The Union Government of India is considering lifting of all COVID restrictions from March 31 in view of the reportedly receding of COVID-19 active cases across India. All institutions are gradually returning to normal operations. However, experts fear that there may be a looming threat of a fourth COVID wave in India, considering the fact that there is a massive surge in positive cases in China, other South Asian countries, Europe and New Zealand in recent past as reported in DNA India, March 25, 2022.
A new study by IIT Kanpur also indicated the possibility of a fourth wave hitting India in June 2022. This was mentioned in an earlier column entitled “Strong need for continued Covid-19 genomic surveillance” published in Imphal Free Press on March 13, 2022. As per the National Centre for Disease Control (NCDC), the prevalence of BA.2 variant is gradually increasing in India. Earlier, BA.1 variant was dominant in India but now the BA.2 variant is gradually increasing, according to Dr Sujeet Kumar, Director, NCDC.
In view of the possibility of a fourth wave hitting the country, Dr T Jacob John, virologist, opined that "one should not let one’s guard down regarding the virus."
Experts are hoping that the fourth wave, if it comes, won't be severe as most of the Indian population has now been administered the COVID vaccine and have acquired protective immunity. A total of 2,22,62,588 beneficiaries have also been administered the precaution dose across the country as of March 25, 2022. As per official sources, India’s COVID-19 vaccination coverage reached 1,82,87,68,476 as per provisional reports till 7 am, March 26.
Is Stealth Omicron more immune evasive than the other Covid variant?
It's not yet known for sure if Stealth Omicron is more immune-evasive than the other Covid variant and can partly escape the protection provided by prior infections and/or vaccinations.
The Stealth Omicron is a sub-variant of Delta that caused a massive rapid third wave in India. It's a bit more difficult to detect in PCR tests than other variants. That is why it is called "Stealth Omicron." It is scientifically designated as BA.2 variant (the original Omicron is called BA.1). The BA.2 variant is highly transmissible and has the potential to trigger a fresh COVID wave across the globe and possibly a fourth wave in our country, India as reported in DNA India, March 26, 2022. Scientists say that the BA.2 is 1.5 times (one and half times) more transmissible than the original Omicron (BA.1).
Current COVID scenario in China and other Asian countries
China has logged more than 56,000 Covid positive cases since March 1, 2022 (ET, Mar. 26, 2022). This is despite the stringent 'zero COVID' policy followed by this Asian giant. Booster rates in China are still low. Only 56.4 per cent of people aged 60-69 years have received the booster dose; while 48.4 per cent of people aged 70-79 years have got a booster shot.
The COVID scenario in Hong Kong highlights the importance of vaccinating the elderly people. A vast majority of deaths have been among those who are not fully vaccinated, with many in the elderly population.
COVID surge is also witnessed in other parts of Asia such as South Korea, where restrictions have been clamped yet again.
New COVID surge in Europe
The spread of Coronavirus cases have reached record levels in England, with around 4.2 million new cases reported across the United Kingdom last week (NDTV News, March 25, 2022). The steep rise has been attributed to the BA.2 Omicron variant (Stealth Omicron). The last record surge was in the first week of 2022, when the United Kingdom logged 4.3 million cases in a week. Germany has recorded 1.5 million new cases in the last seven days (The Hindu, Mar. 26, 2022). A surge in Coronavirus cases has also been reported in other regions of Europe such as Italy and France among others.
COVID Surge in New Zealand
New Zealand on March 22, 2022 reported over 20,000 new COVID cases (Zee News, Mar. 23, 2022). The highest number was recorded in Auckland, followed by Canterbury and so on. Altogether, over 5 lakh COVID-19 confirmed cases have been logged in this tiny country since the start of the pandemic.
Persistent post-COVID symptoms
It may be recalled that a study by a group of scientists at the University of Oxford claims that even a mild infection of COVID-19 leads to cognitive decline due to 'brain shrinkage' (The Print, Mar. 9, 2022). It was found that among COVID-infected people, there was a higher reduction in grey matter thickness, greater tissue damage in regions of the brain related to smell perception, and an overall decrease in the size of the brain. These findings have been published in the leading science journal, Nature.
If symptoms persist in infected individuals for two months or longer after recovery from COVID, it will be treated as LONG COVID, according to experts. Many debilitating symptoms persist in such cases, of which three most common ones have been listed as: Fatigue, difficulties in breathing, and cognitive decline.
Among these, cognitive decline is the most serious complication. According to reports, those who contracted COVID had difficulty performing cognitive tasks that they used to perform easily before, such as memory of events, matching pairs, and other tasks. This cognitive decline may be due to atrophy of parts of the cerebellum, which is involved in cognition. Such decline may result from inflammation of the spinal cord, or sensory deprivation due to not using the olfactory (smell) complex.
Some other long-COVID symptoms include brain fog, loss of concentration, sleep disturbances, heightened anxiety, and intense back pain, etc.
When will COVID pandemic ever end?
The World Health Organisation declared COVID-19 as a pandemic on March 11, 2020 and the disease has raged across the globe for two years now. The global health agency will monitor the global decline in cases, hospitalizations and deaths before deciding if the international health emergency is over. According to reports, Covid cases are waning in the United States and dropped globally by five per cent in the past week. However, cases are seen rising in some other places such as the United Kingdom, Hong Kong, South Korea and New Zealand.
Nobody knows for sure how COVID-19 will end. But past epidemics can provide some clues. There may be three scenarios for a possible COVID ending: medical, political, and social (Business Standard, Mar. 10, 2022). According to Dr Erica Charters, University of Oxford, there could be different types of endings that may not all occur at the same time.
A medical end of the pandemic may happen when the disease retreats. A political end will take place when the government stops preventive protocols and lift restrictions. A social end will occur when the people (society) move on with normal life despite the pandemic. There is ample reason to believe that the end is near. In the United States, 65 per cent of Americans are fully vaccinated, and about 29 per cent are both vaccinated as well as administered booster doses.
We may look at the trajectories of some past pandemics. The 1918 Spanish flu killed about 500 million people globally and came in three waves. Another flu pandemic of 1957 killed about 116,000 Americans and another pandemic in 1968 killed 100,000 more people. Another flu pandemic in 2009 did not turn out to be as serious as it was anticipated; it fizzled out quite soon and quite unexpectedly.
Poor people in many countries still are in dire need for vaccines and medications to treat Covid. In Latin America and the Caribbean alone, over 248 million people have not had their first Covid vaccine dose. Countries with low vaccination rates will still see surges in illnesses, hospitalizations and deaths. Dr Ciro Ugarte, director of health emergencies, PAHO says, “We're still not out of the pandemic and we still need to tackle this raging pandemic with a great lot of caution!”
Meanwhile, in Manipur, citing "significant improvement" in COVID-19 pandemic situation in Manipur, the state government has directed the director of Manipur Health Services to close down all existing Covid Care Centres (CCC) in the state, except the CCC RD Wing, Lamphelpat with immediate effect (March 25, 2022).
However, what Manipur must do in the face of a possible COVID-19 fourth wave?
We need to assume that there may be a fourth wave of COVID-19 in Manipur too. Even if that may turn out to be a wrong anticipation, it is better to err on the side of caution. Accordingly, we must initiate measures to squarely face a possible fourth wave in the state. These may include:
1. Death audits, genomic tracking combined with tweaking of treatment protocol (as deaths due to COVID remain high in Manipur, logging an average of 1 or more daily deaths, for the past few weeks of Jan-Feb 2022); we need to ascertain if deaths are due to Delta, Omicron or both; or, is there a need to fine-tune the COVID treatment procedures; regular genomic surveillance, death audits, and tweaking of hospital admission, treatment and monitoring procedures will be helpful in mitigating deaths.
2. Preparations for administering vaccines to kids in Manipur and booster shots to high-risk people (elderly, healthcare workers and people with weak immune systems).
3. Conducting immediate seroprevalence studies to understand what per cent of population in Manipur and in its different districts are still susceptible to the coronavirus.
4. Speeding up vaccinations in a big way; aggressive vaccinations with monthly targets to cover all eligible populations with first doses in the next few weeks (4-6 weeks); and targeted vaccinations of all adult population with second doses in the next two-three months.
5. Regular and repeated COVID testing in hotspots.
6. Enhancing the ratio of RT-PCR to Rapid Antigen Testing (RAT).
7. Weekly "awareness messaging" about the pandemic to the public by a designated healthcare official.
8. Genomic sequencing of a subset of positive cases and surveillance of the variants including the delta and omicron variants: which COVID strains are there in Manipur, where are they, and where are they moving towards; and whether any new variants are emerging.
9. Contact tracing and government-monitored isolation of positive cases, wherever feasible.
10. Boosting up healthcare provisions such as medical oxygen plants, tankers and cylinders; steroids, antifungal drugs, oxygen concentrators, ventilators, oximeters, masks, PPEs, sanitizers etc.
11. Strengthening of healthcare infrastructure such as construction of new COVID hospitals.
12. Provision of more COVID care centres (CCCs), more Covid beds and ICUs in existing hospitals
13. Constitution of a special taskforce for the third wave; a separate taskforce for pediatric COVID is also highly recommended.
14. Special provisions for kids such as pediatric hospitals, wards, and ICUs, pediatric oximeters, concentrators, and ventilators and strengthening of staff such as pediatricians and pediatric nurses and paramedical workers etc.
15. Limiting crowds in public spaces, and minimizing crowds in offline cultural, political, and political events; as far as feasible.
16. We all owe it to the common people of Manipur to religiously adhere to the standard SOPS to help prevent/mitigate a possible fourth wave in Manipur; and, help save our people from possible hospitalizations and deaths.
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."
Hence, 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 public health authorities must take steps to prevent large gatherings such as weddings and death ceremonies, music concerts, and large meetings. The 'hoi polloi' must voluntarily practice the 3 Ws (watch your distance, wear your masks, wash your hands frequently) and avoid the 3 Cs: crowded places, closed contact settings, and closed spaces. Meanwhile, we must enhance the pace of vaccinations across India including Manipur in a big way.
