Fast forward to the present, India is just reemerging from a deadly second wave of the outbreak. So, where did things go wrong? Didn’t people maintain distance? Didn’t they wear a mask? Didn’t they get inoculated when they could? The simple answer is that the second wave and even the upcoming third wave are inevitable. While some countries like the USA have forgotten about the existence of the pandemic, countries like India cannot.  

There are many parameters to measure the trend of an outbreak, one commonly used is the Basic Reproduction Number (R0). This indicates the number of people to which a single infected person can transmit the disease to. On average, the R0 for SARS-CoV-2 is estimated to be between 2-4 but this is not a fixed value and highly depends on several factors – one of which is population density. Let’s take the example of the cruise ship Diamond Princess. One of the passengers who had earlier disembarked in Hong Kong had been infected with COVID-19 and over the course of a month, while the ship was quarantined in Japanese waters, more than 700 of the total 3711 people aboard were infected. For this cruise ship, both the population density and R0 value was four times that of Wuhan, China. This supports the earlier observations that population density is directly related to the R0 value of a disease.  

There have been multiple comparisons made between India and China in terms of how each country has handled the pandemic. It seems China is the only country with which a valid comparison can be made, considering its large population. However, the population density of China is 153 per km2 while that of India is a little more than double of that standing at 382 per km2. On average, an Indian family is composed of five members and 40% of all homes (100 million) in India have only one room. Physically, social distancing is just not feasible in India. It is a privilege and an oxymoron. With only the logistical perspective, the story is incomplete. It is also relevant to consider that people in India tend to be more social than average and all the events and festivals that run year-round and even food are all activities that are group-based. Consequently, requiring people to stay away from one another, is rather a difficult thing to do.  

Finally, I want to say that even as cases decrease and vaccinations increase, the battle against COVID-19 will be lost once again if we become negligent. Since negligence is expected, the public health infrastructure needs to become stronger and the specific authorities need to be on guard. Let’s breathe cautiously, people!