Society and government should join hands to tackle the situation
The devastating second wave of the deadly coronavirus infection has shaken the very foundations of Indian society and apprehensions are already rife about an impending third wave. Even as the country pulls out all stops to contain the cruel impact of the second wave, it seems befitting to start preparing for the next so as to minimise the damage and not repeat the extremely painful consequences witnessed in the second quarter of this year. Pls check
Science India spoke to Dr Sanjay K Rai, Professor, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, to understand how India can save itself from the third wave of coronavirus infections.
Dr Rai is currently working in the area of HIV/AIDS and is providing technical support to National AIDS Control Organisation (NACO), Ministry of Health and Family Welfare (MoHFW), Government of India. He is also involved in a research on human influenza disease burden in India, and vaccine effectiveness trial studies in collaboration with Center for Disease Control, Atlanta, and University of Alabama, USA.
Will there be more waves of the coronavirus pandemic — globally as well as in India?
In epidemiology, we always talk about three factors — host, agent and environment and all the strategies are based on these three factors. Prediction of any wave would be decided by these factors only. The first factor is host. Here, host is the percentage of a susceptible population. If a susceptible population is more, then the wave would be definitely bigger, something like what we are noticing in our country currently.
The second factor is agent and here, the agent is a variant of the virus. If tomorrow a new variant comes, which is an entirely different variant, then any size of a third wave can be observed. It is very difficult to predict the upcoming variant at this moment. The best way to identify any new variant is through continuous genetic sequencing. Surveillance of this virus is the most important factor to know about the future strain and once we’ll know the strain, we can take timely appropriate action. But if the same type of virus is circulating, then a very big third wave is unlikely. We can get immunity from the virus in two ways, either through natural infection or through the vaccine. If the virus is capable of invading these two, then definitely the third wave could be of any size. But if the virus is unable to invade natural immunity or vaccine acquired immunity, then the third wave would be very mild or low.
If there is going to be a third wave, how can India prepare itself to combat it?
Third wave may happen, but it will most probably be smaller than the present wave. Nevertheless, our health system needs to prepare itself not just for the covid waves, but for resumption of regular health services as well. This wave has taught us about importance of a good public health system. The best way to prevent or manage any future waves is by strengthening the public health system. This is the single most important way to tackle this type of situation in future. It is difficult to predict about the virus strain but irrespective of anything, if our public health system is prepared then we can manage. We cannot do firefighting every time, like we did this time, during the second wave.
Can you explain what the waves of a pandemic mean?
The literal meaning of a wave is a swing, something that goes back and forth or up and down. For example, in the case of COVID-19, last year we saw that India reported more than 1,00,000 cases during September and then there was a gradual decline and in February this year, we saw less than 10,000 cases per day. So, this up and down is called a wave.
The second wave of coronavirus infection really went out of hand. Is there any missing link or gap between the government, people and the agencies providing services to them?
No doubt, there is a need to investigate the reason for this sudden surge of cases. A sudden and a very big wave was not anticipated by the expert advisors to the Government of India. India is experiencing an extraordinary COVID-19 situation. There was a gradual decline in cases in the last six months, from September to February, even when we passed the major festival season and also witnessed assembly elections. During these months, COVID-appropriate behaviour was hardly followed but still cases and deaths continued to decline. If this sudden unexplained increase is continuing, it means we need proper investigation.
Non-adherence to COVID-appropriate behaviour plays an important role but the way these cases have increased, it is very difficult to believe that is the main factor behind the recent surge. The cases are rising not only in India but also in Pakistan, Bangladesh and even in Nepal. People began to think that the pandemic was over; they stopped wearing masks and were not maintaining social distancing.
We have data of around two crore COVID-19 positive patients in digital form, which should be analysed. There are various ways to find why this is happening. We’ll be able to take appropriate action once the data is analysed, otherwise we’ll keep doing firefighting. No doubt there was a lack of information and lack of proper preparation. But the situation is entirely different in our country if you compare it with Europe and others. Europe just faced its third COVID-19 wave. In the UK, there was a very big third wave, seven to eight times bigger than its second wave. We need to find the right reason with proper research and analysis but with an open mind.
Apart from the measures being taken by the government and medical fraternity, what role should the society play at the individual level to ensure that future waves do not become as deadly as the second wave in India?
Society always plays an important role in any type of public health problem. In this case, following the COVID-appropriate behaviour is in the hands of the people. They can’t control a new variant or any other new mutation but can definitely control their own behaviour. The civil society and government mechanism should join hands to tackle this issue.
Why did the government increase the waiting period for the second jab of COVID-19 vaccine from 6 to 8 weeks to 16 weeks? Is it for both the vaccines?
In the last one year, 13 vaccines have been approved by various regulatory authorities all over the world. In India, currently three vaccines are approved and two are in use. The first one is Covaxin, which is an Indian vaccine developed by the ICMR and Bharat Biotech and manufactured by Bharat Biotech. Through the clinical trials, we collected evidence from the data that a four-week gap is sufficient. The second vaccine being used in India is Covishield, developed by Oxford and AstraZeneca and manufactured by Serum Institute of India. When clinical trial for this vaccine was done in three countries — UK, South Africa and Brazil — they found that efficacy was 61.2%. Then, they did some analysis and found out that when the second dose is given after six or eight weeks, the efficacy was better, though that was a smaller group. Now after vaccine rollout, they did some further analysis and found that if the gap is more, then the efficacy is more. But there is a problem, if you are increasing the gap and you are not taking the second dose then you are not protected. If we are increasing the gap between two doses, then we are decreasing the protection efficacy for that particular period. No doubt the gap has been increased based on some evidence, but there should be a balanced approach. If we are getting the second level of protection from six to eight weeks, then we should go for six to eight weeks only. But if it is because of the logistics problem in providing more vaccines to more people then it is difficult to comment but it looks that the decision has been made on scientific basis only.
*The interviewer is Associate Editor, Science India.
