A week from now, perhaps a day earlier or a few days later, India will have a million active cases of the coronavirus disease. It will become the second country in the world after the US to have active cases in excess of a million — the US has around 2.5 million active cases currently (the highest it has had). Brazil, which has seen more cases than India, has never crossed 820,000 active cases. At the current pace, India will overtake Brazil early next week to become the country that has seen the second highest number of cases.

The number of daily new cases of Covid-19 in the US and Brazil are off their peaks; India’s daily tally continues to rise. Some states are still not testing enough, so there’s no telling when India could reach its peak, or what that peak will be — 100,000? 120,000? Any number would be a guess. India ended Friday with 87,691 new cases, taking its overall case number to 4,016,037 and the number of active cases to 844,396. The country saw 1,056 deaths on Friday. On average, since Monday, it has recorded 1,001 deaths a day. Its case fatality rate, based on Friday evening’s numbers may be 1.7%, but in absolute terms, an average of 1,001 deaths a day is worrying. At this fatality rate, Friday’s new cases may result in 1,517 deaths — and that isn’t a small number either.

These are depressing numbers to wake up to on a Saturday morning, but this is the situation India finds itself in — and a struthious mindset isn’t going to help.

Maharashtra, which along with Delhi and Tamil Nadu was among the early hot spots of the disease, continues to be one, accounting for around a fifth of the daily cases in India on average. Tamil Nadu has been on a long plateau for months. And Delhi, which saw a sharp decline in cases, followed by a slight reduction in testing, is now seeing cases increase as the local administration gets more aggressive with testing. It’s too early to say, but the Capital may well settle into the kind of long plateau Tamil Nadu is seeing. Caveat: anecdotal evidence suggests that at least some of the cases being seen in Delhi are of patients from neighbouring (and hinterland) states who are making a beeline for the Capital’s superior medical facilities. Meanwhile, cases in other states in the peninsula and the hinterland continue to rise.

Six months to a day after the first local cases were recorded in India (in Delhi, in early March), it is clear that no Indian state can claim to have defeated the virus. Kerala’s early claims were more a publicity drive than anything else, and Delhi’s rejoicing in early August proved premature.

As India crosses four million cases, this is the situation in which it finds itself. There is no certainty that a vaccine will be found by the end of the year, and be available to India. The country should work on the sourcing, distribution and administration of the vaccine, but be prepared for the eventuality of it not being available before the end of 2021. And there is no certainty that India will achieve herd immunity. Sero surveys (blood tests for antibodies) are a good way to assess prevalence of the disease, but high (or moderate) exposure levels shouldn’t lull administrations into complacency.

This is the 150th instalment of this column, so I will end with five things that I believe India should do now.

One, it should test widely and aggressively, set targets for the states, and insist that unless time is a constraint, only molecular tests such as RT-PCR be used.

Two, it should work with pharma companies to develop quick antigen tests that are accurate (like the new Abbott Laboratories one, launched in the US), or other tests (such as the Institute of Genetics and Integrative Biology’s spectroscopic test that HT wrote about earlier this week) which can be set up in offices, airports and railway stations, and other public areas for quick and accurate testing.

Three, it should review health care infrastructure, especially hospital beds with oxygen facilities and ventilators in the hinterland states which will see a spike in the coming months.

Four, it should enforce social distancing, the wearing of masks, and ban all public events (even 50 people is too large a group).

Five, it should carefully evaluate the costs and benefits of opening up — especially recreational facilities, public transport and schools (when India crossed a million cases, on July 16, this column recommended that the government work on giving every schoolchild who needs one, a device; there’s been no movement on this).

The virus is still at large and spreading. And there’s still no cure for it.