Prevention of the COVID-19 III wave in India

This article was exclusively written for The European Sting by Mr. Rahul Manoharlal Sodhai, a medical student from Vilasrao Deshmukh Government Institute Of Medical Sciences, Latur, India. He is affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

Coronavirus disease (COVID-19), an infectious disease caused by a newly discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In India, first case of COVID-19 infection was reported on January 30, 2020. India declared COVID-19 as a ‘notified disaster’ on 14^th March 2020. The Government of India announced a nationwide lockdown limiting movement of the entire 1.38 billion population of India as a preventive measure against the COVID-19 pandemic on 24^th March 2020 [1]. It was ordered after a 14-hour voluntary public curfew on 22 March, followed by enforcement of a series of regulations in the country’s COVID-19 affected regions [2,3]. The lockdown was placed when the number of confirmed COVID-19 cases in India was approximately 500. After 6 weeks, the restrictions were eased in a stepwise manner with several relaxations in all zones as per the guidelines of Ministry of Home Affairs [4].

Important lessons learnt during the first wave of COVID-19 pandemic in India were:

• After the restrictions have been easied, there is tremendous uncontrolled movement of people across the country. There are some unavoidable social events in the families which calls for visitors like wedding, funerals, etc. In such situations, there is no absolutely substitute for wearing a mask, following social distancing and performing adequate hand hygiene.
• Early contact tracing, testing and isolation of COVID-19 patients is the key to control disease. Due to exponential population in India, there is limited scope of following this protocol due to limited availability of isolation centers and manpower. However, it is ideal to do so.
• Hyperthermia and asymptomatic hypoxia is one of the common sign of COVID-19 infection and is an important reason for delayed presentation of patients to a healthcare professional. Daily and regular monitoring of these parameters with infra-red thermometer and pulse oximeter is crucial.
• Symptomatic COVID-19 patients can be graded for the severity of infection based on temperature, oxygen saturation and CT scan score. Depending on these parameters, the patient can be referred to dedicated COVID care center (CCC).
• The mortality rate of COVID-19 was 14% in patients aged less than 45 years; 35% in patients between 45-60 years of age and 51% in patients aged more than 60 years. Out of this, 78% suffered from associated co-morbidities [5]. Strong risk communication strategies and access to medical care are essential to preserve and protect this population.
• Strengthening of Healthcare infrastructure by increasing the production of oxygen, increasing the hospital beds and ventilators, timely availability of the required medications are the need of hour. A well functioning health-care system is the need of the hour.
• Availability of the COVID-19 vaccine at the earliest. India began its vaccination program on 16^th January 2021, in what was described as the largest vaccination drive in the world. Two vaccines were given a nod for emergency use, the Oxford-AstraZeneca (Covishield) vaccine, and the indigenous BBV152 (Covaxin) vaccine.

After the initial national peak of daily cases (90000 approximately) in September 2020, cases dipped for 30 straight weeks upto less 15000 before they started rising again in mid-February. Currently in its second wave, India has the largest number of confirmed cases in Asia and as of april 2021, has the second highest number of confirmed cases in the world. In India, the second wave is spreading much, much faster than the first. COVID-19 second wave is different in certain crucial ways from all preceding instances of COVID-19 spikes. Firstly, the current case positivity rate (CPR) of 19.25% is much higher than before. Because of this, we are seeing an alarming increase in new cases. Secondly, the percentage of asymptomatic and mildly symptomatic cases is much higher than before. This means that more people are spreading the disease without even being aware of it. The severity of infection is higher in young patients. Many experts believe the surge (second wave) is partly fuelled by the new strains of the coronavirus. Thirdly, children are also being affected in this wave which also points towards a new mutant strain. Overwhelming surge also happened because people let their guard down and were lulled into believing that the worst part of the pandemic was behind them.

To combat the second wave, the Government of India has devised a new strategy, “test, trace, treat”, public compliance and vaccinate. The first three elements of the strategy have already been in place for over a year now. Yet, the current surge is overburdening the healthcare infrastructure. In addition to ‘test, trace, treat’, the 2021 COVID-19 war plan has two additional elements, public compliance and vaccination. ‘If we stick to our current vaccination targets, we can aim for herd immunity in six months’ time according to some experts. The national vaccination drive began on 16 January 2021, across 3,006 vaccination centres. The vaccination program in India started in a stepwise manner-

• Phase 1 – All Healthline worker and frontline worker including police, paramilitary forces, sanitation workers & disaster management volunteers.
• Phase 2 – This phase of vaccination is for citizens above 60 years of age and those aged from 45 years to 60 years and have the following comorbidities. However, any healthcare or front-line worker left out in phase one is also eligible.
• Phase 3 – According to the Ministry of Health and Family Welfare, Phase-III of the vaccination program has begun from the 1st of April 2021. All persons above the age of 45 are eligible for the vaccination.
• Phase 4 – The Government of India on 19 April announced phase 4 of the vaccination drive, all persons above 18 years of age would be eligible to get COVID-19 vaccine doses from 1 May 2021.

As India is reeling under the ‘second wave’ of COVID-19, a third wave of coronavirus pandemic is now sweeping across Europe. The COVID-19 cases and deaths caused due to this infection are on a rise in Europe, forcing many countries to impose lockdown once again in order to curb the spread of the third wave of coronavirus (Sweden, France, Austria, Germany, Switzerland). India can combat the second wave and prevent the third wave by implementing the lessons learned from first and the second wave.

The following preventive measures are being placed in order:

• Strictly following COVID-19 appropriate behavior like avoiding public & religious gatherings, proper sanitization, wearing a mask, avoiding unnecessary travel etc. Studies by US CDC found that wearing a double mask-cloth and surgical or disposable – reduces exposure to the COVID-19 by nearly 95%.
• Vaccinating all age groups as soon as possible and clearing misconceptions among the population regarding the vaccine. By the end of January, a total of around 3,760,000 people have been given the first dose while 0 have received the second dose. By the end of February, a total of around 11,900,000 people had received the first dose while 2,500,000 had received the second dose. At the end of March, India had administrated a total of 55,800,000 first doses and 9,300,000 second doses. [6]
• Strengthening healthcare infrastructure, meeting daily oxygen production target, availability of more hospitals beds, ventilators and increasing awareness regarding regarding early diagnosis, adequate timely treatment and vaccination.
• Getting tested and following strict isolation guidelines as advised by the physician.

References

1. https://www.nytimes.com/2020/03/24/world/asia/india-coronavirus-lockdown.html

2. https://news.un.org/en/story/2020/03/1060132

3. https://www.cnn.com/2020/03/23/asia/coronavirus-covid-19-update-india-intl-hnk/index.html

4. https://en.wikipedia.org/wiki/COVID-19_lockdown_in_India#cite_ref-33

5. https://wwwpibgovin/PressReleasePageaspxPRID=1619609%22%3Ehttps://wwwpibgovin/PressReleasePageaspxPRID=1619609

6.  https://en.wikipedia.org/wiki/COVID-19_vaccination_in_India

About the author

Rahul Manoharlal Sodhai was born in Bhusawal district Jalgaon Maharashtra, India. He studied at the Tapti Public School and Bhusawal Arts Science and PO Nahata Commerce College, before starting his MBBS at Latur. Currently he is pursuing MBBS at Vilasrao Deshmukh Government Institute Of Medical Sciences, Latur. He stood 1st in first academic year of MBBS with distinction in Biochemistry. Currently he is in 2nd year. He is selected as the Academic Secretory for the year 2021-2022 representing his respective college by the Maharashtra University Of Health Sciences, Nashik. He is the member of the Medical Students Association of India and IFMSA.  He is also appointed as the Student Ambassador of CBS Publications (publishers and distributors of medical books) and Prepladder (online learning app for medical entrance exams).

He loves to do painting and sketching in his free time. He also love to play badminton. He enjoys daily chat with his family. He also plays guitar.