Lt Col (Dr) Inam Danish Khan, Dr Shashi Soodan
India is rocking and rolling with a sigh of relief after reducing daily incidence of COVID-19 from 97800 infections per day to 56000 in the wake of festivities across the length and breadth of nation. The Indian COVID-19 first wave peaked on 15 Sep 2020 with 50 lakh infections. Still more than 90% of the population remains susceptible to COVID-19 infection which is likely to reemerge as second wave around December 2020 due to fresh infections and reinfections. Second pandemic wave is likely to affect more patients, overwhelm healthcare infrastructure, cause more deaths, and the ensuing lockdown may lead to double dip economic recession.
There is a bigger picture. The world is witnessing not the second or the third, but the fourth global COVID-19 wave which is purported to be the strongest. There were 4.3 lakhs new infections on a single day on 21 Oct 2020. COVID-19 being a highly transmissible respiratory infection with an R-naught (R0) of 2-3, still has high plausibility of transmission in the community with a potential of outbreaks and clusters due to asymptomatic superspreaders and multiple generations of transmission.
Individual countries are undergoing multiple COVID-19 waves such as Hong Kong is witnessing the fourth COVID-19 wave and US is undergoing the third COVID-19 wave. Europe is witnessing a second wave with fresh lockdowns implemented in Israel, Ireland, Belgium, UK as well as lockdown warnings in France, Germany, Spain, Sweden, Czechia, Pakistan, Latin America and Middle East. Second wave hit hard in countries that largely avoided the first wave, such as Austria and Hungary. Europe’s second wave is leading to rising incidence of COVID-19 compared to first wave.
Pandemic crisis management initiatives and leapfrogging measures have brought forth significant boost in concept development, capacity building, prudent policies and streamlined procedures for control of COVID-19. Despite multipronged efforts, COVID-19 has remained a moving target in mammoth proportions. Epidemic modeling has failed to predict progression of the pandemic and flattening the COVID-19 curve has remained a distant dream. Containment strategized through COVID-19 surveillance, high throughput testing, patient isolation and treatment, contact tracing, quarantine of contacts, identification of outbreaks and clusters, containment zoning is mandatory to ensure adequate infection control.
Optimizing requirements of human capital and critical supply chains have been a special mandate for the government in COVID-19 scenario. Festive celebrations, human travel and consequent overcrowding are likely to increase transmission multifold. Humanity is undergoing a similar phenomenon happened in 1920 Spanish flu wherein millions of people died due to festive celebrations after period of restrictions.
Risk management strategies need to focus on operationalization of behavioural change which has been proven to be the most effective tool for control of COVID-19. Immunity against COVID-19 is both antibody and T-cell mediated and not yet proven to be effective for long term protection. COVID-19 antibodies remain for 60-120 days but their protective effect is yet to be established. So far, 30 COVID-19 reinfections have been proven in India, Hong Kong, South Korea, United States, Belgium, Netherlands, Ecuador and other countries. Reinfections have been seen in Mumbai, Bengaluru, Hyderabad, Ahmedabad and other cities. Some people have been infected by the virus thrice as well. Evidence of increased disease severity with reinfections is alarming. Indian Council of Medical Research has established a cut off of 100 days for reinfection. COVID-19 has a new mutation D614G which has 3-9 times higher transmissibility. Elderly, pregnant women, children and people with comorbidities will need enhanced protection in times to come.
Ongoing caution and reemphasis on hand hygiene, universal masks, physical distancing, sanitization of personal objects such as mobiles, keys, watches and jewellery, in the absence of specific antiviral treatment and vaccine is the essence of COVID-19 infection control. Complacency and procrastination is deemed counterintuitive. We, as a nation need to synergize our thoughts, attitudes, practices and behavior to achieve victory against COVID-19 and create an operational value chain in sync with the guidelines of Govt. of India.
(The authors are Incharge Microbiology Military Hospital Udhampur and GMC Jammu Principal)
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