COVID-19: Infections to rise in India in winter; more hospital resources needed

At least three new sub-variants — BF.7, XBB and BQ.1 — of the omicron variant of SARS-CoV-2 have been detected in India. Several lineages of the fifth variant of concern have begun dominating in different geographies. 

The mutations indicate they are more immune evasive  — the growth advantage allowing them to replace preceding sub-variants like BA.5. But little is understood about its pathogenicity. However, an increase in cases is expected in India and across the world as fall and winter approaches. 

In the past 24 hours, India reported 1,946 new cases, while the active caseload is 25,968 as of October 19, 2022. More than 200,000 tests were carried out in the same duration. 

Plotting these figures on a graph would reflect the lull we are in right now. But as the weather changes, cases are expected to rise. The Institute for Health Metrics and Evaluation (IHME), an independent population health research centre at the University of Washington Medicine in the United States, estimates an increase in infections but not reported cases starting this month till December.

The predicted increase in infections, not accounting for the emergence of a new variant, is expected to be quite large. “But the infection-detection rate, the fraction of infections that get reported as a case in official data, is now down to an incredibly low level. In some parts of the Northern Hemisphere, it's below 2 per cent; in others it may be as high as 5 per cent,” IHME noted. It added: 

That means that this big increase in infections we are modelling for the fall and the winter will not translate into big increases in cases, but we may see a larger increase in hospital admissions where COVID-19 is



present.

For India, IHME expects cases to rise steadily, touching 9,675,464 by January 1, 2023. If mask-use is increased from the current 13 per cent to 80 per cent, cases can be reduced to 7,977,923. Hospital resources required to address this surge in cases is estimated to increase to 57,733 total beds — of which 5,268 will need to be Intensive Care Unit beds — from 21,438 total beds (1,957 ICU beds). 

Like always, Maharashtra and Kerala continue to report a majority of the cases. In the former, cases have increased by 17.7 per cent from October 10-16, compared to the week before. Kerala is now on alert as cases have been rising owing to the new sub-variants. 

Union health minister Mansukh Mandaviya held a COVID-19 review meeting on October 18 in light of the multiple omicron sub-variants being detected in India. The agenda of the meeting was to assess any requirement for fresh guidelines and state of preparedness. 

It was attended by Niti Aayog member VK Paul, head of national expert group on vaccination Dr NK Arora and Indian Council of Medical Research Director-General Rajiv Bahl among other senior health officials. The conclusion was to continue COVID-appropriate behaviour and following mask mandates.

Currently, daily deaths in India and the world are hovering around 19 and 1,294 respectively. This is expected to touch 48 and 4,973 respectively by the end of the year. However, IHME director and lead modeller Christopher JL Murray, in his insights from 12 September, made a distinction: If a 1new variant comes along, all bets are off as we've seen with the emergence of Omicron this year, or even a new sub-variant where there's considerable reduction in cross-variant immunity.