Inside India's Catastrophic Second Wave

India has recorded 30 million Covid-19 cases - second only to the US. It is the new epicentre of the global pandemic.

The second wave in recent weeks has overwhelmed the healthcare system, leaving hospitals struggling to cope and critical drugs and oxygen in short supply.

But infections now seem to be slowing down. On Monday, cases fell below 200,000 for the first time since 14 April.

So is the second wave coming to an end?
Experts believe that at a national level, the wave is waning.

The seven-day rolling average of new reported cases during the wave peaked at 392,000 and has been on a steady decline ever since for the past two weeks, according to Dr Rijo M John, a health economist.

But there's a catch.

Even if the second wave appears to be waning for India as a whole, it is by no means true for all states.

It appears to have crested in states such as Maharashtra, Delhi and Chhattisgarh, but is still rising in Tamil Nadu, for example, as in much of the north east; and the situation in Andhra Pradesh and West Bengal is unclear.

So the wave is not uniform and there are several states that are yet to find their peak in daily new cases, according to Dr John.

To be sure, infections are coming down in most of the major cities.

"But the weak rural surveillance complicates the picture," said Dr Murad Banaji, a mathematician at Middlesex University London. "It is possible that total transmission nationwide has not peaked yet, but this is not visible in case numbers because the infection is mostly spreading now in rural areas," he said.

Such heterogeneity at the local level makes it very difficult to guess whether the India-wide trend of a sharp decline in active cases now is sustainable or not, according to Dr Sitabhra Sinha, a scientist at the Institute of Mathematical Sciences in Chennai.

Bhramar Mukherjee, a University of Michigan biostatistician who has been closely tracking the pandemic, agreed.

"The notion that the peak has passed may give false sense of security to everyone when their states are in fact entering the crisis mode," she said. "We must make it clear that no state is safe yet."

Does the virus's reproduction number offer any clues?
The reproduction number of the virus - also called R0 and R- is a way of rating a disease's ability to spread and estimates the average number of people infected by one already infected person.

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