With more than 2 lakh COVID cases being recorded every day since 14 April, many experts have opined that India was unable to adequately prepare for the second wave of the pandemic, taking our already fragile health infrastructure by surprise.
With our hospitals and crematoriums overwhelmed, and oxygen and vaccine supply running dry – how do we prepare for the next wave that many experts and scientists are predicting?
In an exclusive webinar hosted by The Quint’s health vertical – FIT – on Thursday, 20 May, we spoke to two health experts who played a vital role in India’s fight against the disease:
- Dr Rakesh Mishra, Former Director, CSIR-Centre for Cellular and Molecular Biology & Advisor to CSIR CCMB.
- Dr Giridhar R Babu, Professor, Life-course Epidemiology, Public Health Foundation of India.
A Change in Human Behaviour is Needed: Dr Mishra
Dr Mishra, how worrying are the concerns raised by UK researchers over the B.1.617 variant found in India that is 50 per cent more transmissible than B.1.17?
Any new variant, when it emerges, has the property of being more infectious since it is replacing the old one due of its efficiency of infecting people. While the variants may not have any difference in terms of mortality or symptoms, the sheer number of people heading to the hospitals is creating the problem.
The B1.617 is a virus of concern for India specifically due to its high infection rate and that it’s a good platform to create more variants. We have already detected three sub-lineages from this variant. The variant is only part of the problem; a change in human behaviour is needed.
The B.1.6172 was declared a variant of concern by the WHO and has shown that it does have some vaccine escape response characteristics. Is this a point of concern?
The 617 variant had two mutations in the spike protein and in the 6172 variant, one of these mutations was corrected, which would have make it more efficient. Our prediction and modelling are not that perfect that we can speculate on what the virus will be like.
However, we have seen a lot of breakthrough infection cases in 20-30 per cent of the population since that is what the vaccine efficacy is at the first and second dose.
Dr Mishra, you’ve spoken in the past about warnings to the government on new variants not being, perhaps, taken as seriously as they should have been. Are we going to see a change now, especially as we prepare for another possible wave.
None of us thought that the second wave will be this disastrous. In January, we tested samples where we found more than 7,000 variants. A ‘variant of concern’ is designated only when it starts causing trouble.
I think we didn’t learn from the first wave. But we have certainly learned a few things from the second wave as we are already talking about the third and fourth wave.
Virus Does Not Transmit On Its Own. People Spread It: Dr Babu
Dr Babu, in your opinion, are we seeing trends that the surge may just be ebbing? And is this trend visible in only cities or also in rural areas?
There are three factors that determine the end of a surge. First, is the virus; in this case, the B1.617; second, is the host; and third is the environment.
The virus does not transmit on its own. It’s the people who are spreading it.
More than 50 districts in the large states have seen a 100 per cent increase in the growth rate of the cases over the past month.
Should we celebrate the ebb in cases? I’m not so sure.
There is enough evidence of underreporting of deaths, limited testing capacity and lack of any testing capacity in rural areas. This is not likely to change dramatically in the absence of the above, how do we plan a pandemic response?
Currently, there is no robust data in terms of cases or death. Data, such as what time people were admitted, whether they got a hospital bed or adequate oxygen (is missing). Without data subsets like these, it is difficult to answer basic questions, like whether the virus is more virulent or not.
We need to ask what is the standard expected number of cases each region should detect when the transmission is going on and during low-transmission seasons? What number of cases should we expect? Once we have these baseline definitions based on Indian data, then we can see the regions that are not generating enough number of cases and strengthen the testing there.
If we are to plan for eventual waves – and these waves will happen – how can we enhance our data collection?
India has some great systems of surveillance, starting with the detection of polio. India has AFP surveillance, which is a world class system. We have another ambitious programme called the Integrated Disease Surveillance Project (IDSP).
We should see a chief epidemiologist from the National Centre of Disease Control (NCDC) who can study epidemiological data and give out the advice based on the data. Currently, our process is reversed, wherein we are announcing a policy and then generating data. That is not the way to control COVID-19.
How do we ensure real-time surveillance leads to real-time response?
Epidemiologically, we need to identify the clusters of importance. Let’s assume that in a few weeks, we shall see cases go down and people celebrate. At this time, in some parts of the country, there will be clusters.
This is when the state and local teams need to jump into action and investigate the clusters, take samples and send them for testing. The results should be shared with the state and district and based on the results – whether its the same variant or a new one – a public health action should be taken.
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