India's Covid-19 cases hit 7-month high as Omicron sweeps through Delhi and Mumbai

The Omicron variant is fuelling a Covid-19 surge in India, with new cases climbing nearly 30 per cent to 117,000 on Friday, the most since June last year at the tail-end of the deadly second wave of infections driven by the Delta variant.

Cases have risen 11-fold in just two weeks. The R0 value that indicates the spread of the infection is already 2.69 higher, than the 1.69 recorded at the peak of the second wave.

"The pandemic is expanding and the surge is exponential," said Balram Bhargava, who heads the state-run Indian Council of Medical Research.

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More than 80 per cent of the cases sequenced in the Delhi capital region and financial centre Mumbai now involve the highly infectious Omicron variant, which is increasing as a proportion of infections nationwide, said Anurag Agrawal, head of India's genomics institute.

The good news is that not many people falling sick are needing medical treatment and most are recovering more quickly than in previous waves. Nearly 70 per cent of Indians had been exposed to the coronavirus by the middle of last year, while 64 per cent of adults have been fully vaccinated as of this week.

In Mumbai where the city hit a single-day pandemic record of 20,181 new infections on Friday, only five per cent of the patients have required medical help.

But doctors warn that in a country of nearly 1.4 billion, even a small percentage of the population requiring hospitalisation could overwhelm the country's underfunded medical infrastructure as seen during last year's surge that pushed hospitals to near-collapse and overwhelmed crematoriums.

In the eastern city of Kolkata, scores of young children were hospitalised with breathing distress, severe weakness and high fever. Large numbers of health care workers in New Delhi, including junior doctors who are the first to see patients, have also got the virus.

Memories are still fresh of the Delta-driven second wave between February and May last year that pushed India's hospitals to near-collapse and resulted in crematoriums working round-the-clock.

India's official pandemic death toll is 483,000, but the figure is believed to be a massive underestimation, with some figures pegging the death toll at 5 million.

As cases multiply, states are rolling out stricter curbs on gatherings with night curfews imposed in Mumbai, Delhi and other places. Delhi, Karnataka and Tamil Nadu have also imposed weekend curfews allowing only essential movement. Schools and universities are shut and offices are at 50 per cent capacity.

Mumbai's municipal commissioner Iqbal Singh Chalal, however, said he sees no need for a lockdown amid concerns it could impede economic growth. India was forecast to post 9.5 per cent growth in this financial year to March, the fastest expansion of any major economy, recovering lost ground after output shrank by 7.5 per cent in 2021.

But while Prime Minister Narendra Modi has told citizens to practice caution and "wear masks like we wear shoes," electioneering is in full swing in five poll-bound states including in the high-stakes state of Uttar Pradesh which has 200 million people and is run by a Hindu hardline protege of Modi.

The prime minister and his rivals, often wearing no masks, have been staging big rallies that virologists have branded "super-spreader events". Delhi chief minister Arvind Kejriwal, who is a regional political force, announced he tested positive right after attending one such rally.

While the Indian government will start administering "precautionary" booster shots to medical, they will only go to frontline workers and people over 60 with comorbidities from January 10.

Even then, there will be a nine-month wait from when they got the second shot, which doctors say is far too late as immunity starts waning four to five months after the second Covishield jab that most Indians received. British scientists said that a third shot of the domestically made version of the AstraZeneca vaccine "significantly boosted antibody levels" against symptomatic Covid-19.

The Indian government, which took time to roll out its initial vaccine drive, now "is unfortunately stuck on Omicron being a natural vaccine," said Shahid Jameel, a prominent Indian virologist and a fellow at Oxford University.

"For this wave, we are too late. Nothing will now rein it in," said virologist T. Jacob John.

"We were warned on November 25 [about Omicron by South Africa]. We should have had a plan of action on November 27. But we waited till December 24-25."

While Omicron appears to be milder than the Delta variant, with studies suggesting it replicates less efficiently once inside the lung tissue, "the new strain can very quickly overwhelm the health care system," said Jameel, the virologist.

"Do not be lulled by the narrative that the third wave fuelled by Omicron is mild and not fatal. It is equally fatal for those who are not vaccinated and have comorbidities," the government in the western Maharashtra state said in a note to district officials.

So far, while dedicated Covid-19 wards in hospitals are filling up, they are nowhere near full capacity. But a look at Britain, which has a population of 67 million and a robust public health service, suggests India's situation could change rapidly.

New cases in the UK crossed 200,000 on Wednesday, with the swamped National Health Service advising potential heart attack victims to "take a taxi or get a lift" to the hospital because of a shortage of ambulances.

Back in New Delhi, chief minister Kejriwal said his administration was prepared in the event the third wave is "extremely dangerous."

The city was the epicentre of the second wave during which relatives frantically posted appeals for oxygen cylinders and medicines on social media. Many hospitals around the country have added captive oxygen plants in an attempt to avoid last year's catastrophe.

Experts are hoping that due to how widespread the second wave was, people have gained some additional immunity and that India's Omicron experience may mirror South Africa's, where cases declined rapidly after a four-week peak.

"[It] was a flash flood more than a wave," said Fareed Abdullah, a director at the South African Medical Research Council.

When Omicron struck, South Africans had accumulated some immunity from three previous waves. But virologists say given India's massive population, the Omicron surge could last longer there than in South Africa which has 60 million people.

"Massive election rallies, low mask compliance and business as usual tell me that we may have a more protracted course with the caseload shifting from urban to rural areas," said virologist Jameel.

This article originally appeared on the South China Morning Post (SCMP).

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