There is a lot of uncertainty as to when and if at all the third wave of COVID-19 will hit the country. Amid the ongoing claims, WHO Chief Scientist suggests that India might be entering an endemic stage. MUSBA HASHMI speaks with experts to understand what awaits us
The third wave is imminent, said an expert. We are heading towards achieving endemicity, said another. There are several such claims and assumptions made by eminent experts and doctors.
However, the fact of the matter is that nobody has yet been able to fully understand the nature of the virus, which is why many doctors believe that it will take us at least another year, if not more, to draw concrete conclusions.
Scientists worldwide are on the go. They are chasing the virus’ evolution and its mutants with a few winning streaks. But a silver lining in the dark clouds of what seems to be a never-ending pandemic is that the country might be entering an endemic stage.
Dr HK Mahajan, Anaesthesiologist, Indian Spinal Injuries Centre, Vasant Kunj, tells you that as per the World Health Organisation’s Chief Scientist Dr Soumya Swaminathan, India is entering into an endemic stage. “This suggests that a population has learnt to live with a virus. There is a low or moderate level of transmission going on. There are no peaks or exponential growth like pandemic or epidemic,” he says.
The high cases, he points out, occur where immunity is less, people are not vaccinated or not infected in the previous waves.
However, as per the experts from National Institute of Disaster Management (NIDM), a third wave is imminent and can hit the country any time between September and October. “It will not be that severe, but paediatric cases will be more, though not backed up by any scientific evidence. In this case, we need to have paediatrics infrastructure, ICU wards and doctors and trained nurses to deal with children getting infected,” says Mahajan.
If the stats are anything to go by, they suggest that the country will see cases anywhere between one lakh and five lakh a day.
“NIDM has predicted three scenarios. One, the third wave may peak in October. Two, three lakh cases per day. Three, if more virulent variants emerge, it may peak in September with five lakh cases per day. Four, it could peak in late October with two lakh cases per day,” adds Mahajan.
All these models, he says, are based on calculations and are basically for forecasting and making predictions to anticipate the dynamics of the pandemic. “How many cases, virulency, morbidity and morbidity trends will happen are demonstrated based on mathematical models. In India, these are mostly done by experts from IIT Kanpur and IIT Hyderabad. They take clues from several warnings indicating an imminent third wave, understand them and prepare for it,” explains Mahajan.
Dr Shuchin Bajaj, Founder & Director, Ujala Cygnus Group of Hospitals, agrees with Mahajan and says that with the highest zero positivity rate and progressively increasing vaccine coverage, it appears that India is heading for an endemic stage of the virus. “Kerala, which is seeing very high numbers is currently suffering from the third wave because of the low zero positivity rate, which is less than 40 per cent compared to about 70 per cent in the Northern part of the country. So, with the increased vaccination coverage, we are already administering about 50 lakh vaccines a day and we’re hoping that we will be doing about one crore vaccines per day to achieve our target of complete vaccination by the end of the year. We hope that the next wave, if it does come, will be like the British third wave, which even though with increased numbers, it had very low hospitalisation rates as well as very low death rates,” says Bajaj.
However, Dr Akshay Budhraja, Pulmonologist, Aakash Healthcare, Dwarka, says that if we go by stats, a third wave won’t happen. “Having said that, no stats or analysis can clear this doubt with absolute certainty, only time will. The virus is mutating and we are not sure how long the immunity lasts after vaccination or COVID infection. We don’t even know how effective the vaccine will be to newer mutant strains in coming times. So, in any case we must continue to follow the COVID protocol in this time of uncertainty, till we achieve herd immunity, which isn’t far now. It is a matter of eight-10 months,” opines Budhraja.
He adds that we may see a rise in the number of cases but the mortality rate won’t rise like in the second wave. “If at all a third wave hits us, we will surely emerge stronger than before. Simple reason is more people will be immune. The very reason the number of cases are declining at present,” he says.
The future looks bright. We have so many vaccine options now and a ramped up vaccination rate. “All of the available vaccines are efficacious and safe. We have understood the nature of the virus. Like any other virus, it is mutating, but at a faster rate. The only solution to this is, increasing the vaccination rate, followed by an annual booster dose, if required. Only herd immunity can end this. Till then, uncertainty regarding coming waves will remain. It’s a respiratory virus, you cannot eradicate it completely. It will remain here for lives to come. But you can surely eradicate the disease caused by it,” Budhraja tells you.
Bajaj, too, is of the opinion that once the third wave hits, we will emerge much stronger because we are much more prepared. “We have developed our ICUas well as hospital infrastructure, including oxygen supply. And I think this is a hidden blessing from the pandemic because we are now focusing on ramping up our healthcare infrastructure, which will serve us well in the long term to fight other diseases as well,” says Bajaj.
The future, he says, holds the same fate as it was with the Spanish flu. “The current flu virus is apparently a mutation of the Spanish flu virus that happened about 100 years ago, and then became endemic into the community and now needs almost yearly immunisation and booster shots for those at risk. So, this COVID virus will also mutate into a virus that is endemic to the community and will always be a risk for those members who are high risk like immunocompromised elderly, or very young, and the rest of the community will slowly become immune to that,” opines Bajaj.
But the high risk community members, he adds, will definitely need yearly boosters to make sure that they do not suffer. This virus will replace the common flu virus which is prevalent now.
“So we will not be fighting against multiple viruses. But this will be the predominant virus that will live with our community until God forbid the next pandemic comes in,” says Bajaj.
But for that to happen, the vaccination drive also needs a booster dose. “Only 7.6 per cent people, that is 10.4 crore people, have been fully vaccinated. This rate has to be increased substantially. Otherwise cases would increase and that would need healthcare infrastructure and staff. This is still compromised and deficient. We also have to expedite the vaccination of kids and follow COVID appropriate behaviour and judicious lockdowns,” says Mahajan.
Dr Vineeta Singh Tandon, Consultant, Internal Medicine, PSRI Hospital, New Delhi, says that with the different projections, that may or may not turn true, what we need is a robust health care system that can hold a caseload like this. What we would need is localised lockdowns in case numbers shoot up and that needs to be implemented strictly by the authorities.
“Fear-mongering does more than good. Third-wave to a large extent depends on multiple factors like people not following COVID appropriate behaviour, lax vaccination and people mingling in crowded zones. Vaccination holds hope and we should focus on this number going up. By all signs, the third wave (if it happens) should not be as devastating as the second one,” says Singh. Future holds promise and vaccination by all accounts would give us protection against this virus. It will remain among us but would reduce its severity, she adds.
A ray of hope, Mahajan, says that by the end of 2022 we would achieve 70 per cent vaccination coverage in the whole world and then countries can get back to normal. “Vaccination is the key to get the herd immunity and hence ultimate protection,” he concludes.
