Page 7 - April 2021
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         Europe and the USA were infected way before us in the first wave, and so is the case with the second wave.
The 1918 influenza pandemic occurred in three waves and was the most severe pandemic in history. More recently, the 2009 H1N1 influenza pandemic, though mild, had two distinct waves. COVID-19 is no exception. The wave pattern depends upon the behavioural patterns of individuals and its severity also depends upon the immunity level in the population.
Medically, a second wave refers to the resurgence of infection in a different part of a population after an initial de- crease. The WHO says past pandemics have been characterised by “waves of activity spread over months”.
As of today, India is in the middle of a second wave. By the first week of April, active cases were on the upswing, and daily cases were crossing 50,000 regu- larly. The last time that happened was in October 2020, when India was emerg- ing out of its first wave.
The health ministry said in the first week of April that a variant with two mutations — E484Q and L452R — that make them better at evading the body’s defenses was found in India. In addition, the UK, Brazilian and South African variants have also been circu- lating. Considering these factors and the duration from the present level of daily new cases to the peak India saw last year, we’re expected to reach the high in the second half of April. The second wave, which could last until the end of May, could see an addition of 25 lakh cases, according to a report by SBI’s Group Chief Economic Advisor Soumya Kanti Ghosh.
Currently, scientists are unclear as to what is driving the increase in cases, particularly after widespread infection last year prompted speculation about whether parts of India were enjoying a degree of herd immunity. A factor
that is being considered was the lifting of most lockdown restrictions, which sent people flocking back to restaurants, weddings and even cricket stadiums. But it is also true that the new COVID-19 variants could be fuelling the spread, and possibly reinfection. With the Ma- hakumbh and election rallies in parts of India, the numbers only rose.
With the third wave already under- way in a lot of western countries, it is bound to have a domino effect in India too, with air pockets open to one and all. Tight border controls, contact trac- ing, route mapping and strict quaran- tine protocols, lockdown and staggered work timings may not be suitable in the strictest measure considering the large economic impact.
Coronavirus has been intensely re- searched globally in the last more than one year. Its genome was published quickly and that aided the development of vaccines in less than one year, a re- cord feat in itself. Different elements that go into vaccine development, including science, medicine, regulatory processes, policies, logistics, and financial support, were aligned.
Two vaccines were initially made available in India — Oxford Research Group’s Covishield, co-produced by AstraZeneca and the Serum Institute of India, and the indigenous vaccine, Covaxin, developed by Bharat Biotech. By April 12, India had administered 100 million doses of the vaccine.
Yet, India continues to face con- cerns of vaccine hesitancy among its population. Part of the problem is that people are just passive recipients of our awareness activities. There is vaccine hesitancy even among the highly edu- cated. Apart from government efforts, community engagement and awareness are important for the vaccination drive to be successful. We need at least 60% of the population to be vaccinated within a short span. The government strategy has to quickly evolve to vaccinate everyone above 18 years in the given situation. The mobile younger population is likely carrying the disease home.
Questions like, whether the vaccine helps me develop immunity, individually or not, are immaterial as development of the herd immunity will help combat further waves of the disease. Is vaccine going to protect from variants? There are some common spike proteins which are definitely covered by vaccines, but pertaining to mutations, it is likely that the tweaking of molecular structures may be required in future regularly.
Whether reinfections are occurring or infections after the vaccine, is a great concern in the minds of the general pop- ulation and medical researchers alike. Some small studies do show them oc- curring, but the severity is less and hence the hospitalisation rates.
Some lessons are hard learned, but the vaccination drive will continue to play a major role in fighting the pandemic. As doctors, we are always on guard and our only plea is that citizens must con- tinue to follow protocols. The sense of apathy we are currently seeing owing to COVID-19-fatigue is disheartening.
The only solution is to reduce trans- mission. This is possible. We have done it once already. The chance of encoun- tering an infected person — at the store, at work, at a social gathering — is great- er now than at any time in the history of the pandemic. If there was ever a time to be cautious, it is now.
As a medical practitioner on the frontlines of the COVID war, I think the quick development of the COVID-19 vaccines was an unprecedented and en- couraging step toward putting an end to the pandemic. We started acknowledg- ing that the concern over vaccine safety stemmed from trying to make the right decision for themselves and their loved ones — something we all want. With infection rates like we saw last year, I strongly recommend choosing what it takes to avoid infection, as with vaccines and other prevention measures.
*The writer is Intensivist and consulting Physician, and Professor in Critical Care Medicine.

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