19 coronavirus patients in Kerala cured, active cases stand at 178 in State

New Delhi, Apr 24: The trajectory of COVID-19 cases could have plateaued and might even fall for some weeks after the lockdown is lifted but India is likely to see a second wave in late July or August with a surge in the number of cases during the monsoon, say scientists.

The timing of the peak will depend on how India is able to control physical distancing and on the level of infection spreads after restrictions are relaxed, they said.

It looks apparent that the trajectory of daily new cases has reached a plateau and eventually it will take a downward fall, maybe for some weeks or even months, Samit Bhattacharya, associate professor at the Department of Mathematics, Shiv Nadar University, said.

Still, we may get a surge of new cases of the same coronavirus and this will be considered a second wave, Bhattacharya explained.

The second epidemic may come back in late July or August in the monsoon, although the peak timing will depend on how we control social distancing during that time, he said.

Rajesh Sundaresan, professor at Bengaluru's Indian Institute of Science (IISc), agreed.

“Once we return to normal activity levels, there is a chance that infection may begin to rise again. China is seeing this to some extent post easing of some restrictions on travel,” Sundaresan, corresponding author of a working paper by researchers at IISc and the Tata Institute of Fundamental Research (TIFR) in Mumbai, said.

On March 25, when the number of coronavirus cases was 618 with 13 deaths, the government announced a nationwide lockdown that was later extended to May 3.

On Friday, the death toll due to COVID-19 rose to 718 and the number of cases to 23,077, according to the Union Health Ministry.

In good news, officials said this week that the doubling rate of cases has slowed down in the period, going from 3.4 days before lockdown to 7.5 days, with 18 states doing better than the national average. The recovery rate has also almost doubled in the last 10 days.

"Looking at the new cases in the past few days, it seems the growth of new daily infection is much slower than earlier. This apparently indicates that we might have reached at the plateau of the growth curve, Bhattacharya said.

He noted that recent studies in China and Europe observed that the infection might relapse in those people who have already recovered from earlier phases.

So, there is no evidence that the earlier infection may help acquire immunity against the second infection. And in that way, the entire population may be vulnerable to the second wave to some extent, said the scientist.

In their study unveiled this week, IISc and TIFR researchers analysed the impact of strategies such as case isolation, home quarantine, social distancing and various post-lockdown restrictions on COVID-19 that might remain in force for some time.

The study modelled on Bengaluru and Mumbai suggests the infection is likely to have a second wave and the public health threat will remain, unless steps are taken to aggressively trace, localise, isolate the cases, and prevent influx of new infections.

The new levels and the peaking times for healthcare demand depend on the levels of infection spreads in each city at the time of relaxation of restrictions, they said.

The lockdown is currently upon us. It has given us valuable time. Let us test, trace, quarantine, isolate, practice better hygiene, search for a vaccine, etc. We should do these anyway, and these are being done. When and how to lift the lockdown is going to be a difficult decision to make, said Sundaresan.

It's clear that it's going to be phased. What our team is focusing on is to come up with tools to help the decision makers assess the public health impact of various choices, he said.

According to the experts, infectious diseases spread via contact between infectious and susceptible people. In the absence of any control measures, an outbreak will grow as long as the average number of people infected by each infectious person is more than one.

Once enough people are immune there will be fewer people susceptible to the infection and the outbreak will die.

However, when an outbreak is brought under control by social distancing and other interventions, it is possible only a small proportion of the population will have been infected and gained immunity, they said.

This means enough susceptible people may remain to fuel a second wave if controls are relaxed and infection is reintroduced.

Until the vaccine comes on the market, we have to remain alert Once sporadic cases occur here and there in the country, we immediately need to implement quarantine or social distancing locally for the people in that region, and also need to perform tests to identify positive cases irrespective of showing symptoms, Bhattacharya explained.

Note that these monsoon months are also flu season in many places of India. So, we should not ignore the early signs of the flu symptoms. Irrespective of symptoms, we need to increase tests in the hotspots to identify people and contain the surge, he said.

Sundaresan added that the timeline for a second wave will depend on a lot of circumstances which may change as the time passes.

Significant testing may have been underway, there may be behavioural changes with people becoming more careful about their hygiene, wearing masks may become more common, etc. All these responses may help restrict the second wave, he said.

A study published in The Lancet journal earlier this month modelled the potential adverse consequences of premature relaxation of interventions, and found it might lead to a second wave of infections.

The finding is critical to governments globally, because it warns against premature relaxation of strict interventions, the researchers said.

While interventions to control the spread of SARS-CoV-2 are in place, countries will need to work toward returning to normalcy; thus, knowledge of the effect of each intervention is urgently required, they said in the study.

According to a recent analysis by the Harvard Chan School of Public Health, the best strategy to ease the critical care burden and loss of life from COVID-19 might be on-again, off-again social distancing.

In the absence of such interventions, surveillance and intermittent distancing may need to be maintained into 2022, which would present a substantial social and economic burden, the researchers wrote.p

New Delhi, Mar 26: The government on Thursday announced a Rs 1.7 lakh crore stimulus that included free foodgrain and cooking gas to poor for three months, and cash doles to women and poor senior citizens as it looked to ease the economic impact of the nationwide lockdown.

While over 80 crore poor ration card holders will each get 5 kg of wheat or rice and one kg of preferred pulses free of cost every month for the next three months, 20.4 crore women having Jan Dhan bank accounts would get one-time cash help of Rs 1,500 spread over three months.

Over 8.3 crore poor women, who were handed out free cooking gas connections since 2016, will get free LPG refills for the next three months, while poor senior citizens, widows and disabled will get an ex-gratia cash of Rs 1,000.

"Since the lockdown has been in force (since Wednesday) and therefore we have come out with a package which will immediately take care of the concerns and welfare of poor and suffering workers and those who need immediate help," Finance Minister Nirmala Sitharaman said at a news conference here.

The package, she said, is being announced within 36 hours of the 21-day nationwide lockdown announced by the Prime Minister to protect the nation's 130 crore people from the fast-spreading coronavirus. "We do not want anyone to remain hungry."

She hinted at more announcements if a need arises.

"So, today's measures are very clearly aimed at reaching out with food and money that they need to have it in their hands. We will obviously think about other things. I will gradually address if there is more to attend," she said.

The package included advancing the payment of one-third of the Rs 6,000 a year pre-2019 general election cash dole scheme for farmers, government contributions to retirement funds for the next three months of small companies with 90 per cent of staff earning less than Rs 15,000, and a Rs 50 lakh insurance cover to healthcare workers.

For rural workers, the daily wage under the MNREGA employment guarantee programme has been increased to Rs 202 from Rs 182, benefiting 5 crore workers of about Rs 2,000 in all.

India joins countries -- from the US to Singapore -- that have pledged spending to contain the economic fallout of the pandemic that has infected almost 5 lakh people globally and left over 21,000 dead.

The pandemic has infected 649 persons in India and has killed 13 so far.

While the free food grains and pulses would cost Rs 45,000 crore, Rs 2,000 payment to 8.7 crore farmers under Pradhan Mantri Garib Kalyan Yojana will cost Rs 16,000 crore.

The cash to women Jan Dhan account holders will cost Rs 31,000 crore and another Rs 13,000 crore is estimated to be the expenditure for providing free cooking gas.

Sitharaman, however, evaded a reply to questions on how the government will finance the package given that the impact of the closure of businesses across the country will be felt over the next few months and would have a direct bearing on already strained tax collections.

She also did not say if the government will relax budget deficit targets or resort to additional borrowings to fund the programme.

The revised fiscal deficit - the gap between revenue and expenditure - has been put at 3.8 per cent of the GDP in the current fiscal. For the fiscal starting April, the government is targeting a 3.5 per cent fiscal deficit.

"Today's measures are very clearly aimed at reaching out to the poor," she said. "At this stage, I am more concerned about reaching out to those who need help."

With businesses closed during the lockdown, the government will contribute employees as well as employer's contribution to the provident fund for the next three months of companies with up to 100 employees with 90 per cent earning not more than Rs 15,000. The contribution will be a total of 24 per cent of eligible wages.

Also, workers will be allowed to draw a non-refundable advance of 75 per cent from credit in provident fund account or three months salary, whichever is lower, she said.

Sitharaman said the limit of collateral-free loans to 63 lakh women self-help groups is being doubled to Rs 20 lakh, impacting 7 crore households.

The free foodgrain and pulses are over-and-above the existing entitlement through the public distribution system (PDS). The ration card holders can take the foodgrain and pulses from the PDS in two installments, she added.

The government had previously relaxed timelines for meeting tax and other statutory filing requirements as well as allowed companies to divert their philanthropy or CSR funds to support the fight against coronavirus.

These measures and the ones announced on Thursday will be topped up by the expected announcement of interest rate cuts by the Reserve Bank of India (RBI) at its bi-monthly monetary policy review meet slated next week.

Commenting on the package, Anil Talreja, Partner, Deloitte India said the announcements are is expected to give reprieve to the mass sections of the population. "This is a good way to ensure that the poor and needy get what they deserve. It has ensured that the farmers, poor senior citizens, widows and specified sections of the society as well as people who are attached to the healthcare sectors get rewarded for their hard work and sacrifices".