave worse than the second.

Despite the availability of drugs in hospitals and pharmacies, presence of trained, mostly vaccinated health workers, enhanced bed capacity, three approved vaccinations, markedly reduced test prices and easier treatment affordability, the second wave saw a much faster spread of the disease.

The failure to follow Covid-19 safety protocols amidst the events such as election rallies, farmers’ agitations and religious gatherings has had severe consequences in the form of spiralling cases, reduced supplies of essential treatments, and increased deaths particularly in the young.

No state or union territory has been spared by the pandemic, especially in the second wave, but the spread of infections has been disproportionate, and the policy response and outcomes have been varied. This asymmetric impact of Covid-19 across states, both in terms of spread and mortality has its explanation in not just medical factors such as availability and accessibility of health care resources, but several socio-demographic and economic factors. These determinants of the state wise variation have important implications for socioeconomic planning and policies, particularly because state governments have been using measures such as closures and containments, and during the second wave, were seen as ‘laboratories’ for the control of Covid-19.

Our analysis focuses on identifying determinants of the spatial heterogeneity of the pandemic, in terms of number of cases and deaths per million population for a 15 month period starting mid-March 2020 until the end of June 2021. Our findings suggest that the pandemic has had a greater intensity in regions with higher per-capita incomes and urbanization rates. That the richer regions show a higher number of cases compared to the poorer regions could partly be attributed to better rate of testing, but also because the richer regions are more likely to attract more frequent travels due to business, and migrants and thus initially expected to be the hubs of the coronavirus infection with a more rapid diffusion to other regions.

While higher incomes would enable easier access to health care facilities, and the ability to work remotely, higher incomes are also associated with greater mobility, and consumption of income elastic items such as dining out, entertaining and socialization – items that generate higher infection risk. Urban areas are more susceptible to the spread of Covid-19, primarily because of greater density, congestion, and may be home to urban slums with inadequate hygiene and sanitation.

Our finding results also suggest a greater intensity of the pandemic in states with higher disease burden due to non-communicable diseases, higher proportion of population in the age group 60 years and above, and lower proportion of population belonging to disadvantaged socioeconomic groups. Thus, interplay between affluence and urbanization, environmental risks and co-morbidities, and the associated higher fatality rates seem highly likely.

A comparison of the state-wise incidence of the pandemic during the first and the second wave reveals the importance of decentralization of essential health services as a one-size-fits-all approach in flawed. States and districts should have the autonomy to respond to the changing local situations, and there is an important role of technology in streamlining the management of resources (including funds) within and across regions.

An active management information system, with accurate data on demographic distribution of cases, deaths, hospitalisations, vaccinations, along with statistical modelling to predict the spatial spread of infection can enable regions to proactively prepare for the likely caseloads in the future.

There is continuing uncertainty about how the Covid-19 epidemic will unfold in the near future. There are reasons why we should be wary. Firstly, vaccination does not eliminate the risk of infection. Besides, the chances of vaccination reducing transmission to others are undermined by the finding that the new variants start spreading even in the absence of symptoms. Moreover, vaccine-induced immunity wanes with time and new variants. For instance, a growing body of ongoing researchsuggests that the vaccines used in most of the world offer almost no defense against the Omicron variant.

The necessity of booster doses, except in the immune compromised, is not fully understood but it’s likely that they will prolong protection. Another concern with vaccinations is hesitancy around getting inoculated.

In short, the current regime of vaccination offers neither “herd immunity” nor long-term protection. So the outcome of the endless battle remains shrouded in uncertainty.

Nidhi Kaicker is an Assistant Professor of Management at Ambedkar University Delhi. Radhika Aggarwal is an Assistant Professor of Management at SMVD University, Jammu.