The continuing challenge of Covid-19: Lessons from the second wave
In April 2021, India witnessed a ferocious second wave of the Covid-19 pandemic that led to acute overburdening of the public health system. However, collective efforts of the health care professionals, government, international support and the country at large led to its containment, resulting in declining cases and gradual easing of lockdown restrictions. While the second wave has significantly diminished, with close to 40-50,000 cases reported daily, the spread of the Delta and Delta Plus variants continues and the challenge of seeing through the virus remains. With more infectious variants of the virus driving the rates, we may continue to see localized but significant surges which may overlap with the so-called third or subsequent waves. As of August 4, the country has witnessed a week-long surge in cases but remains under the 5% benchmark established by the World Health Organization (WHO) for manageable cases. The detection of Epsilon variant - also known as the CAL.20C in Pakistan - is deemed highly transmissible and vaccine resistant. This raises cause for concern for India as well. Further, the rise in R-value in states like Kerala, Manipur, Arunachal Pradesh raises cause for concern regarding the spread of the virus.
Given current vaccination rates and the emergence of new variants, a third wave in India is likely. To prepare the nation for the next wave, it is crucial to address the gaps in the health care infrastructure. The second wave of the pandemic seemed insurmountable, considering its sudden and fierce nature that put the healthcare infrastructure, professionals, and diagnostic labs under undue pressure. Data from the World Bank states that in India there are only 0.5 hospital beds per 1,000 people.
Additionally, there is a shortage of health care professionals, with fewer than 10 doctors per 1,000 people. Learning from the experiences of the second wave, particularly in relation to the rising requirement of oxygen supply, it would be useful to set up Pressure Swing Adsorption (PSA) oxygen plants, which can produce up to 360 litres of oxygen per minute, sufficient for serving 60-70 oxygen beds. Further, oxygen storage capacities can be easily be created in hospitals by using ISO tanks (built to the specifications of the International Organization for Standardization), which can store over 21,000 litres of oxygen. Such interventions would however only solve the supply side issues and adequate infrastructure for transporting oxygen from large production hubs to the end consumer needs to be put in place. Additionally, these efforts need to also be complemented with efficient oxygen management protocol in hospitals to ensure oxygen is scientifically managed and administered.
The Delta and Delta Plus variants responsible for driving the infections of the second wave have only highlighted the need for strengthening mitigation strategies. For instance, testing and tracing continue to be of utmost importance to monitor the rate of Covid-19 infections. In absolute numbers India’s testing numbers are high but they remain low in proportion to its population. A cumulative 47,65,33,650 samples have been conducted in the country. Going forward, the testing and tracing infrastructure needs to be ramped up further, made affordable, easy to use, and the necessary innovations introduced wherever possible. Moreover, periodic tests should continue as a part of mitigation measures and ensure greater safety from the virus. Correspondingly, accelerating genome sequencing would allow for tracking the Covid-19 mutations in real-time and develop appropriate containment and public health measures.
While reflections from the second wave reiterate some key measures to enhance overall pandemic response, the massive vaccination roll-out across the country is promising. It is clear from the experiences of other countries that have had large scale vaccination against the virus that using any of the approved vaccines, including those by WHO, is the best scientific intervention to control the pandemic so far. However, we must proactively account for what experts at the forefront of India’s pandemic response continue to warn against. As the country re-opens its economic activities, it will face third and possibly subsequent waves of infection, the intensity of which will depend on various factors. One of the most important measures to curtail these potential waves is to successfully vaccinate the adult population and subsequently children above the age of 12 as well.
Against this, it is important to restate, while more than a dozen vaccines for Covid-19 have been approved worldwide, including six by the WHO, equitable access of vaccines, especially in developing countries continues to remain a challenge. India has successfully administered more than 50 crore vaccines, and has about 8-10% of fully vaccinated people, with two shots, and the rest with a single shot. To address myths and hesitancies around vaccines, and improve overall outreach, communication campaigns that underscore the need for vaccination could be developed in numerous languages. Additionally, champion voices of influential local leaders, individuals who have been vaccinated, and others would help those unsure to build confidence towards accepting vaccination. Community health workers should also be mobilised to track vaccination status and encourage registration, especially among those most marginalised and neglected.
While ensuring these efforts, we must not forget to follow Covid-appropriate behaviour like wearing masks, using sanitisers, hand washing and social distancing norms, even after vaccination. This is a collective responsibility, with all stakeholders coming together, and each of us needs to play a unique role to ensure the safety of those around us.
(The piece has been authored by Dr Virander Singh Chauhan, Arturo Falaschi emeritus scientist and founder, ETI, Deepali Khanna, managing director, Asia Regional Office, Rockefeller Foundation)