Opinion Why Covid-19 cases are rising in India, and what you need to know

Several countries are reporting Covid-19 surges; World Health Organisation (WHO) data show noticeable increases in South-East Asia. On May 13, Singapore reported a rise from 11,100 cases during April 20-26 to 14,200 during April 27-May 3.

What is the current situation in India?

There were 1,010 active infections as of Tuesday evening, according to data on the Health Ministry’s Covid-19 dashboard. The largest number of cases (43%) were in Kerala, followed by Maharashtra (21%). Delhi, Gujarat, and Tamil Nadu had 10%, 8%, and 7% of cases.

Since May 19, deaths have been reported in Maharashtra (3), Kerala (2), and Karnataka (1). However, the Ministry has said “more details are awaited” before these deaths can be attributed to Covid-19.

The outbreak seems to be geographically limited. The numbers of active cases were in double digits in only nine states on Tuesday, and only Kerala, Maharashtra, and Delhi had more than 100 cases each.

However, a clearer picture is expected to emerge over the next fortnight, as testing of symptomatic individuals increases.

Official data on hospitalisation are not yet available. But large hospital chains have not reported any significant increase in Covid-19-related admissions. The few patients who have been admitted mostly have pre-existing comorbidities — which suggests that new cases are not, as of now, leading to severe disease.

What is triggering the increase in cases?

While reporting their surge on May 13, the Singaporean health authorities pointed out that periodic waves of Covid-19 — like other endemic respiratory diseases — were expected throughout the year.

SARS-CoV-2, the virus responsible for Covid-19, has not disappeared, but it no longer behaves like an unpredictable emergency — rather, it has become part of a recurring cycle of illnesses, similar to the flu. Several factors could be contributing to the rise in cases:

• Waning immunity: Protection from vaccination or past infection decreases with time, leaving individuals more vulnerable to reinfection.
• New variants: Like other viruses, SARS-CoV-2 continues to mutate. Some of these new variants may spread more easily or evade immunity to a greater extent, triggering fresh surges.
• Seasonal patterns: Respiratory viruses, including SARS-CoV-2, often spread more efficiently in colder or more humid periods. Notably, several cities in India are currently experiencing a rise in other viral flu infections, which may reflect broader seasonal trends in respiratory illness.
•  Not enough testing: Reduced surveillance in many countries, including India, means rising case numbers may remain undetected for longer. Covid-19 is now considered endemic, and testing and genome sequencing efforts have been scaled back, delaying the identification of outbreaks.
• High-risk groups: Individuals with weakened immune systems or severe comorbidites remain especially vulnerable. With relaxed public health measures, they face a greater risk of severe outcomes during periodic waves.

Which new variants have emerged, and which one is currently widespread?

Three categories of variants are closely monitored.

• Variants of Concern (VOC) are those that spread more easily, cause more severe illness, present different symptoms, evade the immune system, or reduce the effectiveness of vaccines and treatments. No variant is currently classified as VOC.
• Variants of Interest (VOI) include those with mutations that are suspected or known to significantly alter their behaviour compared to the original strain. These changes may impact the spread of the virus or the way it interacts with the immune system.
•  Variants Under Monitoring (VUM) are those that experts are observing to see if they might pose a greater risk in the future. The WHO is currently monitoring eight SARS-CoV-2 variants, including one VOI — JN.1 — and seven VUMs.

JN.1 accounted for 16.3% of sequenced cases in the epidemiological week that ended on February 2. Singaporean authorities have reported that two JN.1 descendant lineages — LF.7 and NB.1.8 — make up more than two-thirds of locally sequenced cases. However, they have clarified that “there is no indication that the variants circulating locally are more transmissible or cause more severe disease compared to previously circulating variants.”

In India, the virus in most samples sequenced over the past couple of months has been identified as either BA.2 or JN.1. Health officials have said there is no indication that they are more transmissible or cause more severe disease compared to earlier variants.

What precautions should you take?

If you’re in a crowded place, or have symptoms like a runny nose, sore throat, headache, or a fever, it’s important to wear a mask. According to the 2023 AIIMS/ ICMR-COVID-19 National Task Force guidelines, people with mild symptoms should isolate at home.

At home, you should maintain physical distancing, wear a mask, and practice good hand hygiene. Mild cases can usually be managed with rest, fluids, and medicines for symptom relief.

Stay hydrated, monitor your temperature and oxygen levels (SpO2), and be in touch with your doctor. Do not use antibiotics unless there’s a clear sign of a bacterial infection.

Seek immediate medical attention if you have trouble breathing, your oxygen level drops to 93% or lower, or if you have a high fever or severe cough lasting for longer than five days.

Those older than 60, or with heart disease, diabetes, a weakened immune system, tuberculosis, chronic lung, kidney, or liver disease, or obesity, or those who are unvaccinated should be extra cautious.