How 2022 became a turning point in Covid-19 outbreak

Saturday, December 31, 2022, marks exactly three years since the day the Chinese government informed the World Health Organization (WHO) that it was trying to ascertain the cause of an “unidentified pneumonia outbreak” that had made 44 people sick in the city of Wuhan. Much has been written about how that pneumonia outbreak, now known as the coronavirus disease or Covid-19, has redefined that world as we know it since then. Looking back at the pandemic three years on can offer some crucial insights into how and why it transformed the world, and how it may continue to do so.

The year 2021, on the other hand, was the year humanity fought back — it will be remembered as the year of the vaccines; the year that offered a glimmer of hope of how humanity can move on from the virus.

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2022, meanwhile, will go down as the year the world started reaping the dividends of the vaccination effort put in through 2021. For India, as the year started, the first month offered a very clear preview of what was to come. In first few weeks of 2022, the Covid-19 curve of infections in the country started rising rapidly, before eventually becoming what is now known as the third wave or Omicron wave. Cases across India soared to levels that were last seen only during the brutal Delta wave (in the first half of 2021), but deaths remained low.

The chart given with this story illustrates that. In it, the case and death curve (the seven-day average for both parameters) are plotted against each other in a ratio of 100:1. So, if the death curve is above the case curve here, it means that more than 1% of cases are leading to deaths in that time period, and if it is below the case curve, then fewer than 1% of new infections are resulting in deaths. Such a chart makes it clear that while deaths consistently followed the case curve through 2020 and 2021, they have stopped doing that in 2022.

Another way to look at it is by seeing the number of cases and deaths recorded through each year. According to HT’s database, a total of 10.3 million infections were reported across India in 2020, which resulted in the reported deaths of around 149,000 people – giving the year an overall case fatality rate (CFR) of 1.45%. In 2021, due to the massive Delta wave, there were more than twice as many infections, with 24.6 million people getting infected, of which around 333,000 people ended up dying. This meant that despite the brutal Delta wave, the CFR through the year was 1.35%, actually improving from 2020.

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In contrast, 2022 painted a completely different picture. There was a total of 9.8 million infections reported in the country this year, with just a little over 50,000 reported deaths from the disease. This means that the nationwide CFR dropped to around 0.5% in 2022.

But here, a major caveat must be mentioned – one that is dominating global headlines right now. Over the past few weeks, China has seen an explosive surge in infections in the country that has, according to reports, already started to overwhelm the country’s health care infrastructure.

Reports emerging from the country (that has a notoriously opaque sharing of public health data) are suggesting that not just hospitals and ICUs, but also crematoriums are overwhelmed due to the case surge. So, the question to ask is that after a year of what finally appeared to be a turnaround against the virus, are we likely to see another surge that will push us back to phases of the pandemic not seen in the country since 2021?

The short answer is that it’s not very likely.

The surge in China appears to be a unique phenomenon that is a result of factors that appear to be largely confined to that country. The primary reason is that majority of the vaccines used in China (CoronaVac and Sinopharm) have proven to be less effective against severe infection in older people. This problem is compounded by the fact that its age-wise vaccine coverage is opposite to India’s: China has covered a higher proportion of younger rather than older people, as illustrated by HT’s Abhishek Jha in a December 22 article.

Furthermore, the relatively mild Omicron surge appears to have given natural immunity to a vast proportion of Indians through 2022 – something that the Chinese populace has not had thanks to the country’s strict “Zero Covid” policies.

So then, how is the outbreak likely to unfold in India (and the rest of the world) through 2023? Despite the headlines in the past few weeks, it appears unlikely that the world will again regress to outbreak levels that it has seen in the past three years (and in 2021, more particularly). But that remains a theory that will need to repeatedly be asserted in action.

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The real reason the world saw a better side of the pandemic in 2022 was because it managed to stay ahead of the curve. Billions of people were able to resume their lives because of the onset of high-quality vaccines delivered at a historic pace. The importance of robust vaccines (ones that keep changing to counter the changing nature of the virus), timely booster doses, and precaution at a personal level, cannot be stressed enough.

While the first factor among those remains an action limited to scientists and policymakers, the other two are precautionary steps that can be taken by the common man. More than 700 million people are overdue for their booster shots in India at the time of this article being written. That’s more than half the country’s population that can easily be given added protection from the disease immediately.

While 2022 may have been the year humanity turned the tide against Covid-19, the next year must be the one that ends the pandemic (or at least as we know it). Booster shots, masking at times of case surge or mass events, are all tools that can ensure that the world never again goes back to pandemic levels that it has witnessed over the past three years.