The 2nd wave is declining in India. What lies ahead?

1. Covid 19 Stats in India –
Update 22
Review of key data and presentation of a projection model
Data updated till 7.06.21
Data Sources: https://www.covid19india.org/; https://www.worldometers.info/;
https://censusindia.gov.in/2011-prov-results/paper2/data_files/india/paper2_1.pdf
https://ig.ft.com/coronavirus-
chart/?areas=eur&areas=usa&areas=bra&areas=gbr&areasRegional=usny&areasRegional=usca&areasRegional=usfl&area
sRegional=ustx&byDate=0&cumulative=0&logScale=1&perMillion=0&values=deaths
https://ourworldindata.org/covid-vaccinations
https://www.mygov.in/aarogya-Setu-app/

2. Agenda
• Presentation of key data for All India
• Review of cases and deaths in states
• Analysis of 2nd wave
• Vaccination
• 3rd wave possible scenarios
• Discussion

3. Data Integrity
• India data on deaths is being strongly questioned by researchers both in
India and abroad. Anywhere between 2 – 4 times the official death rate is
being talked about as the real figure
• Cases are anyway ‘discovered cases’ and it is well known that the real
figure is multiple times
• Approach
• We will look at surrogate variables to get a directional indication (TPR and Daily
Growth in Active Cases are two such)
• We will also use the official numbers for modelling and look for correlation with the
surrogate variables

4. All India Data

5. • Testing has not been able to keep pace with the
pandemic after the second wave has started
• Positivity rates have crossed 20% (the peak in
September was 15%). However, recently, testing has
been ramped up and TPR is now around 5%
• TPR is coming down from a peak of 24.85% on 9th May.
The rate of decline is steeper than the ascent. Testing
has come down in the last couple of days. Hope it is a
temporary blip

6. • Cumulative CFR is trending upwards. This is a
disturbing trend indicating that fatalities in the 2nd
wave are higher
• This is clearly visible when you see the 7DMA CFR.
It is now at 2.4%. In the 1st wave the maximum
level was 1.4%. Clearly the second wave is more
lethal than the 1st wave. The extent of
underreporting is also higher

7. • New infections reached their lowest point on 11.02.21 at
10,983 7DMA
• Cases have galloped after that and the previous peak was
surpassed on 4.04.21
• The highest number has been 414,280 on 6 May. The highest
level on a 7DMA basis was 392,330 on 8th May. The declining
trend in cases is now well established. When coupled with a
decreasing TPR this is a more robust figure. Daily cases have
dipped below 100,000 on 7.06.21 for the first time after the
decline commenced
• The pace of decline is now slowing down. This may lead to a
plateauing as the polynomial curve is projecting

8. • Active Infections have peaked. From 22nd April, the rate
of growth has been slowing.
• On 10th May for the first time in the second wave, Active
Infections declined by 30,499. Thereafter, the declining
trend has got established
• Daily Growth in Active Infections is a reasonable lead
indicator of what direction the wave is taking
• The load on the healthcare system is also coming down
• However, the rate of decline in Active Infections is
slowing down. This is another indicator of a plateau
approaching

9. • Deaths had reached a plateau from around the
10th of May. However, the numbers have been
distorted by Previous Period Adjustments carried
out by Maharashtra on several days.
• For this presentation I have shown the raw
numbers without adjustment
• The 7DMA is showing a peaking on 23rd May. The
30 DMA has peaked on 27th May
• The salient point is that deaths have continued to
grow after cases peaked on 8th May on a 7DMA
basis. This may indicate that serious cases are
taking more time to resolve. Complications such
as mucomycorsis are also gaining ground
• The declining trend is now clearly established

10. States

15. 10 Feb Level 10 Times Days
Punjab 229 18-Mar 35
Haryana 77 19-Mar 36
MP 141 23-Mar 40
Chattisgarh 222 24-Mar 41
AP 50 24-Mar 41
Maharashtra 3451 31-Mar 48
Delhi 127 31-Mar 48
Rajasthan 107 31-Mar 48
UP 121 31-Mar 48
Uttarakhand 35 31-Mar 48
Jharkhand 45 31-Mar 48
Karnataka 415 31-Mar 48
Bihar 64 02-Apr 50
West Bengal 179 04-Apr 52
Telengana 157 06-Apr 54
Tamil Nadu 479 09-Apr 57
Odisha 92 09-Apr 57
HP 83 12-Apr 60
All India 12539 07-Apr 55
• An interesting feature of India’s second wave is how
consistently and swiftly the cases have ramped up
• The chart shows how long various states took to reach a level
of 10 times the daily cases that they had registered on 10th
Feb (lowest level). It is remarkable how consistent this data is
• Some speculations:
• Punjab and Haryana had been hit the earliest probably
by the Alpha (UK Variant)
• The Delta Variant (popularly known as the double
mutant) emerged in Vidarbha and rapidly spread to some
of the adjoining states of MP, Chhattisgarh and AP
• Delta then rapidly overpowered all other strains and
spread all over the country like wildfire. This is the
possible explanation for the consistency of the spread –
that it is caused by the same variant. Genome
sequencing is in progress
• It is becoming increasingly possible that massive second
waves in most countries are due to the emergence of variants.
These, in turn, are nurtured in areas where the infection is
widespread
These speculations
made 4 weeks ago
have been largely
proved correct

16. • Phase 1 states (green) are showing a remarkable consistency in the decline curve EXCEPT for Maharashtra.
• Phase 2 states (yellow) seem to decline faster than Phase 1
• States marked in Brown – picture is not clear yet
• Need to carefully watch at district level for outbreaks in these states that could also signal a new variant
Population
Date No Per Mn CFR Date No Per Mn CFR 90% Days 75% Days 50% Days 25% Days
Delhi 1,67,87,941 23.04.21 25294 1,507 1.00% 3.05.21 398 23.71 1.70% 5.05.21 12 9.05.21 16 14.05.21 21 20.05.21 27
Maharashtra 11,23,74,333 24.04.21 65447 582 0.90% 23.05.21 1019 9.07 3.50% 5.05.21 11 13.05.21 19 20.05.21 26 4.06.21 41
UP 19,98,12,341 27.04.21 34813 174 0.60% 7.05.21 329 1.65 1.10% 4.05.21 7 10.05.21 13 16.05.21 19 22.05.21 25
Chattisgarh 2,55,45,198 28.04.21 15583 610 1.50% 3.05.21 248 9.71 1.70% 8.05.21 10 12.05.21 14 18.05.21 20 27.05.21 29
MP 7,26,26,809 29.04.21 13105 180 0.70% 3.05.21 98 1.35 0.80% 10.05.21 11 14.05.21 15 20.05.21 21 27.05.21 28
Gujarat 6,04,39,692 30.04.21 14305 237 1.20% 1.05.21 169 2.80 1.20% 8.05.21 8 15.05.21 15 21.05.21 21 27.05.21 27
Telengana 3,50,03,674 1.05.21 8036 230 0.60% 7.05.21 58 1.66 0.80% 5.05.21 4 12.05.21 11 20.05.21 19
Bihar 10,40,99,452 6.05.21 14191 136 0.60% 23.05.21 102 0.98 1.90% 11.05.21 5 14.05.21 8 19.05.21 13 28.05.21 22
Rajasthan 6,85,48,437 8.05.21 17590 257 0.90% 12.05.21 162 2.36 0.90% 15.05.21 7 18.05.21 10 22.05.21 14 28.05.21 20
Haryana 2,53,51,462 9.05.21 14430 569 1.10% 10.05.21 163 6.43 1.10% 14.05.21 5 17.05.21 8 22.05.21 13 28.05.21 19
Karnataka 6,10,95,297 9.05.21 47502 778 1.00% 13.05.21 500 8.18 1.00% 13.05.21 4 20.05.21 10 30.05.21 21
Uttarakhand 1,00,86,292 11.05.21 7555 749 1.90% 20.05.21 177 17.55 3.90% 14.05.21 3 18.05.21 7 23.05.21 12 1.06.21 21
Kerala 3,34,06,061 12.05.21 38153 1,142 0.20% 2.06.21 191 5.72 0.90% 17.05.21 5 23.05.21 11 4.06.21 23
Punjab 2,77,43,338 12.05.21 8576 309 2.10% 20.05.21 203 7.32 3.00% 17.05.21 5 21.05.21 9 29.05.21 17
West Bengal 9,12,76,115 15.05.21 20085 220 0.70% 25.05.21 157 1.72 0.80% 27.05.21 10 30.05.21 15 4.06.21 20
AP 4,95,77,103 20.05.21 22051 445 0.50% 23.05.21 108 2.18 0.50% 25.05.21 5 29.05.21 9 6.06.21 17
Tamil Nadu 7,21,47,030 25.05.21 35307 489 1.20% 2.06.21 484 6.71 1.70% 31.05.21 6 5.06.21 11
Odisha 4,19,74,219 26.05.21 11657 278 0.30% 28.05.21 2 1.06.21 6
All India 1,21,05,69,573 8.05.21 392331 324.0879 1.00% 23.05.21 4191 3.46 1.60% 15.05.21 7 20.05.21 12 29.05.21 19
Peak Cases Peak Deaths Decline in Cases

17. • Difficult to find a pattern in cases/Mn. States with
higher testing appear to have higher peaks.
• Maharashtra is an outlier in terms of the shape of the
curve. The build up and the decline are both slower.
Need to keep a very close watch for further outbreaks
and possible new variants
• Kerala, Karnataka declines are also slower and TN has
peaked later

18. Discussion – 2 weeks ago
• The spread of the 2nd wave has been swift. Most of the country has peaked
within 3 – 4 weeks of each other. This implies that the dominant variant Delta
spreads extremely rapidly
• After the peak, the decline is also quite consistent. There are 2 points here:
• States that peaked close to each other follow a similar decline curve
• The decline curve is steeper for those states that reached peak later (not fully observed) –
does this indicate a weakening in the virus strain with time?
• What triggers a decline? We are nowhere near herd immunity or saturation
vaccination. Especially since the peak cases/mn are very different across states.
• Anecdotally, having watched several programs coming in from rural UP, even the
rural, uncounted cases and deaths have declined in the last 2 weeks.

19. Discussion – 2 weeks ago
• The consistency of the rise and fall across states, urban and rural implies that human
intervention – lockdowns, social behaviour etc have relatively low impact on the progress
of the virus once a wave is triggered. This time around the states were implementing
their own policies and it is hard to imagine that poor, rural oriented states like UP or
Bihar could implement anything as effectively as Delhi or Mumbai. Is there something
inbuilt in the virus that causes these peaks and troughs?
• Speculatively, are virus mutation cycles and the life cycle of new variants becoming
shorter? Both UK with Alpha and India with Delta have experienced short, intense peaks
• Clearly, new variants are a big danger. Genome sequencing and big data to throw up
abnormal trends are the way forward to identify these as they emerge.
• The states to watch out for are Maharashtra and South India and maybe Punjab and
West Bengal

20. 3rd Wave

21. Waves vs Wavelets
• Speculation:
• Are wavelets of the type that Delhi
exhibited prior to the wave in
April/May 2021 the same as the
latter?
• Wavelets appear to be caused by
relaxation in Covid appropriate
behaviour such as what happened in
Delhi and North India around Diwali.
They tend to recede when behaviour
is tightened.
• Wavelets appear to be caused by the
same strain as the original. A true
wave is caused by a new strain (in
India – Delta) and in UK – Alpha
• India’s second wave has been
remarkably consistent across states
and geographies – pointing to the
relative ineffectiveness of normal
covid control measures in stopping
the wave cased by the Delta variant

22. 3rd Wave www.nature.com Multiwave pandemic dynamics explained: how to tame the next wave of infectious diseases
Giacomo Cacciapaglia 1,2,5*, Corentin Cot1,2,5 & Francesco Sannino3,4,5
• “The key to control the arrival of the
next wave of a pandemic is in the
strolling period in between waves, i.e.
when the number of infections grows
linearly. Thus, limiting the virus
diffusion in this period is the most
effective way to prevent or delay the
arrival of the next wave”
• UK 3rd wave is predicted to peak on
24.07.21 with 75% cases of the 2nd
wave

23. 3rd Wave UK – Manindra Agrawal
• Predicts a mild wave (around 25% of wave 2 peak) due to high
vaccination (60% at least 1 dose and 40% fully vaccinated)
• Also peaking around July 2021

24. India 3rd Wave
• Influencing Variables
• Strolling period
• New Variant
• Speculation
• The gap between Wave 2 and 3 in UK is projected to be around 6 months.
Assuming a similar situation for India it would indicate a peak for Wave 3
around Nov 2021
• Strolling period behaviour unlikely to be Covid appropriate. Vaccination drive
will remain slow at least for June and probably July
• If there is no variant we may get away with a mild wave. If there is a new
variant it could be worse than Wave 2

25. Vaccination

26. • Govt had committed a target of 85 Mn doses in May. Actual jabs were 58 Mn
• Progressive Average is 1.65 Mn doses/day. 7 DMA is 2.88Mn doses/day. June has improved over May
• There is an uphill task ahead in June where the target is on the lower side (120Mn) vs the rest of the
year. However, good to see that the trend has been rising in June
• For this year the Govt has committed to vaccinating all Indians by End Dec 2021. I have taken that to
mean at least 1 jab for all adults by year end
India Vaccination Progress
Day Jun-21 FY 21
Target 12,00,00,000 1,35,49,50,000
Avg/Day 40,00,000 63,31,542
Achievement
01-Jun 1 25,00,029
02-Jun 2 24,97,026
03-Jun 3 30,65,755
04-Jun 4 37,50,869
05-Jun 5 34,62,100
06-Jun 6 14,64,065
07-Jun 7 34,12,244
Cum 2,01,52,088 23,27,86,482
Avg/Day 28,78,870 16,27,877
Bal 9,98,47,912 1,35,33,22,123
Bal Avg/Day 43,41,214 65,37,788
Acceleration 150.8% 401.6%

27. Vaccination – New Strategy on 7.06.21
• Welcome steps:
• Central Govt to procure vaccines for Govt hospitals and vaccination centres (Central and
State). All adults to be administered vaccine free.
• Private sector can buy directly from manufacturers (up to 25% of the output of local
manufacturers - presumably). Service charge limited to Rs 150/jab above the cost of the
vaccine.
• What we would like to see:
• Empowered Committee (Covid Ministry? Headed by a top professional)
• Clarity and time table on procurement. Procurement data to be shared in real time
• Forecasting, Logistics and MIS need to be streamlined
• Process simplification required (registration on Co Win, requirements of smartphone)
• Marketing Plan and Implementation including integration with States – Budgets?
• Carrot and stick approach
• Delivery touch points increase

28. Questions for Discussion
• Vaccination strategy and implementation
• 3rd Wave

29. Thank You!
Please mail me at debubhatnagar@gmail.com
with any comments.
Disclaimer: These projections and analysis are not official and are the work of an
amateur. They should not be the basis of any decision making.