Experts cautious as India's falling Covid-19 case numbers raise hope

For the first time in months, Izhaar Hussain Shaikh is feeling somewhat optimistic.

The 30-year-old ambulance driver in Mumbai has been working tirelessly ever since the Indian metropolis became the epicentre of a catastrophic Covid-19 surge in the country.

Last month, he drove about 70 patients to hospital, his mobile phone constantly vibrating with calls.

But two weeks into May, he has carried only 10 patients. Cases are falling and so is the number of phone calls.

“We used to be so busy before, we didn’t even have time to eat,” he said.

In the past week, the number of new cases fell by nearly 70 per cent in India's financial capital, home to 22 million people.

After a peak of 11,000 new cases a day, the city is now seeing fewer than 2,000.

The turnaround represents a glimmer of hope for India, still in the clutches of a devastating coronavirus surge that has raised public anger at the government.

A well-enforced lockdown and vigilant authorities are being credited for Mumbai's success.

Even the capital of New Delhi is seeing signs of improvement as infections slacken after weeks of tragedy and desperation playing out in overcrowded hospitals, crematoriums and on the streets.

With more than 24 million confirmed cases and 270,000 deaths, India's caseload is the second highest after the US.

But experts believe that the country’s steeply rising curve may finally be flattening – even if the plateau is a high one, with an average of 340,000 confirmed daily cases last week.

On Monday, the health ministry reported 281,386 new infections and 4,106 deaths over the previous 24 hours. It was the first time the daily case count had dropped below 300,000 since April 2.

But it is still too early to say things are improving, with Mumbai and New Delhi representing only a sliver of the overall situation.

For one, drops in the national caseload, however marginal, largely reflect falling infections in a handful of states with big populations and/or high rates of testing.

So the nationwide trends represent an incomplete and misleading picture of the situation across India as a whole, experts say.

“There will always be smaller states or cities where things are getting worse, but this won’t be as clear in the national caseload numbers,” said Murad Banaji, a mathematician modelling India’s cases.

Given India’s size and population of nearly 1.4 billion, what is more important to track is a cascade of peaks at different times instead of a single national one, experts said.

“It seems like we are getting desensitised by the numbers, having gotten used to such high ones,” said Bhramar Mukherjee, a University of Michigan biostatistician tracking the virus in India.

“But a relative change or drop in overall cases does not diminish the magnitude of the crisis by any means."

With more than 3.6 million active cases, hospitals are still swamped by patients.

Experts also warn that another reason for an apparent peak or plateau in cases could be that the virus has outrun India's testing capabilities.

As the virus jumps from cities to towns to villages, testing has struggled to keep pace, stirring fears that a rural surge is unfurling, even as data lags far behind.

Combating the spread in the countryside, where health infrastructure is scarce and where most Indians live, will be the biggest challenge.

“The transmission will be slower and lower, but it can still exact a big toll,” said K Srinath Reddy, president of the Public Health Foundation of India.

Even in big cities, testing has become increasingly harder to access. Labs are inundated and results are taking days, leading many to start treating symptoms before confirming a coronavirus infection.

In the past month, cases have more than tripled and reported deaths have increased by six times, but testing has only increased by 1.6 times, Ms Mukherjee said. Meanwhile, vaccinations have plummeted by 40 per cent.

One of the biggest concerns for experts is that India may never know the full death toll from the virus, with fatalities undercounted on such a scale that reporters are finding more answers at crematoriums than official state tallies.

But while authorities previously appeared to struggle to even acknowledge the scale, they are now taking action.

“Before, there just wasn’t a focused attention. But now everyone is focused on containing it as much as possible,” Mr Reddy said.

Hit by a staggering shortage of beds, oxygen and other medical supplies, many states are now adding thousands of beds a week, converting stadiums into Covid-19 hospitals, and procuring as much equipment as possible.

States across India are preparing to be hit by another torrent of infections and even courts have intervened to help untangle oxygen supplies.

Aid from overseas, while still facing bureaucratic hurdles, is starting to trickle in. More than 11,000 oxygen concentrators, nearly 13,000 oxygen cylinders and 34 million vials of antivirals have been sent to different states.

Still, help is arriving too slowly in many districts as new infections surface in every single region – even the remote Andaman and Nicobar islands in the Indian Ocean.

Even though Mumbai looks as if it might have turned a corner, surrounding Maharashtra state is still seeing around 40,000 daily cases. “You have a really, really complicated and mixed picture,” Mr Banaji said.

But in at least one Mumbai hospital, “the burden is 30 per cent to 40 per cent less than before”, said Om Shrivastav, a doctor and a member of Maharashtra’s Covid-19 task force.

Already, the city and state are bracing for more infections. A court told Maharashtra this week to continue updating and ramping up measures as authorities look into getting vaccines from abroad to fill a domestic shortage.

“We are making sure we’re not caught napping. In the event this happens again, we’re going to do better,” Dr Shrivastav said.

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