Challenges of new Covid wave in India
We must enforce rigorous use of masks even in indoor activities.
Besides the well-known UK, South African and Brazilian variants, we now have the so-called 'double mutant' in India. Sixty-one per cent of the samples tested in the worst-affected state, Maharashtra, had been shown to carry this double mutant. This Indian variant has now also been found in some foreign countries, including the UK, Germany and USA.
Toward the end of February 2021, India was hit with an alarming second COVID wave with devastating effects. Daily number of new infections have crossed the 2-lakh mark. The number of deaths per day is now over 1,000. It took nearly two months for adding 1 million new infections in December-February; whereas it took just six days for a rise in infections by 1 million during the current wave.
How is the second wave more menacing than the first one?
-It seems much more transmissible
-It also affects significant number of children and young people
-Second wave virus behaviour seems different, along with some new symptoms.
-It seems, however, to be established if the currently approved vaccines will be less effective/or ineffective against the coronavirus mutants.
-The scientific consensus is that the chances of developing severe disease or dying seems much lower in vaccinated people.
Besides the well-known symptoms of high fever, body ache, cough and sore throat, some novel symptoms have been observed in parts of India. These include diarrhea, cramps, dizziness, pink eye, and loss of hearing etc.
Lack of reliability of RT-PCR test
In a significant section of patients suffering from coronavirus infections in the currently raging second wave, a significant number of them failed to get +ve results in RT-PCR-the gold standard for COVID detection. These people were nonetheless having typical COVID symptoms. Some have even died though their diagnosis yielded Covid-negative results.
In these patients, successful diagnosis could be performed by a lung CT-Scan that showed opaque patches, called as ground-glass appearance.
Or, fluid is collected from the lungs through a procedure known as bronchopulmonary lavage (BPL).
Why is the RT-PCR test erroneous?
It seems in the second wave of infection the virus enters deep into the lungs without causing significant nasal infections. Because of this reason, the nasal swab doesn't pick up a significant viral litre that can be detected by the RT-PCR test.
What is the Lancet Publication saying?
Coronavirus is airborne
A recent publication in the premier medical journal Lancet (April 15, 2021) reports an ominous finding. The coronavirus that causes COVID-19 uses the airborne transmission as one of the major routes for transmission.
This report has serious implications for modified protocols for pandemic prevention during the 2nd wave. This means that airborne transmission is one major route for transmission besides the spread through droplets and fomites.
Avoid crowding in indoor environments – Use masks even in indoor activities
We may also infer that crowding especially in indoor environments is dangerous and must be avoided as fast as possible. If it cannot be avoided, we must enforce rigorous use of masks even in indoor activities.
What must be done?
1. First, the pace of vaccinations in India/Manipur must be immediately increased.
2. Second, COVID-appropriate behaviour must be strictly enforced (use of masks, hand hygiene and social distancing).
3. Large crowds and social gatherings must be avoided especially in closed spaces.
4. Public health authorities must follow the protocol of "test, track, and treat." Test vulnerable populations for COVID-19, track the infected people and close contacts; isolate the infected individuals, and promptly treat serious/severe patients.
If we let our guards down as well as fail to increase the speed of vaccinations, the coronavirus, including the raging variants, would get a free run and spread quickly in the population. Many people with co-morbidities would then lose their lives. Among the surviving population, the virus may further mutate leading to rise of the so-called "vaccine escape mutants" that would not be neutralized by the currently approved vaccines.
That would be a rather scary scenario. Scientists would then have to go back to the drawing board and freshly design vaccines specifically targeted against the coronavirus variants. In order to avoid such grim outcome, let's all strictly adhere to recommended SOPs, enhance the pace of vaccinations, as well as strengthen the public health infrastructure including increase in number of dedicated hospitals, number of Covid beds, ventilators, provision of oxygen cylinders for medical use, and number of dedicated staff-doctors, nurses, and paramedics etc.
The pandemic won't end overnight
As an editorial in the prestigious medical journal, The Lancet Microbe (Jan. 1, 2021) says, "Vaccines will be instrumental in the control of COVID-19, but their global distribution will be challenging and their effect won't be immediate." Though the vaccine rollout has begun in several countries, many poor nations will still be out of the coronavirus vaccine protection ring, till a global facility such as COVAX procures enough doses for distributing free or at low cost to low-income countries. It may probably take a few years to fully reign in the virus worldwide. Till then, non-pharmaceutical interventions to contain the tricky coronavirus must remain in place across the globe.
Do not let your guards down
So, in the meantime, we must not let our guards down and we must still strictly observe the non-pharmaceutical interventions such as the major SOPs of the use of face masks, physical distancing, and hand hygiene and avoidance of 3 Cs: crowded places, close contact settings, and closed spaces (with poor ventilation).
We must religiously follow the protocol of 'test, track, and treat' for months to come. If possible, the appropriate authorities must take steps to prevent large gatherings such as wedding and death ceremonies, music concerts, and large meetings. The 'hoi polloi' must voluntarily practice the 3 Ws (watch your distance, wear masks, wash your hands frequently) and avoid the 3 Cs: crowded places, closed contact settings, and closed spaces.
Speed up vaccinations
Meanwhile, we must enhance the pace of vaccinations across India including Manipur in a big way.
In this intricate games of chess, humanity must be one step ahead of the wily virus!