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Is India heading towards a fourth wave of COVID-19?

COVID-19 cases in India have risen to surpass 8,000 new cases per day for the third day in a row, sparking fears that a fourth wave could occur in the coming weeks.


COVID-19 SARS-CoV-2 Coronavirus superspreaders blood test 2019-nCoV,SARS-CoV, MERS-CoV chinese infection blood test in Laboratory. COVID-19 cases concept. Illustration of first coronavirus death in India. Representation of coronavirus testing. Image credit: photovs / 123rf COVID-19 testing concept. Mutations illustration. antibodies concept.
Image credit: photovs / 123rf

Experts have been quick to dismiss these fears. They have said that the “new wave” is likely not a potential fourth wave that could amount to the same scale of outbreak as previous waves, rather it is an “expected fluctuation” during endemic prevalence of COVID-19. They have attributed the rise to a laxed attitude on mask wearing and low uptake of boosters since COVID-19 has fallen out of the news cycle. 

The previous peaks had a far more concerning case count, with figures eclipsing the 100,000 mark for extended periods. As previously noted by Health Issues India regarding the first wave, “cases surged to an all-time high in mid-September of 2020, hitting what was then a record point of more than 100,000 new daily cases. Following this, cases began to gradually fall, with the international community at the time hailing India as a clear case of handling and curtailing a crisis. Cases plateaued and remained at a low point — though still ever-present — until late February.”

India’s second and third waves – attributed to the Delta and Omicron strains respectively – resulted in cases rising to exceed 400,000. Cases have since subsided, with daily cases dropping below 1,000 in early 2022. 

“Rising cases are probably due to a new subtype of Omicron variant. No need to get panicked about it as it`s causing mostly upset respiratory tract infections with very rare severe disease,” Dr Harshal R. Salve, Associate Professor at Centre for Community Medicine at the All India Institute of Medical Sciences (AIIMS), told Indo-Asian News Service (IANS). “Such peaks will be expected in future as mutation in the virus is a continuous phenomenon,” he continued.

The latest surge in COVID-19 cases is being attributed to sub-strains of the Omicron variant, BA.2, BA.4 and BA.5. “The reasons for the current wave include, but are not limited to the newer variants like BA.4, the opening up of the public places and indoor meetings, not mandating masks, reopening of the school and waning immunity,” Dr Dipu TS, Associate Professor, Division of Infectious Diseases, Amrita Hospital, Kochi, told IANS.

The surge has not yet resulted in a notable rise in daily deaths, however, the overall death toll remains a point of contention. India’s official death toll places the figure at 524,771, however, the World Health Organization (WHO) has cited studies that suggest the figure could be as high as four million. Such a discrepancy is considerable, and would place India’s death toll as the highest in the world.

The WHO has cited the fact that even under normal circumstances, pre-COVID-19, India’s record for official medical certification of deaths is lacking. Many deaths go unreported, and even when recorded the cause of death is often not listed. Roughly 86 percent of estimated total deaths are registered, medical certification covers less than one in five deaths. As such, the actual number of deaths, particularly those in rural settings where medical certification is less common, may indeed be higher than currently reported.

Currently, projections by experts do not expect a considerable rise in additional deaths. The COVID-19 variants from the latest surge in cases have been noted as being far milder than previous waves. Omicron itself was documented as being far less likely to cause severe illness than the Delta variant. As such, the cause for concern is lower. However, experts have still urged caution, and recommend continued use of masks and avoidance of large public gatherings.

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