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India’s raging second wave: Lessons to be learnt from India, and are we next?

26 Apr 2021

By Dr. Dilshan Anthony Fernando   India is facing a raging resurgence of a second wave of Covid-19 since late March this year. It has hit India like a storm, stated Indian Prime Minister Narendra Modi. While the second wave gathered momentum gradually, now it’s speeding forward like an unstoppable bullet train. Some major cities like Mumbai are currently in lockdown in a desperate effort to salvage this sinking ship. India has currently reported more than 15.5 million cases since the beginning of the pandemic, with the death toll at more than 181,000, according to World Health Organisation (WHO) statistics. The Maharashtra State has been at the eye of the storm, with the highest number of cases being reported from that region. However, Punjab has recorded the highest percentage of mortality with reported 2.6 deaths per 100 reported cases. Many countries, including the US, as per the instructions of the Centres for Disease Control and Prevention (CDC), have issued travel warnings against travelling to India, even for those who are vaccinated. In analysing the latest trends, India is currently reporting more than 250,000 cases per day, with deaths at more than 1,500 per day and steadily reaching the 2,000 death toll; there are also ominous warnings of the possibility of the deaths even reaching 3,000 per day, similar to what the US recorded during its worst phase. On 5 April, India reported more than 100,000 cases for the first time, as the trend of steadily increasing numbers showed no signs of plateauing – for more than 40 days in a row, the case numbers are steadily on the rise, leaving in its wake a path of destruction. The highest worldwide daily total of Covid-19-positive cases, of 881,124 per day, was recorded on 21 April; the total number of deaths that day was 14,122. Meanwhile, that very day, India reported the highest daily total of 315,802 new Covid-19-positive cases and a daily death toll of 2,102. In the initial phases of the second wave, the death toll was less, which was widely attributed to the fact that there was a milder variant of covid-19 circulating. However, in retrospect, Indian officials believe that over time, the management of the Covid-19 situation and competence of the staff had improved, giving better outcomes. But the health system is currently in shambles, as the avalanche of cases has overwhelmed and exhausted resources, and many deaths have occurred due to the lack of facilities and hospital and ICU beds.   The Indian healthcare system in shambles   A video of a tearful doctor from Mumbai took the internet by storm on 20 April, and put into perspective the real and perilous situation India is facing at the moment. Her eyes tearful, her voice quivering, and demeanour sombre, she was giving out a powerful message and warning that the health system in India is at breaking point. Doctors are managing Covid-19 patients at home with oxygen and hospital beds have all been occupied, most of the time with two or three patients sharing the same bed. Patients lie in corridors and under beds gasping for oxygen, which is in short supply. ICUs (intensive care units) are all filled up to its maximum capacity and wailing ambulances add ominous background music to the unfolding story of horror. Crematoriums are overflowing and functioning day and night at full capacity, and many have had to wait hours to get their dead cremated or buried; a resource-constrained, overpopulated India is at its breaking point. An avalanche of Covid-19 cases has overwhelmed the Indian health infrastructure.   How India failed to curb the second wave   India was managing the Covid-19 spread quite well until recently, so much so that the Indian Health Minister declared that the country was “in the end game” to defeating Covid-19. The case numbers had dropped in February to around 11,000 cases per day as opposed to the whopping 93,000 in September last year. And the general feeling was that India was “out of the woods” and out of danger. The Indian Central Bank even reported that India was bending the Covid-19 curve. As BBC reported, they even used poetic reference to describe the euphoria of the idea of defeating Covid-19, saying: “Breaking out amidst winter's lengthening shadows towards a place in sunlight.” Amidst this premature celebration, India let their guard down. We saw many cricket matches which allowed spectators without masks – the closely followed Road Safety World Series was one such example where we saw many spectators enjoying the matches carefree without masks and the India vs. England series played in Gujrat was open to about 130,000 fans, most of whom were without masks. The Indian public, fuelled by this premature optimism, took to the streets and went about doing their routine work, gathering in masses at public places and for religious gatherings, the health and safety measures forgotten. To cap it all off, India announced an election in five states where 186 million people were eligible to vote and campaigning had started as usual without special safety measures or social distancing. While political rallies went on in full swing, the Indian Premier League (IPL) started behind closed doors.   The new variants   In one of my previous articles, the double mutant variant reported in India was explained. “The double mutant virus” strain shows two mutations compared to the original Covid-19 virus. Indian virologist Dr. Shahid Jameel explains that a “double mutation in key areas of the virus's spike protein may increase these risks and allow the virus to escape the immune system”. The spike protein is the part of the virus used to penetrate human cells. And the vaccines train the human host cells to identify the Covid-19 spike protein and develop antibodies against the virus. However, if the Covid-19 spike protein undergoes significant mutations, it may cause “vaccine escape”, meaning it may make the currently available vaccines redundant. The double mutant variant is also playing a part in contributing to the crisis faced, and the fears of vaccine escape looms in the background.   The faltering vaccination drive   The Serum Institute of India has been the largest manufacturer of Covid-19 vaccines globally and has been rolling out millions of doses of the AstraZeneca Covid-19 vaccine, not only to India but to Sri Lanka and globally. These exports of the AstraZeneca vaccine have been temporarily banned because India doesn’t have enough for their population.   Current situation in Sri Lanka   Sri Lanka seems to have made the same mistake as India in dropping its guard with a premature sense of safety from the virus. The festive New Year season saw hordes of people flocking together at shopping malls for New Year shopping. Few images of such crowds circulated in social media at popular shopping malls and public places such as the Horton Plains, which was clogged with tourists who had gone out of Colombo to celebrate the New Year season. Currently, we seem to be paying a hefty toll for that momentary lapse of judgment in thinking that Covid-19 is on a downward trend, which was misguided by the dropping numbers. Sri Lanka seems to be facing what appears to be the emergence of a third wave of Covid-19 with the daily totals soaring above 800 cases per day which was a significant increase from the average daily numbers which were reported earlier.  With 826 Covid-19-positive cases reported on 24 April, the total number of patients so far in Sri Lanka passed the 100,000 mark (100,517). Several ominous but necessary actions were taken by the Government in light of this new rise in case numbers. The Thithawellagala Grama Niladhari Division in Ganewaththa, Luliyapitiya Police Area in Kurunegala, and a few other areas were isolated in an effort to curb the spread of Covid-19 within the course of last week. With this new turn of events, new measures have been implemented by the Government in an effort to stem the spread of Covid-19 in Sri Lanka. The Ministry of Covid-19 Disease Control, under Dr. Sudarshini Fernandopulle, issued new health guidelines to be followed till 31 May. These guidelines prohibit public gatherings and parties until further notice, and places of worship were given orders to cancel collective events of worship with a maximum number of 50 devotees to be gathered at one time. A decision was made to conduct at least 15,000 PCR tests per day, at a meeting of the Special Review Task Force under Minister of Health Pavithra Wanniarachchi to maximise the identification of Covid-19-infected patients. Visitors will not be allowed into any of the prisons for two weeks to minimise Covid-19 risks. Furthermore, the Ministry of Higher Education made a decision to postpone the reopening of universities islandwide from 27 April by two weeks. In Sri Lanka, the Advisory Panel on Non-Communicable Diseases decided to commence vaccinating for the second dose of the AstraZeneca Covid-19 vaccines from the first week of May, State Minister of Pharmaceutical Production, Supply, and Regulation Prof. Channa Jayasumana told the state media recently, but with India stopping the export of the AstraZeneca vaccine from the Serum Institute of India, this might not become a reality.   The virus is now airborne   In a worrying new development, an article published in a highly acclaimed and reputed publication in the medical community, The Lancet medical journal, titled “Ten scientific reasons in support of airborne transmission of SARS-CoV-2” by Trisha Greenhalgh, Jose L. Jimenez, Kimberly A. Prather, Zeynep Tufekci, David Fisman, and Robert Schooley, which was published on 15 April 2021, demonstrates that there is consistent, strong evidence that SARS-CoV-2 spreads by airborne transmission. Although other routes can contribute, the airborne route is likely to be dominant. If an infectious virus is mainly airborne, an individual could potentially be infected when they inhale aerosols produced when an infected person exhales, speaks, shouts, sings, sneezes, or coughs. Reducing airborne transmission of a virus requires measures to avoid the inhalation of infectious aerosols, including ventilation, air filtration, reducing crowding and time spent indoors, use of masks whenever indoors, attention to mask quality and fit, and higher grade protection for healthcare staff and frontline workers is a must. These facts were corroborated by Dr. Neelika Malavige. A pioneer in the field of microbiology in Sri Lanka, Dr. Malavige stressed on the importance of wearing facemasks and continued practice of social distancing and sanitising, now more than ever. All these facts corroborate that Covid-19 is not on a downward trend but returning to devastate with more force than before. Like a Greek mythological monster where when you cut off one head, two heads appear, the Covid-19 monster has reared its ugly head once again, and we as individuals and collectively as a community with the support of the government guidelines and diligence and commitment of the health sector, should not let down our guard and should work together in combating this monster.   (The writer is a medical officer currently attached to a government hospital. His experience spans across the medical profession as a medical practitioner, and across the pharmaceutical and surgical equipment industry. He also possesses an MBA and a Diploma in Economics. Having represented his university rugby team in international tournaments, he also has a special interest in sports medicine)    Main image (c) REUTERS


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