India in a delicate phase of its Covid battle as cases surge

In early February, physicians in Amravati district, some 700km (435 miles) from India's commercial capital, Mumbai, noticed a sudden surge in the number of people suffering from Covid-19.

Life in this cotton-growing district in the western state of Maharashtra had almost returned to normal after the first wave of infections last summer. The ICUs of the 1,600-bed state-run hospital and half-a-dozen private hospitals were nearly empty.

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"But everything changed in February," says Anil Jadhav, a local journalist. "And now there's panic in the district."

Since the beginning of February, Amravati has recorded more than 10,000 cases and over 66 deaths from Covid. More than 1,000 were receiving treatment for the disease this week. The positivity rate is in frightful double digits. Amravati and a few other districts in Maharashtra have been again locked down.

The hotspots in a district of 2.5 million people are mainly congested urban areas, say locals.

"We really don't know what the cause of the surge is. What is worrying is that entire families are getting infected. This is a completely new trend," Dr Shyamsunder Nikam, civil surgeon of the district, says.

A number of neighbouring districts have also seen a sharp uptick in cases and Maharashtra recorded nearly 9,000 cases on Thursday, the largest single-day spike in four months. It reported 80 deaths on the same day.

"People here have been not wearing masks. They have been attending unregulated mass gatherings such as marriages and campaigns for local elections. There is free intermingling of people, carriers are not getting isolated, and testing and tracking is low. This has led to this situation," Dr Sanjay Oak, a member of the state's Covid task force, told the BBC.

It's not just Maharashtra where cases have grown recently. Some areas in Kerala, Karnataka, Telangana, Madhya Pradesh, Chhattisgarh and Punjab states have also reported surges. This comes at a time when much of India is reporting a sharp fall in cases - with daily infections for the county falling to less than 20,000 from a peak of over 90,000 in September.

And that has baffled scientists, disease modellers and epidemiologist. The most common reasons given for the spikes in some states are the same as in Maharashtra - big weddings, people not wearing masks, reopening of cinema halls, gyms and swimming pools, and large political rallies in states like West Bengal where elections are due soon.

Epidemiologist Dr Lalit Kant says a "false sense" of normalcy has "swept the country".

"We cannot afford to drop our guard and we have to be cautious about opening places of mass gatherings. Testing, tracing and isolation has to be again scaled up massively in all states - we cannot wait for things to get worse."

Dr Kant adds that the rise in the number of cases in some states was expected because it followed the global pattern. "We have seen spikes in several countries after a lull of two to three months."

Disease modelling expert Gautam Menon agrees that the spike was expected.

"Modelling work and sero survey results would suggest that much of India should be still susceptible to the disease, so a resurgence of the sort we are seeing is not very surprising."

But why is the resurgence happening only in a handful of states, particularly in Maharashtra?

Mr Menon says the only reasonable conclusion is that surveillance in these states is stronger and that a similar rise in other states may simply have gone undetected so far.

Another possible reason, experts say, could be mutation. Viruses often mutate to change their genetic code, which is like their instruction manual. Mutations allow viruses to spread faster and, in some cases, render antibodies less effective.

This has been seen in the UK, South Africa and Brazil - new variants from these countries have spread much faster in large clusters. Cases linked to these strains have been detected in India, but there is no evidence yet that they have spread in the community.

"This is at once good and bad news," says Mr Menon. "Good because the other [foreign] variants are known to spread faster and can potentially escape immunity generated from a prior infection. Bad news because we know little about whether the Indian variants may behave similarly."