Is the third wave of Covid-19 inevitable?

How likely is a third wave? Knowing that the virus is still actively circulating in the country increases this likelihood. The global spread of the Delta variant and the recent emergence of the Delta Plus variant (AY.1) indicate that the virus still retains the capacity to infect speedily. With only around 20 percent of the adult population having received a vaccine shot and around 4% fully vaccinated so far, a third wave is very much possible, says Dr. Krishna Reddy as he answers some frequently asked questions on the future of the Covid-19 pandemic in the country.

Is the third wave of Covid-19 imminent? If yes, can we predict its timing?

Future waves of pandemics are inevitable when a sizeable proportion of population (> 30%) is vulnerable due to lack of immunity. People who have not been infected or who have not got vaccinated are vulnerable. How long does the immunity last is not yet clear, even as available data points to protection for up to 8 months after natural infection and up to 6 months after vaccine. Longer follow up will tell us how long the immunity will last after natural infection, after original course of vaccine, and after booster doses. It is therefore possible that people who are currently immune may see their immunity weakening over time. Yet another possibility is that existing immunity may fail to fight the new variants due to strategic mutations in the virus. 

Hence, the timing of future waves cannot be predicted. It will depend on how well the population is following pandemic containment measures (face mask, hand wash, social distancing, testing, tracing, and isolating, lockdowns etc.,), how fast the vaccination coverage is progressing, emergence of new variants, and how long the immunity lasts.

The second wave was more fatal than the first one, led partially by variants.
Will the third wave be stronger the second one?

The reasons for the behaviour of the second wave are as follows: nation-wide full opening with mega congregations (elections, marriages, religious gatherings etc.,)and the two new variants (especially B1.1.1.7 and B1.617.2) being more transmissible (almost 70% to 100% more) than the variant dominant during first wave. The strength of next wave will depend on how fast we act and how fast the new variants transmit. 

What key policy decisions and steps will help us be safer and more prepared for the third wave?

Implementing basic public health containment measures in every district with rigorous surveillance systems, including micro-lockdowns at a pre-defined threshold of positive cases for a given test positivity rate of <5%, continued public messaging on Covid appropriate behavior relentlessly; expanding vaccination coverage as fast as possible; putting district-wise infrastructure preparedness in place for a worst-case scenario and to build resilience; and providing a social security net to safeguard people against financial crises. These steps will help us mitigate the impact of future waves.

Why is it predicted that children will be at a higher risk during the third wave? How can we protect them?

So far, children have largely been protected from exposure to the virus because of the shutting down of schools and public places for long periods of time. Hence, the proportion of uninfected children is much larger compared to adults, though we do not have scientific data about this at present. Secondly, children will be the last to get vaccinated – both as per priority listing and also because of the current unavailability of vaccine safety and efficacy data in children below 18 and 12 years. Social vaccination will continue to protect them during this time. Vaccination for children will happen as and when feasible as per demand-supply equation and priority list. 

Though more children will be infected in future waves as a proportion of total infections, the risk of developing moderate to severe Covid illness is likely to be the same as now. Children have the lowest risk of developing moderate to severe Covid illness and also the lowest case fatality rate (<0.2% compared to 2% in entire population) across different age groups. 

What mistakes from the second wave can we learn from to be more prepared for the next one?

Following are some weak points that we need to urgently strengthen to be more prepared for future waves. Strengthening public health infrastructure across the country including villages for effective surveillance and control of not only Covid but also various other communicable diseases; increasing human resources for health in their numbers and competencies; transparent and effective messaging to public; engaging the private healthcare sector (healthcare providers, health goods producers, health technologists, health researchers, epidemiologists etc.,) in pandemic preparedness; making health insurance players and healthcare providers accountable to people in terms of health insurance protection (public, social, and private); making available loans to meet unexpected medical expenses; providing a social security net to secure access to food and shelter; and rapidly vaccinating as many people as feasible.

Is it possible that the vaccines currently in use might not be effective against newer mutated strains that might arise in the future?

The chances of this happening are diminishing, but yes they still exist. Ongoing genomic surveillance coupled with in-vitro testing of vaccines against new mutants, and epidemiological surveillance to assess the risk of infections in people fully vaccinated will allow us to prepare better and in a dynamic manner.

Many drugs are being launched in the market including the antibody cocktail, DRDO 2G drug. At the same time plasma therapy and Remdesvirhave been discontinued. Are we hurrying the approval of drugs and treatment processes even before fully understanding their clinical benefits?

We have pre-existing protocols and rules for emergency use authorisation (EUA) of drugs. We had no data when the pandemic started last year. We started using many drugs based on theoretical expectations on an empirical basis. However, as robust clinical data started coming in, the approvals and guidelines are being updated. Hence, people (both patients and physicians) should respect the regulatory agencies and bodies that give out practice guidelines (WHO, CDC, ICMR, FDA, CE, DCGI etc.,) from time to time and not rush into confusion and conclusions based on the ongoing infodemic. 

*Photo Credits: PBS

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