Editor’s note: Be sure to check out our guide to Omicron if you need a refresher. 

Researched by: Sara Varghese & Ankita Ghosh

First, the India numbers

On Monday, India recorded 35,565 new cases—and our official total Omicron tally is 1,889 to date. The total number of active cases have once again breached the 100K mark. As usual, the big cities are the worst hit. The seven-day average for Delhi—reported 4,099 new cases on Monday—has grown a whopping 832% from the week before. Mumbai with 8,082 new cases witnessed a rise of 624%.

The big surge: What’s notable about this wave is the dizzying rate of increase—which is even higher than the Delta-driven second wave. According to a Hindustan Times analysis, the seven-day national average has grown by 175% as of January 2. At the peak of the second wave, that number was 75%. Equally eye-popping: How quickly we’ve gone from dwindling numbers to a huge spike: 

“Just five days ago, the weekly growth rate of average daily cases was in the negative, meaning the wave was contracting compared to preceding week. So it took just five days from a contracting case rate to one that has surpassed the pace of growth seen even during the second wave.”

The R Number: or reproductive number indicates how many people will be infected by a single person. So if it is 1, then 100 people will infect 100 others. As a wave recedes, that number keeps dropping. Anything above 1 indicates the virus is spreading to greater numbers of people. The R number for Delhi and Mumbai has already breached 2—and is currently 2.5 for Delhi. The India-wide R value is 1.22. The last time we breached 1 was in February 2021—right before the second wave.

The big spread: While the metros take up most of the attention, the pandemic is spreading across the country. On December 24, only six states saw daily growth rates exceeding 5%. By December 26, this had grown to 11 states, and by December 29, to 14 states. 

When’s the peak? Many experts are unwilling to time the actual peak, but an IIT-Kanpur study published last month put the date at February 3. Point to note: It did not consider vaccination data.

So this is Omicron, right?

In other parts of the world—notably South Africa, the UK and US—the latest wave has been fuelled by the propulsive spread of Omicron—which is now known to be far more infectious than Delta. But our Omicron tally is puzzlingly low—and accounts for about 5% of all new cases. So what’s going on? 

One likely reason: We are doing a poor job of genome sequencing the new cases. The Hindu notes that the key union government lab responsible for sequencing is so swamped that it’s asked states to stop sending it samples. It was tasked with sampling 5% of all Covid cases, but has only managed 1%—primarily due to a shortage of funds and tools necessary to rapidly scale up. The samples are supposed to be diverted to other labs—but we have only a few that can do this kind of work. 

The evidence: suggests that the country’s Omicron tally is a vast underestimate. According to the latest genome sequencing report released by the Delhi government, 81% of all cases tested are attributed to Omicron. In Mumbai, that number stands at 55% as of January 1. An NDTV analysis of data from two key labs in Delhi and Mumbai reveals the following:

“Particularly alarming is the fact that Omicron cases are rising much faster than Delta—from about 2% share of total Covid cases two to three weeks ago, then shooting up to 30% a few days ago—and is now close to 60% of all Covid cases. During this period, the share of the Delta variant has fallen consistently, making Omicron the dominant variant in India.”

How bad will it get?

Most experts say the numbers will be far higher than the Delta-driven second wave simply because Omicron spreads further and faster. According to NDTV:

“[I]f this third wave accelerates in India like it has across the rest of the world, India could see between 16 lakhs to 20 lakh cases every day at its peak compared with the 4 lakh Delta cases that India had at the peak of our second wave.”

Cause for worry: As with the onset of the second wave, we are once again headed for elections in Punjab and Uttar Pradesh—and the Election Commission has ruled out rescheduling them. Less than 50% of eligible residents in UP have been vaccinated, while Punjab has the lowest percentage in the country at 40%. Also headed for elections: Manipur, Uttarakhand and Goa.

Milder than Delta? Omicron doesn’t cause severe disease to the same degree as Delta. And the number of hospital admissions are evidence of the same. A Mint analysis shows that less than one in 10 infected patients in Delhi have been hospitalised—compared to 25% at a similar stage during the second wave. Point to note: The number of hospital cases are, however, ticking upwards—increasing from 247 on Saturday to 420 on Monday.

But, but, but: this doesn’t mean the variant can’t cause havoc. The reason: Even if the percentage of severe cases are lower, the sheer number of Omicron cases could result in hospitals being swamped, according to some analyses:

“Six of 100 Delta cases need hospitalisation, and let's say only half that, three out of 100 Omicron cases need hospitalisation, take a look at the huge consequences: the second wave peaked at four lakh Delta cases, resulting in about 24,000 hospital admissions, and in the worst scenario, a third wave peak of 20 lakh Omicron cases would result in 60,000 Omicron hospitalisations per day.”

Point to note: Given Omicron causes less severe disease, many experts—including America’s Covid czar Dr Fauci—say it may become more important to track hospitalisations as opposed to total number of cases.

What about immunity? As of December 30, 64% of India's adult population is fully vaccinated and around 90% has received the first dose. That still leaves 100 million adults who haven’t received a single dose. And a high number of Indians are more vulnerable due to underlying health conditions such as diabetes etc. That said, most experts do not expect a repeat of the second wave nightmare:

“The Covid world pre-Delta and during the Delta wave was very different from the post-Delta wave. Very small fraction of the population in any country was vaccinated. But now, vaccine coverage has increased and Delta also caused a lot of infections. In India, 67.6% of the population was antibody positive by July 2021. Now, vaccine-induced as well as hybrid (both infection and vaccination) immunity protects much better from severe disease.”

Whither booster shots? The government is dragging its feet on authorising booster shots for the general population. This even though multiple studies indicate that Covishield offers little protection against severe disease after three months. As for Covaxin, the government’s claims that it’s like “Bruce Lee” in fighting Omicron is sketchy, to say the least. Besides, a government study found that both Covishield and Covaxin may become far less effective after four months.

Should we expect lockdowns?

A full lockdown is extremely unlikely. But we may get massive disruptions as cases rise—much like the US and the UK. Key services may be overwhelmed because there is simply not enough staff. Schoolchildren will continue to suffer—as in Mumbai which has shut down all classes except for grades 10 and 12. And companies may move back to a work-from-home schedule. The Google Mobility Index expects Omicron to significantly impact the service industry—which accounts for over 55% of the GDP—as people increasingly stay at home.

Point to note: Health authorities in the US and Europe are changing their quarantine requirements to minimise disruptions to daily life. In the US, people who are asymptomatic can now leave isolation after five days—though there is some talk about requiring a negative test after a huge backlash. In France, vaccinated people and children only need to isolate for seven days. But it isn’t clear if India will follow their lead.

Tip to note: Given how infectious Omicron is, doctors in the US are now urging people to ditch cloth face masks and move to surgical or respirator masks. Or you can layer a disposable mask with a cloth one.

The bottomline: All we have to offer is this eerily appropriate cartoon from 100 years ago: 

Reading list

The reporting on Omicron in India is fairly fragmented so there isn’t much more to read. BBC News offers a good overview of the coming third wave. It’s also worth checking the NDTV and Hindustan Times analysis of the numbers. The Hindu has a good introduction to genome sequencing in India.