As the third winter begins in India after the COVID-19 pandemic began in January 2020, fresh daily infections of the novel coronavirus — there was a small spike in July and August — have been dipping since the third wave peaked in late January 2022. Daily new cases nationally dropped below the 1,000-mark after November first week, and below 500 in the last four days. While the case decline may not be a true reflection of the actual level of infection in the population, given the low level of testing across the country, the test positivity rate and the number of hospitalisations due to moderate to severe COVID-19 disease are at a low level — a far cry from the peak of the second wave in 2021. COVID-19 deaths too have been very low, with many States not reporting any for days together; Kerala has been reporting some backlog deaths on certain days but nil fresh deaths on many days. Nationally, the case fatality rate was 1.19% as of November 22. The situation in India is vastly different from what it is like in a few other countries where the daily infections are witnessing a sharp spike. Even the extremely high transmissive Omicron sub-lineages and recombinant lineages have only caused a small spike in fresh cases but no concomitant increase in hospitalisations or deaths in India.
Given the very low number of cases and hospitalisations, the situation in India is no longer cause for concern. Even with most businesses and educational institutions back to functioning as in the pre-pandemic days and large gatherings being seen even in poorly ventilated places with almost no voluntary mask wearing, there has been no spike in cases since the peak of the third wave. This makes a strong case to ease any mandatory COVID-appropriate behaviour, masks included. A week ago, India made mask wearing optional for air passengers precisely because of the improved ground situation. It is only in hospitals and health-care settings that mask wearing should remain mandatory. The low level of infection notwithstanding, it is advisable that the vulnerable population including the elderly and those with comorbidities at least wear a mask to reduce the risk of infection. Long COVID is real and poses a risk even to otherwise healthy people. The virus is evolving, and the emerging variants of concern will, by default, be even more highly transmissive. Their lethality cannot be predicted as transmission happens prior to disease onset and so the selection pressure is for higher transmission and not disease severity.