How prudent to drop all COVID mandates?

Last week, while unveiling the Living With COVID strategy, British Prime Minister Boris Johnson said England was exiting the "grimmest years in our peacetime". His statement underpinned how the UK's aggressive Coronavirus-mitigation strategies had made it the freest country in Europe. Health Secretary Sajid Javid went as far as calling February 24, 2022, as Freedom Day after the government scrapped all remaining emergency COVID laws after two years of crippling lockdowns - no face masks in London's public transport, no five-day isolation after testing positive.

A similar situation is gradually panning out in the US, where all states but one - Hawaii - have dropped the mask mandate, or have announced plans to do so in coming weeks. The infection rates have been steadily falling on the home front too, prompting the Brihanmumbai Municipal Corporation (BMC) to announce its decision to ease almost all restrictions in the city in the coming days, besides wearing a mask at public places. Currently, restaurants, theatres, gyms and auditoriums are working at 50 per cent capacity. Last week, the Bombay High Court hearing public interest litigations challenging the prohibition on use of local trains by unvaccinated people, said such a prohibition was illegal. Will the state executive committee lift the restriction? On Friday, Mumbai reported 128 new COVID-19 cases.

Dr MP Cariappa and Dr Ambrish Dutta

But, as the world steps into the next phase of the pandemic, there's one question facing public health experts and citizens: Can we well and truly let our guard down? While scaling back restrictions is warranted given the encouraging infection rates, it needs to be done in a phased manner, thinks Dr Rajiv Sarkar, epidemiologist and associate professor at the Indian Institute of Public Health, Shillong. "If there's one thing we know about the virus, it is that it can adapt and mutate. The first reported variant, Alpha [B.1.1.7] was followed by Beta [B.1.351]. Then there was Delta and its various offshoots. We now have Omicron BA.2, that is said to be more transmissible than BA.1." He suggests keeping track of the transmission that's taking place in the animal population. "Animals can not only spread pathogens like the Coronavirus, but also become a source of new mutations. So, there's always a danger of a new version of the virus spilling over into the human population," warns Dr Sarkar. This process that scientists call spillover and spillback poses its own threats to public health, he adds. Most studies of natural infections in animals have focused on cats and dogs, but there are other species that live closely with humans and carry the risk of infection.

Meanwhile, the drop in cases and the reduced hospitalisation rates have prompted the civic body to close down the COVID-19 jumbo centres in Dahisar, NESCO in Goregaon, Mulund and Kanjur Marg. According to reports, the centres at BKC, NSCI in Worli and Richardson Cruddas in Byculla will continue along with the Seven Hills Hospital in Marol. Additional Commissioner (health) Suresh Kakani of the BMC says it's evident that the overall population has developed antibodies, and this immunity is working effectively against new infection. "Ninety eight per cent of Mumbai's population is vaccinated with the second dose and 100 per cent with the first dose. When it comes to the 15 to 17 age group, it stands at close to 60 per cent. Yes, the pace is slow but that's because it's exam season and children aren't keen to get the jab. But I'm confident that the numbers will improve," said Kakani. There are two strategies that he says they are not letting up on: vaccination and COVID-appropriate behaviour. "While we have shut down some of the jumbo centres, the infrastructure is in place lest we are hit by a fourth wave. We have the expertise to ensure adequate oxygen supply, ventilators, water supply if the situation demands," he explains. The reasons for the closure of the jumbo centres is the mounting expenses required to maintain these facilities. Kakani admits that free and random testing requirements have been relaxed as per the revised ICMR guidelines that say only symptomatic patients need to be tested. "We have 266 facilities that offer COVID antigen tests free of cost. We are testing whoever walks in, as a precautionary measure. The city is almost back to normal which, I think, is a positive sign." Worldwide, COVID-19 cases are down 21 per cent and new deaths have fallen eight per cent, according to data from the World Health Organisation. Despite the relative stability, Dr Sarkar says it is too soon to believe that we have reached the endemic stage.

Dr Rajesh Parikh and Suresh Kakani

Last month, the Ministry of Health, Government of India, cut down the isolation period. Under the new guidelines, a "patient under home isolation will stand discharged and end isolation after at least seven days have passed from testing positive and no fever for three successive days". This period was earlier at 10 days from the onset of symptoms.

While making policy decisions, it's important to bear in mind the interconnectedness of the world, cautions Dr Rajesh Parikh, Director of Medical Research and Hon. Neuropsychiatrist at the Jaslok Hospital and Research Centre, and author of What You Need To Know About The Global Pandemic. "In the UK, local governments are going to extremes [by lifting all curbs], and there's danger in doing so, which we have seen time and again through the pandemic. The last example being, when the world ignored Africa, with less than 10 per cent of the population vaccinated. That's how the Omicron variant turned up in the continent. While focusing on local issues, we should not ignore global occurrences." Between two ends of the spectrum - complete lifting of restrictions and extreme caution - lies a golden middle path and this is what every country, state, city and municipality, needs to identify, he says.

Last week, the Bombay High Court hearing PILs challenging the prohibition on use of local trains by unvaccinated people, said such a prohibition was illegal. Will the state executive committee lift the restriction? Pic/Getty Images

Aping the policies of the West is not advisable, thinks Dr Ambarish Dutta, additional professor, epidemiology at Public Health Foundation of India (PHFI) in Bhubaneshwar. "Countries like the UK and US have the resources and expertise to fight another wave. We can't boast the same. Sadly, not much has improved in the country when it comes to healthcare facilities. Which is why we should err on the side of caution; dismantling facilities and scrapping curbs needs to be done wisely." According to him, the severity of the pandemic hinges on how many people die or fall seriously ill. The moderate and mild infections don't matter.

And, although we know a lot more about the virus than we did three years ago, there are many unknowns, especially surrounding how pathogens operate and evolve. That, he says, is reason enough to continue doing epidemiological studies. "We need to closely monitor populations for cluster outbreaks, and conduct genomic sequencing which will tell us if there are signs of another wave. This will help us reintroduce restrictions at the earliest." Dr Sarkar agrees. Ramping up surveillance systems will ensure we aren't caught on the wrong foot. "This includes environmental surveillance because there's evidence that you can pick up signs of rising infection in sewage water." Proper use of masks and avoiding large crowds unless necessary, are precautions that should not be done away with, he urges.

A majority of commuters without face masks at Waterloo station during morning rush hour. This month, England scrapped all remaining emergency COVID laws after two years of crippling lockdowns. Pic/Getty Images

Driving home this message at a juncture when the worst appears to be behind us, is a challenge that public health departments are currently facing. "We are beyond fatigue now. We have reached the stage of, ‘I don't care'," says Dr MP Cariappa, public health specialist and former director of medical services to the Government of India.

A wise governance decision at this point is one that adapts to the people's mood, he feels. "What the Centre has now done is that it has shifted the responsibility to the state. Which is a pragmatic approach, in my opinion. I'd say the time for government high-handedness is over. The need of the hour is to galvanise social change at the individual level." He calls for a "sanitation awakening" that can nudge us to rethink respiratory hygiene. "Respiratory illnesses may not always kill you, but they cause sickness. The state's responsibility now is to not let the situation go back to ‘normal', but guide and nudge people in the right direction."

500
Revised fine for not wearing masks announced by the Delhi Disaster Management Authority. The previous amount was Rs2,000

296
No. of vax centres started by the BMC during the pandemic

270
No. of vax centres operating currently