Dr Tasaduq Hussain Itoo
As the COVID-19 third wave seems inevitable as per expert reviews, to start preparing for it, first we should understand how an outbreak behaves in a population especially when it happens in constant recurrence of waves.
The first wave usually affects the most vulnerable sections of the population–the old, sick and the immuno-compromised. The second wave starts when the epidemic spreads into the general population, which may not have got the infection during the first wave and who do not have protective antibodies against the pathogen. The second and third waves of the infection are usually due to mutant strains, which may partially escape the immunity offered by previous infections.
So the first thing we need to understand is the behaviour of the previous alike epidemics/ pandemics. No respiratory viral infection has been as deadly as the 1918 Spanish Flu. Data from United Kingdom shows us that the disease followed three waves. The second wave was more deadly and long-lasting than the first or third ones. The learnings and lessons from that outbreak are to large extent applicable in the case of current COVID-19 pandemic.
We could see a lot of parallels between the Spanish Flu virus and the one causing COVID-19, though they are very different phylogenetically. Therefore, it is only reasonable to anticipate a third wave of virus infections and prepare for it.
Available vaccines are the most potent tool that we have against COVID-19 infections. Though we do not have concrete data on the level of protection offered by the various vaccines against the mutant strains, most of the experts believe that some degree of protection against severe infections do exist. Therefore, relying on vaccines is the most rational way to prevent a third wave.
However, at present we do not have the capacity to produce vaccines fast enough to vaccinate our entire population in the next few months. As per data, the combined production capacity of Covishield and Covaxin is only around 60-70 million doses/month and at this rate it may take more than two years to vaccinate India’s whole population. So scaling up capacity by the vaccine manufactures in India need to be augmented, and import of ready-made vaccines from abroad seem to be the only viable option if we want to vaccinate the most vulnerable groups and economically-productive sections of the population rapidly. The decision to allow the import and use of approved vaccines from abroad like Germany including other developed countries should be encouraged.
Besides vaccination, we should also aim to enhance the surveillance systems with regard to rapid identification of cases by increasing the level of testing and strict isolation mechanisms, strengthening of protocols regarding containment zones–that could come a long way in containing the pandemic. Apart from that, we need to institutionalize the processes to ensure adherence to “social vaccines” (hand washing, use of face masks and physical distancing). This can be done through a mix of behaviour change communication, regulatory efforts and community mobilisation. All of this has to be continued till we achieve a vaccination coverage of more than 80 percent.
Moreover, a need of strict adherence to optimal scientific research and evidence-based medical guidelines is the key to ensure better treatment outcomes in our patients. The strategy to adopt in approaching the patients has to be economical, rational and in accordance with the original scientific guidelines. We should learn to ensure scientific and evidence-based investigative and therapeutic practices to effectively deal with COVID patients. As per scientific research, the use of steroids should be avoided in patients who do not require supplemental oxygen. The indiscriminate use of otherwise useful drugs may even prove harmful and counterproductive to patients, as well as pose a risk for scaling up the opportunistic infections like Black Fungus in immunocompromised patients.
People must not self-medicate with steroids, antibiotics or other medications at home, rather they should use them under proper supervision by a doctor and under scientifically proven guidelines. Experts from abroad must help and guide their professional colleagues to follow evidence-based clinical best practices, so as to provide the best possible care to patients. Patients with co-morbid conditions must be given quick access to treatment at public healthcare facilities. Optimum and timely treatment of such patients for the underlying diseases would not only ensure better outcomes but would help in reducing mortality among such patients.
Dr Tasaduq Hussain Itoo