July 19, 2021 2:46:37 am
Experts and doctors have cautioned that to avert the worst impact of a possible third wave, vaccination coverage needs to be better and extreme vigilance must be maintained of multiple markers indicating a surge in cases and emerging variants.
Speaking at a day-long virtual international conference on ‘Covid and beyond’, organised by Collaboration to Eliminate Tuberculosis among Indians (CETI) and Indian Institute of Public Health Gandhinagar (IIPHG) on Saturday, professor at IIPH Bengaluru and epidemiologist Giridhara R Babu said, “Given the current pace of vaccination, the third wave is imminent. The peak of the third wave depends on how fast we are going to vaccinate and how many people we are going to cover… Covid appropriate behaviour has to be at the same level as it was during the first wave. If not, the peak will be higher and probably earlier.” Babu estimated the next wave hitting by end of October.
Dr DJ Christopher, professor at Department of Pulmonary Medicine, CMC Vellore, said that while non-pharmacological interventions such as social distancing reduce incidences of influenza, it increases the infection-susceptible population. Echoing Babu’s assessment, president of Public Health Foundation of India (PHFI) professor K Srinath Reddy, stressed that vaccine hesitancy needs to be countered.
Naveen Thacker, president-elect at the International Pediatric Association (IPA), however, highlighted that to better vaccination coverage, it is important to address concerns around vaccines.
“We do not have widespread anti-vax movement like in the US and Europe… we have concerns among people on safety, efficacy and AEFI, which can be addressed… There are issues of accessibility, non-availability of vaccine, digital divide,” said Dr Thacker, stressing that there should be focus on communication. Reddy also highlighted that herd immunity, which is a population-level attribute and not an individual level attribute, goes out as a “very wrong public health message”.
“There were many assumptions of herd immunity which were not applicable in Covid-19. First one was assuming a uniform R0 (reproductive number) … It is not realistic as it differs with area, population density, age structure, culture, etc… the virus is changing and therefore, only vaccines and not infection (can protect)..,” explained Babu.
“We ought to promote that herd immunity is best acquired through vaccination, which is an individual attribute,” said Reddy.
Reflecting on the key drivers for the first two waves of Covid-19 in India, Babu said, apart from emergence of more infectious variants during the second wave, insufficient ramp-up of testing capacity could be attributed as reasons for a fatal second wave.
“Where we missed (picking up the early signs of an emerging second wave) was in March and April this year when cases were rising and we missed interpreting that,” said Babu. He, however, added that without a lockdown during the first wave, India might have seen outcomes worse than the second wave.
Providing a contrarian view, pediatrician and virologist professor T Jacob John estimates that with an approximate 216 million people who are assumed to have not been affected by Covid-19 in India till now, “it is not sufficient for a real third wave”. His calculation was based on the three national serosurveys and estimated population affected during the second wave. John, however, cautioned that “vigilance is essential” to monitor variants.
However, highlighting that India is “not a homogenous country” and the serosurveys were national surveys, Reddy indicated that the data is not sufficient to dismiss the possibility of a third wave. “There are parts of the country where even 20 per cent of the population do not have antibodies,” added Reddy.
Gujarat-based microbiologist Dr Nidhi Sood, who is also officer on special duty for diagnostic services at Gujarat Medical Services Corporation Limited (GMSCL), too, cautioned that with variants of concern in circulation, “we have to be very very vigilant…we have to be careful of introduction of variants in our country”, and also advocated the need to establish policy to keep strict vigilance on detection of variants.
Director of Tata Institute for Genetics and Society in Bengaluru, Rakesh Mishra, stressed on the necessity of genome sequencing to follow the virus and how it is spreading from “which country and correlate it with clinical aspects of the variant”.
“There will be more efficient variant that will emerge… it will probably have less symptomatic manifestation… and some of the mutants can escape the protection we have acquired…” said Mishra.
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