The health department on Monday said it is adequately prepared to tackle a second wave of Covid-19 infections in the district, if one were to arrive in the coming weeks, or months. Officials, including the chief medical officer of Gurugram and the district surveillance officer, clarified that while there were no immediate plans to ramp up surveillance for Covid-19 in the district, the current rate (and the strategy) of testing will continue until further orders from the state government. They added that the present strategy to tackle Covid-19 infections in the state would suffice in case a spike in cases occurs. Moreover, 25% of all hospital beds in Gurugram will also remain reserved for Covid-19 patients, in the anticipation of the virus’ resurgence within the community.

“At present, we don’t see any need to increase testing capabilities, but we are not going to reduce testing either. Whether we will see a second wave or not is a matter of debate, but for our part, we are confident that the existing surveillance system will be enough to help us tackle another rise in cases,” said Dr Jai Prakash Sharma, the Integrated Disease Surveillance Programme’s district surveillance officer in Gurugram, who emphasised that the health department’s “test-trace-isolate” policy has been successful at curbing transmission of the SARS-Cov-2 virus among the district population.

While Gurugram is conducting between 2,000 to 2,500 tests a day (with about a quarter comprising the more reliable RT-PCR method), the test-positivity rate has been on the decline over the past six weeks, now resting at below 5%. This is down from almost 60% in mid-June. For at least the past 10 days, Gurugram has reported less than 100 new cases of Covid-19 each day, with recoveries outweighing new positives. The recovery rate stands at 91 percent, up from 86 percent three weeks ago, while the mortality rate now stands at 1.2% (with 125 deaths in total), as opposed to 1.4% three weeks ago.

While experts were less reluctant to attribute Gurugram’s improvement solely to public health interventions, they agreed that increasing testing may not be necessary at this stage. Dr Prabhakaran Dorairaj, vice president (research and policy) at the Public Health Foundation of India, said, “With rural districts now emerging as the hot spots, it makes more sense to divert resources there instead of deploying them in urban centres where there has been a perceptible decline in cases and deaths.”

Dorairaj also said that this perceptible decline is a natural progression of the epidemic, which has only been slowed down by the lockdown. “But transmission of the virus has continued despite curbs, as shown by serological studies from Delhi and Mumbai, where as many as 23% of the sampled population has been exposed to the virus. Gurugram, being a part of Delhi-NCR, would likely have a similar proportion of population infected, and this may have reached a natural threshold after which the virus has slowed down,” he said, clarifying that this hypothesis requires supporting evidence, which is yet to emerge.

This view was also echoed by a senior epidemiologist at a public university in Delhi who, requesting anonymity, said, “It has yet to be proven scientifically, but my hunch is that the slowdown in NCR is happening because of a large number of people having acquired immunity through exposure. In some models, the prevalence for herd immunity is as little as 25%. Faridabad’s reported case numbers, for example, are growing not because the outbreak there is more severe, but because the population is more than Gurugram’s. Given what we know about seroprevalence in large cities now, the role of public health vigilance should be to preventing deaths when they occur, not really stopping the spread of the virus.”

Gurugram’s chief medical officer, Dr Virender Yadav, was skeptical of a second wave, as it is traditionally understood in epidemiology. “India as a whole is still going through a first wave. India is so large that we will see different states, and different districts within states, reach their peaks at different times. It is good to be vigilant because cases will naturally increase as people start moving about more, but whether this counts as a ‘second wave’ can be debated. That term comes from our experience with the influenza virus, which is seasonal. We don’t know the seasonality of SARS-Cov-2 yet. Nevertheless, we have enough hospital beds reserved to treat an increase in cases, which may happen as people start going about their normal lives.”