“Ark prepared in advance could save us from the impending flood”
The peak of second wave of COVID-19 is waning and WHO has aptly described the situation as ‘Beyond Heartbreaking’. The only permanent solution is to develop a vaccine against SARS Cov2, and in the mean time to take all the necessary measures to restrict its movement, upgrade the medical system and improve the management.
Effective lockdown, efficient contact tracing, social distancing, disinfection and timely treatment are some of the important to control COVID-19. Developed nations such as the USA and a few European countries, relying on their better health infrastructure, have hardly gone for complete lockdown and probably could not carry out efficient contact tracing. That led to an enormous number of COVID-19 cases and a very high number of fatalities. India realizing its health infrastructure imposed a two month complete lockdown in May-June 2020 that helped in pushing first wave till Oct 2020. Somehow India was fortunate also that the virus didn’t wreck havoc in first wave. This led to complacency in public and government and instilled a false sense of supremacy that Indians are resistant to this virus.
However, very soon the improper utilization of this window period by government and reckless public behavior put the entire nation in deadly second wave of COVID-19. Probably, we failed to understand that unless 60-70% population achieve immunity (herd immunity stage), ‘No one is safe until everyone is safe’. COVID-19 related deaths were below 100 in mid Feb 2021 and India prematurely celebrated the victory. The public places were opened, social and religious gatherings were allowed, and some of the states even went thorough elections. It is high time to learn from our mistake and the introspection to identify some of the areas of concern that are needed to be addressed in order to avoid or tackle the impending third wave, if any.
One such big disappointment came from the task force constituting scientific communities, mathematicians and epidemiologist which were looking into the different mathematical model to forecast waves of Covid-19. The IIT Kanpur has though developed a mathematical model named Sutra for this purpose; unfortunately its prediction has been far from true. An exact prediction could have bought time to get prepared for the enormity of second wave and to formulate a concrete strategy for effectively controlling the disease and dreadful situations borne out of it. An improved or a better alternative method needs to be developed for this purpose.
Viruses are millions of year old organism and they trick human host by change in genetic materials or mutation. Corona virus has up to a million times high mutation rate then their host human and thus corona virus generate a new variants. A viral mutation helps in redesigning diagnostic kits, viral drug resistance, or designing new vaccines or antiviral drugs. Setting of INSACOG consortium was to detect virus genomic variants to study evolution of any new strains and their infectivity, transmissibility and immune escape. There should be more sequencing of SARS CoV 2 from COVID-19 patients since all the ten participating institutes are underutilized of their sequencing capacity. To access the databases on COVID-19 testing and genome sequencing of viruses, many prominent Indian scientists have written an open letter to government. Access to this information would help not only in analyzing the details of co-relations between related diseases, age, and epidemiology but also how and where new strains get evolved.
Transparency and more clarity is needed from concerned authorities before sharing their opinion of making claims. Recently, the Secretary of the Department of Science & Technology has mentioned that because of the scale, speed, intensity and ferocity of the situation that we witness today could not have been foreseen by scientific agencies and committees that were directly monitoring the situation. On the other hand, a member, Health, Niti Ayog, has assured that Children will not get serious COVID infection when report of B.1.167 variant affecting children in Singapore came to his notice. Reassurance would have been encouraging had he apprised of the means to tackle it or had India precisely predicted and effectively controlled the second wave of COVID-19. It has to be kept in mind that similar assurance has come in early march from the Health Minsiter of India when he declared that India was in the “endgame” of the epidemic and thereafter India witnessed the worst phase in several decades.
The unfortunate demise of Padma Shri Awardee Dr KK Agarwal, 62 yrs, and a few other health workers, despite of receiving both the doses of vaccines, warrants the investigation on effect of SARS CoV2 in vaccinated people. This information can strategically be used to prevent a large number of deaths. As mentioned by the manufacturers that vaccine is around 70% efficient, it is important to know whether the vaccine has activated the immune response in these deceased cases or not. The serological test of all the health workers needs to be conducted as it will identify the persons in whom antibody has been generated in response to the vaccine doses. Thereafter, what kind of response their bodies elicit upon SARS CoV2 infection and how many people succumb to it. Cases where antibody was not generated despite of vaccination, which could roughly be 30%, can have the alternative vaccines. This serological drive can later be extended to other people, if needed.
Another area of concern has been insufficient medical facilities and improper resources management. Life saving equipments was already in shortage and some of the newly bought ventilators were reported to be malfunctioned. A vast number of lives were lost because of unavailability of oxygen. Realizing the importance of these, the central and state governments are trying to produce enough oxygen to meet the unprecedented demand and arranging other medical items.
Vaccination is the elixir that would save the life and sooner it is done, better for humanity. Initial 100 million dosages took 61 days to vaccinate while the last 100 million only 5 days however, more synergy needed between center and state. Although India stands second in terms of daily administration, because of its large population the population coverage is still merely 6.8% as against 58% in Israel, 43% in the USA, 20-25% in European countries and 15% in China. In order to rapidly increase the population coverage, India needs to involve more partners in vaccination drive. In Feb 2021, the WHO recommended the gap between two doses for maximum efficacy should be 12 weeks but in India it was 4 weeks till last week. If this was taken in consideration from the beginning of vaccination in India, at least 1 crore more people might have got their first jab. As predicted by some of the virologist, that children could be next target in third wave. Trial of Covaxin for the age group 2 to 18 years is a welcome step.
Knowing that India needed almost 1500 million doses to reach the herd immunity stage, pace to look for alternative methods from the beginning of procurement vaccines, manufacturing in collaboration with a few other companies and promoting a few more local pharmaceuticals companies is slow. To avoid delay in vaccine procurement, now state government are inviting global tenders for vaccine and some of the local companies are roped in by Bharat Biotech on the behest of PM for vaccine production. Similarly, approval of new vaccines and speedy bridge trials would be helpful in achieving the vaccination target. India may buy Moderna and Pfizer vaccine from the USA to administer pregnant, breast feeding women and immunosuppressed patients as it is already tested and being administered in the USA.
This is not a time to play blame games. India has to go a long way and it requires contribution from all its citizen. Thanks to the medical staff that in general have exceeded all the expectation and doing everything to save the life at the cost of their own life. Government also deserves some applause to feed crores of poor people during the first lockdown in mid-2020 at the cost of massive financial losses. People need to understand that Government cannot enforce lockdown every now and then as the repercussion of lockdown is long lasting and irreparable and therefore all the individual need to play their part sincerely.
Sudhakar Srivastava and Rajeev Raman
Beijing Forestry University, China
Rajeev Raman, Leibniz Institute for Neurobiology, Magdeburg, Germany
