The 2nd wave is retreating. However, Kerala and to some Maharashtra are growing again as are the North East States. Meanwhile vaccination is averaging only 4 Mn doses/day. What are the possibilities for a 3rd wave? Read the presentation to see the latest position.

1. Covid 19 Stats in India –
Update 23
Review of key data and presentation of a projection model
Data updated till 12.07.21
Data Sources: https://www.covid19india.org/; https://www.worldometers.info/;
https://censusindia.gov.in/2011-prov-results/paper2/data_files/india/paper2_1.pdf
https://ig.ft.com/coronavirus-
chart/?areas=eur&areas=usa&areas=bra&areas=gbr&areasRegional=usny&areasRegional=usca&areasRegional=usfl&area
sRegional=ustx&byDate=0&cumulative=0&logScale=1&perMillion=0&values=deaths
https://ourworldindata.org/covid-vaccinations
https://www.mygov.in/aarogya-Setu-app/

2. Agenda
• Presentation of key data for All India
• Review of cases and deaths in states
• Kerala – The Canary in the Coal Mine
• Vaccination
• 3rd Wave predictions
• Discussion

3. Data Integrity
• India data on deaths is being strongly questioned by researchers both in
India and abroad. Anywhere between 2 – 4 times the official death rate is
being talked about as the real figure
• Cases are anyway ‘discovered cases’ and it is well known that the real
figure is multiple times
• Approach
• We will look at surrogate variables to get a directional indication (TPR and Daily
Growth in Active Cases are two such)
• We will also use the official numbers for modelling and look for correlation with the
surrogate variables

4. All India Data

5. • Testing was not been able to keep pace with the
pandemic after the second wave started
• Positivity rates had crossed 20% (the peak in
September was 15%) in the 2nd wave. With the ramp
up of testing, TPR went below 5% after the first week
of June.
• TPR reached a peak of 24.85% on 9th May. It declined
thereafter but testing has been coming down in July.
This is leading to an increase in TPR in the last few
days.
• Kerala (10.5%) has high TPR along with the North
Eastern States. Maharashtra TPR has dropped below
5% indicating that the pandemic is coming under
control.

6. • Cumulative CFR is trending upwards. This is a
disturbing trend indicating that fatalities in the 2nd
wave are higher
• This is clearly visible when you see the 7DMA CFR.
The adjustment of previous period fatalities
repeatedly by Maharashtra and now by MP have
rendered the fatality numbers infructuous for any
meaningful analysis

7. • New infections reached their lowest point on 11.02.21 at 10,983
7DMA
• Cases had galloped after that and the previous peak was
surpassed on 4.04.21
• The highest number has been 414,280 on 6 May. The highest
level on a 7DMA basis was 392,330 on 8th May. The declining
trend in cases is now well established. When coupled with a
decreasing TPR this is a more robust figure. Daily cases have
dipped below 50,000 on 27.06.21 for the first time after the
decline commenced. On 12.07.21 the 7DMA is 40,828
• The pace of decline has slowed down. However it has still not
turned upwards. We will analyse Kerala, the most problematic
state later

8. • Active Infections have peaked. From 22nd April, the rate
of growth has been slowing.
• On 10th May for the first time in the second wave, Active
Infections declined by 30,499. Thereafter, the declining
trend has got established
• Daily Growth in Active Infections is a reasonable lead
indicator of what direction the wave is taking
• The load on the healthcare system is also coming down
• However, the rate of decline in Active Infections is
slowing down. This is another indicator that a plateau
may be approaching

9. • Deaths had reached a plateau from around the
10th of May. However, the numbers have been
distorted by Previous Period Adjustments carried
out by Maharashtra on several days and now by
MP.
• For this presentation I have shown the raw
numbers without adjustment
• The 7DMA is showing a peaking on 23rd May. The
30 DMA has peaked on 27th May
• The salient point is that deaths have continued to
grow after cases peaked on 8th May on a 7DMA
basis. This may indicate that serious cases are
taking more time to resolve. Complications such
as Mucormycosis also came up.
• The declining trend is now clearly established.
Hopefully further PPAs will not happen.
• Clearly, fatalities are not a reliable number for
forecasting at this point

10. States

11. • Kerala (discussed separately) and Maharashtra (plateauing) are the two major problem states
• North East is also rising
• All others have declined

12. Kerala – The Canary in the Coal
Mine

13. • The 2nd wave in Kerala peaked at the same time as most of
the other states on 12.05.21 at 38,143 cases 7DMA.
• The decline afterwards was also in line with the rest of the
country though a bit slower.
• The lowest point reached was on 19.06.21 at 12,091 cases
7DMA.
• Since then the cases curve has been flattish with a little
growth. Deaths are clearly rising.

14. Rural Urban Total % Urban Cum Cases Cum Deaths Cases/Mn Deaths/Mn Tests % Cases to pop Tests/Mn
1 Ernakulam 10,47,296 22,32,564 32,79,860 68.1% 3,69,430 1,435 1,12,636 438 11.3%
2 Thrissur 10,20,537 20,89,790 31,10,327 67.2% 2,87,217 1,515 92,343 487 9.2%
3 Kozhikode 10,14,765 20,74,778 30,89,543 67.2% 3,23,524 1,436 1,04,716 465 10.5%
4 Kannur 8,82,745 16,42,892 25,25,637 65.0% 1,68,211 919 66,601 364 6.7%
5 Alappuzha 9,74,916 11,47,027 21,21,943 54.1% 2,06,729 1,047 97,424 493 9.7%
6 Thiruvananthapuram 15,28,030 17,79,254 33,07,284 53.8% 3,10,974 2,989 94,027 904 9.4%
7 Kollam 14,43,363 11,86,340 26,29,703 45.1% 2,42,834 1,008 92,343 383 9.2%
8 Malappuram 22,94,473 18,16,483 41,10,956 44.2% 3,53,295 1,126 85,940 274 8.6%
9 Kasargod 7,97,424 5,05,176 13,02,600 38.8% 92,325 277 70,877 213 7.1%
10 Kottayam 14,13,773 5,65,611 19,79,384 28.6% 2,03,473 592 1,02,796 299 10.3%
11 Palakkad 21,33,699 6,77,193 28,10,892 24.1% 2,19,711 1,282 78,164 456 7.8%
12 Pathanamthitta 10,64,076 1,31,461 11,95,537 11.0% 1,21,443 458 1,01,580 383 10.2%
13 Idukki 10,55,428 52,025 11,07,453 4.7% 85,748 162 77,428 146 7.7%
14 Wayanad 7,84,981 31,577 8,16,558 3.9% 68,202 243 83,524 298 8.4%
Kerala 1,74,55,506 1,59,32,171 3,33,87,677 47.7% 30,53,116 14,489 91,444 434 2,43,08,000 9.1% 7,28,053
Maharashtra 11,23,74,333 45.2% 61,49,264 1,25,528 54,721 1,117 4,38,00,139 5.5% 3,89,770
All India 1,21,05,69,573 31.2% 3,08,36,262 4,08,072 25,473 337 43,08,85,470 2.5% 3,55,936
• As expected, the correlation between Urbanisation and Covid impact is not there for Kerala
• Testing in Kerala is more than double of the national average.
• Discovered Cases per/mn in Kerala are very high – this is mostly due to higher testing but also that TPR (10.4%) is still high. Almost 10%
of the population (2011 census) has had Covid (discovered)
• Anecdotally, the identification of Covid deaths is better in Kerala. Hence, the recorded deaths/mn are higher than the national average
but if unrecorded deaths are taken into account the national figure would be far higher

15. • Thiruvananthapuram is the only district recording a continuing decline in cases
• Other districts on this slide are showing a flattening/slowly rising trend

16. • All these districts are showing a rising trend

17. Kerala Discussion
• As of now, no new VOC has been identified in Kerala
• Hence the rise in cases may be linked to relaxation in social behaviour
or similar factors – this is more like a ‘wavelet’ as discussed in the
previous presentation

18. Vaccination

19. • June target of 120 Mn doses was met. July target has been taken at the same level.
• So far July is on target
• For this year the Govt has committed to vaccinating all Indians by End Dec 2021. I have taken that to mean at least 1 jab for all adults
by year end
• There is no clarity regarding availability of Sputnik or capacity enhancement at SII or Bharat Biotech. Accelerating beyond 4 Mn
doses/day is dependent on this and/or availability of some new vaccines
India Vaccination Progress
Day Jul-21 FY 21
Target 12,00,00,000 1,35,49,50,000
Avg/Day 38,70,968 38,71,286
Achievement
01-Jul 1 43,60,213
02-Jul 2 45,35,059
03-Jul 3 66,10,015
04-Jul 4 16,70,740
05-Jul 5 46,61,566
06-Jul 6 37,69,936
07-Jul 7 35,24,001
08-Jul 8 41,43,673
09-Jul 9 32,05,046
10-Jul 10 38,36,318
11-Jul 11 13,19,915
12-Jul 12 41,45,145
Cum 4,57,81,627 38,14,97,646
Avg/Day 38,15,136 21,43,245
Bal 7,42,18,373 97,34,52,354
Bal Avg/Day 39,06,230 56,59,607
Acceleration 102.4% 264.1%

20. 3rd Wave

21. Waves vs Wavelets
• Speculation:
• Are wavelets of the type that Delhi
exhibited prior to the wave in
April/May 2021 the same as the
latter?
• Wavelets appear to be caused by
relaxation in Covid appropriate
behaviour such as what happened in
Delhi and North India around Diwali.
They tend to recede when behaviour
is tightened.
• Wavelets appear to be caused by the
same strain as the original. A true
wave is caused by a new strain (in
India – Delta) and in UK – Alpha
• India’s second wave has been
remarkably consistent across states
and geographies – pointing to the
relative ineffectiveness of normal
covid control measures in stopping
the wave cased by the Delta variant

22. 3rd Wave www.nature.com Multiwave pandemic dynamics explained: how to tame the next wave of infectious diseases
Giacomo Cacciapaglia 1,2,5*, Corentin Cot1,2,5 & Francesco Sannino3,4,5
• “The key to control the arrival of the next
wave of a pandemic is in the strolling
period in between waves, i.e. when the
number of infections grows linearly. Thus,
limiting the virus diffusion in this period is
the most effective way to prevent or
delay the arrival of the next wave”
• UK 3rd wave is predicted to peak on
24.07.21 with 75% cases of the 2nd wave
• Update: As on 11.07.21 UK 7DMA is
31,215. The 2nd wave peak was 59,441 on
11.01.21. 75% of that peak is 44,580

23. 3rd Wave – Manindra Agrawal
• Sutra Model
• Contact Rate – Beta. Closely related to R0. R0 = 10Beta
• Reduction Factor – Epsilon. Measures the ratio between reported and actual cases
• Reach – Rho. Measures fraction of population over which pandemic is active. Captures loss of
immunity and vaccine driven immunity
• Model is theoretically sound. However, forecasting of parameters appears to be
based on imperfect studies and many estimates. My sense is that it may work in a
fairly stable situation but may find it difficult to capture the rapid spread of a new
variant such as Delta or even overwhelming covid inappropriate behaviour
• Manindra Agarwal explains the rise in cases in Kerala saying that Epsilon is rising.
This is also captured by a high TPR. Kerala needs to test more to bring TPR down
from 10.4% to 5%. No of discovered cases will go up but not in the same
proportion. This will also help in contact tracing and isolation

24. • Manindra Agarwal
- Monster 3rd wave
unlikely
• Timing around 3rd
week of October.
However, his
assumption that
Covid appropriate
behaviour will
continue through
August is already
proving wrong

25. India 3rd Wave
• Influencing Variables
• Strolling period
• New Variant
• Speculation
• The gap between Wave 2 and 3 in UK is projected to be around 6 months. Assuming
a similar situation for India it would indicate a peak for Wave 3 around Nov 2021
• Strolling period behaviour unlikely to be Covid appropriate. Vaccination drive has
remained slow in June and probably July. This might hasten the 3rd wave
• If there is no variant we may get away with a mild wave. If there is a new variant with
significant immune escape it could be possibly worse than Wave 2

26. Questions for Discussion
• 3rd Wave

27. Thank You!
Please mail me at debubhatnagar@gmail.com
with any comments.
Disclaimer: These projections and analysis are not official and are the work of an
amateur. They should not be the basis of any decision making.