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India’s second massive Covid-19 wave underscores pandemic monitoring preparedness (PMP)

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Since the first reported case of Covid-19 in India on 30 January, 2020 in Kerala, daily infection tally steadily reached its peak in mid-September, 2020 when the highest number of single day reported cases and fatalities were observed as about 98000 and 1000 respectively. Afterward, Covid cases and deaths gradually declined and dipped to the lowest at 9000 to 12000 daily cases and deaths less than 100 during the first week of February, 2021. Prior to the nationwide vaccination programmes launched on 16 January, 2021 in India, all social restrictions imposed through state regulations were relaxed and faded away in Covid-Win euphoria.

Consequently, pandemic fatigue national populace immediately got back to the pre-covid ease of life being oblivious to the tenets of epidemiology; pandemics often show long scaring tail and merely minor mistakes can transform the scary tail into gigantic quaking trunk within a short span of time. What exactly happened during April, 2021, the second surge of Covid-19 slowly started in Maharashtra and Kerala during February-March, 2021, rapidly became a full blown pandemic in India during mid-April, 2021. As of now, India is the first country in the world to record the highest 332000 single day infections, and also top leading country in Asia to harbour maximum number of confirmed cases.

Lacunae in predictive pandemic monitoring preparedness (PPMP)

Lacunae in predictive pandemic monitoring preparedness increasingly became apparent during the month of April when daily infection trajectory in India crossed 3.0 lakh mark with cumulative addition of about 15000 cases per day and death rate also shot up by 500% during the month. Laxities in state imposed restrictions and people’s Covid inappropriate behaviour grew parallel to the declining trend in daily cases and deaths on account of Covid since October, 2020. Paucity of predictive pandemic monitoring preparedness on part of regulators is now explicitly evidenced through large scale export of country made vaccines; underestimating the planetary health implications of high infectivity variants evolved in UK, South Africa, and Brazil; and being ignorant to the effect of forthcoming environmental conditions during March to June as conducive to virus transmission & evolution. Amidst the massive surge, we cannot safeguard our positions by merely saying that nobody made emphatic predictions on India’s second Covid wave.

PPMP in India requires comprehensive comparative studies on Covid epidemiology of various Indian states in the light of global epidemiological models drawn from the best and the worst Covid managed countries. Israel has well managed the pandemic through rapid vaccine (BioNTech-Pfizer) rollout on 20 December, 2020 and aggressively continued with 55% of population got vaccinated till 18 April, 2021. No. of infections in Israel is falling significantly, for above 60 age group 56% less infections, 42% less severity and 35% less death have been noticed.

Whereas, USA, Brazil, UK, Mexico, and India have suffered the most because of underestimating and undermining virus behaviour, course of epidemiology with respect to their demographies.The uniqueness of Covid-19 epidemiological model of Delhi in India with distinct temporal peaks was quite suggestive of future inevitability of the second resurgence of Covid-19 in India if Covid appropriate behaviour of people deflects from the standard operating procedures. Indian euphoria of global appreciation of stringent measures in controlling initial viral spread during March to October, 2020, low case fatality rates, and availability of country made safe and efficacious vaccines in fact made us overconfident and undermining of the idea of future pandemic escalation. Our false notion of Covid control and all is well got suddenly shattered through big blow by the current surge in Covid cases and deaths which is highly explosive due to high infectivity variants of SARS CoV-2 with altered pathogenicity.

In the second surge, changes in virus character due to mutations have made them tricky to the extent that they could escape human immune response as well as diagnostic tests. Consequently, severity in disease progression has been enhanced that pose a great challenge to the existing medical infrastructure throughout India. Now hue and cry is rampant from all quarters for supply of vaccines, medical oxygen, ICU and Oxygen beds, and anti-viral such as Remdesivir, Tamiflu, Faviflu, and  steroid tocilizumab for critical care patients.

Political blame game over resurgence of pandemic

After a year of pandemic onset in India, the whole country of 1.3 billion population got revert back to the pre-covid ease of life as soon as Covid restriction measures were faded away in the beginning of the New Year 2021 coinciding the gradually declining state of the virus spread, and availability of the country made safe vaccines, Covishield and Covaxin. However, aforesaid euphoric mindset of the national populace including policy makers proved lack in pandemic monitoring foresight with respect to high infectivity variants coupled with altered and lethal pathogenicity, effect of viral transmission conducive environmental conditions during March to June, and aggressive vaccination drive for all age groups. Intriguingly, misperceptions of the declining state of virus spread made new mindset of opportune moments for earning benefits through vaccine diplomacy and export from India.

Whereas, Israel is now world leader in reducing infection rate significantly through planned and aggressive vaccinations. Nonetheless, augmented healthcare infrastructures during the first wave were also withdrawn and medical oxygen & anti-viral Remdesivir were exported as being alleged. Being oblivious to the ever changing characters of insidious virus, political leaders organized huge conglomerations at election rallies, devotees took holy dip in masses at Kumbh Mela at Haridwar, and pandemic fatigue common people vehemently hugged their nears and dears during festivals. Such human social behaviours are certainly inappropriate during Covid era. Quite frightenedly, sudden upsurge in virus transmission during March-April served to trigger national political blame game on prevailing inadequacies in vaccines, medical oxygen supply, ICU critical care, and anti-viral Remdesivir in controlling ever rising Covid cases as high as 3.0 lakh in a single day.

And overwhelming hospitalisation of Covid patients under limited medicine supply in many Indian cities have resulted in daily death toll more than 2000. Consequent upon, abrupt lockdown, corona curfew, and badly needed Covid appropriate behaviour again became buzz words in national print and electronic media. Whom to blame, national think tank for Covid management or the public who soon resorted to Covid inappropriate behaviour of all sorts?

Need of the hour

At this point of time amidst pandemic, India urgently requires all heads put together beyond the political blame game. Since we could not halt the second wave, we must learn lessons through its predisposing causes and act unceasingly to save many precious lives currently trapped into the Covid tsunami by safeguarding ourselves through applying Covid appropriate behaviour (scrupulous face masking, hand hygiene, and social distancing), healthy lifestyle measures (herbal prophylactics, balanced nutritional diets, and traditional wisdom of yoga), and adherence to state imposed restrictions (utmost minimization of crowd size at public places such as railway stations, airports, bus stops, amusement parks, and socio-politico-religious gatherings). In fact, SARS CoV-2 virus should have been strategically arrested to the finish during the first week of February, 2021 when viral transmission diminished to a small size of about 8000-10000 daily cases through stringent preventive measures (Testing-Tracing-Treatment) at various containment pockets in Indian territory.

Simultaneously, scrupulous exclusion of foreign suspects of UK, South African, and Brazilian high infectivity variants should have been monitored at all international airports. By the way, now Damocles sword of Covid-19 has dropped deep, despite variation in immunogenicity of vaccines, aggressive vaccination program must continue unhindered to reduce severity of disease, virus shedding and infectious doses for all age groups since UK variants are also targeting children and young population. Constant genomic surveillance for molecular monitoring of variants would define virus lethal characteristics thereby helping doctors and patients for preventive and treatment measures.

For example, SARS CoV-2 variants of the current second wave in India exhibit air-borne high infectivity and altered clinical symptoms such as early lesion formation in lungs within 3-4 days of infection, increasingly more oxygen requirement in severity and frequently evading human immune reactions. Relying on 1918 Spanish flu pandemic story with four waves within two to three years period and accordingly waiting for the third and successive Covid-19 waves, we would be downgrading the scientific and technological might of 21st century. Therefore, apt application of novel scientific idea for outright check on current escalation and future successive third wave in India is need of the hour otherwise we would be allowing viruses to acquire peculiar characteristics through mutations as transmission progress unhindered and successive waves take place.

Future of Covid-19 pandemic in India

Owing to favourable environmental conditions during April-June for virus transmission, India is all set to become top country in the world which could record the highest daily cases between 4.0 to 5.0 lakh and daily deaths between 4 to 5 thousand in a single day. However, steep escalation could be slowed down through stringent preventive measures. Moreover, peak of the current Covid wave could be anticipated before June, 2021 largely depending upon the preventive control measures. Nevertheless, months between September to mid November are another conducive time period for virus transmission and escalation of Covid cases in India.

Therefore, now onwards stringent preventive measures need to be followed unceasingly in scrupulous manner till viruses diminish to small pockets through herd immunity acquired by aggressive vaccination of all age groups as decided by the Govt. on 19 April, 2021. It would ultimately lead to attenuation of SARS CoV-2 without severity. India can fairly control Covid-19 before the first half of 2022 by ensuring that about 70% of the population must get vaccinated by January, 2022 and also people scrupulously adhering to Covid appropriate behaviour. If vaccination drive is prolonged and goes beyond one year period, acquired immunity of the earliest vaccinated people might be fading away.

                                        Monthly average daily Covid cases in India as of 20 April, 2021

                               (Data source: Ministry of health and family welfare, Government of India)

                               Monthly average daily Covid deaths in India as of 20 April, 2021

                            (Data source: Ministry of health and family welfare, Government of India)

Bar graph displaying percentage of population of the best Covid-19 managed (Israel) and the worst Covid-19 managed (USA, Brazil, UK, India, Mexico) countries got Covid-19 vaccinations as of 18 April, 2021 (Data source: Covid-19 vaccine statistics).

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