Former chairman Karnataka state health commission

Former VC Bangalore university

Former Director Jayadeva institute of cardiology.

nprabhudev@gmail.com

India may not see a big second wave of COVID19

Is the Worst Over!

It is likely that India may not see a big second wave of COVID19. This does not mean we can drop our guard and get back to pre-pandemic levels of congregations; rather, it means that if we continue to be careful, we will all be safe. Covid-19 vaccines seem to have come in at just the right time for Indians to battle the COVID head on!

India, Argentina and Poland are the three countries among the 15 nations having the highest number of COVID cases that are not showing a second peak.

In India the risk of a second wave is small in most places across the country because most people have already been exposed. For the same reason, we might not need to be overly concerned about the new variants either. Unexposed and susceptible people will continue to get infected. If immunity lasts for only a year or less, then we may have small peaks at intervals for the next few years.

Good vaccine coverage will control this effectively. India’s COVID graph peaked on Sept. 16 and since then, the decline has been steady. I strongly feel that India may not see a big second wave of corona virus cases although there may be small clusters here and there! The mutant strains are only a partial modification of the original virus. The antibodies for the original virus can take away 60 to 70 % of the virulence of the altered strains of the virus. The vaccines are likely to be effective on the mutant strains as well.

Herd immunity, also known as ‘population immunity’, is the indirect protection from an infectious disease that happens when a population is immune either through vaccination or immunity developed through previous infections. It is not a good public health strategy to achieve herd immunity by allowing a disease to spread through segments of the population, as this would result in unnecessary increase in infected cases and unwarranted deaths and the process is scientifically problematic and unethical.

Herd immunity against COVID-19 should be achieved by protecting people through vaccination, not by exposing them to the corona virus. Vaccines train our immune systems to create proteins that fight disease, known as ‘antibodies’, just as would happen when we are exposed to a disease but — crucially — vaccines work without making us sick. Yes, there may be mild to moderate reactions as in many other cases.

Vaccinated people are protected from getting the disease in question and passing on the pathogen, breaking the chains of transmission. To safely achieve herd immunity against COVID-19, a substantial proportion of a population would need to be vaccinated, lowering the overall amount of virus able to spread in the whole population. It may be necessary to vaccinate at least 60% of the population for sustainable results.

The official data and Sero-prevalence surveys suggest that in most countries, less than 10% of the population have been infected with COVID-19. There is no evidence yet that nature-induced antibodies are any worse, or those produced by the vaccines any better or longer-lasting. India finds itself in today, with impressive levels of natural immunity as a result of controlling the pandemic through measures such as lockdowns and social distancing and personal hygiene!

Extensive sero-surveys, from the Indian Council of Medical Research have shown us that the actual number of people infected is more than the official tally suggests. This would include those who were never tested, and thus could not be counted. Most of these infections were presumably asymptomatic or of mild nature, and recovered on their own. However the surveys have shown that for every ‘case’ count in India there are 50 or more undetected and hence uncounted infections that were mostly cured on their own.

As on date Total COVID cases in India- 11,112241 cases multiplied by 50 times of undetected and hence uncounted infections amount to 555,612,050. So a conservative estimation comes to a total body of infections comes to over 55 crores. Many quote even a figure as high as 75 crores.

The development of the pandemic in India, however, had a very different course. It was somewhat late in reaching the country, and thus a lot of hindsight was available to plan a more effective response. A rather long and stringent lockdown was imposed as the primary response to the pandemic.

The lockdown was both a success and a failure. Many Indians have been casual in response to COVID restrictions. It was a blessing in disguise! It meant that the widespread pandemic was building herd immunity silently and naturally. Urban slums were perfect places for the virus to spread quickly, lockdown or no lockdown. In fact, a vast number of poor migrant workers trapped in these slums could have only meant exposing them quicker to the infection. It was then not surprising that a large number of them were infected, before they were even allowed to go back to their homes. The virus reached all nooks and corners- many with symptoms and many more asymptomatic.

As time passed, people realized that Covid-19 was not as risky as it was made out to be. Many COVID patients suffered because of wrong admission policies. Only 15% needed admissions. 85% could have been treated as outpatients and in home quarantine. It was wrong to have admitted all patients and the hospitals were not able to cope with. Those who needed admissions were languishing g in the ambulances and at home. Those who should have been treated at home were in ICUS and hospitals. Most of the initial casualties were due to inadequate institutional quarantine facilities and hospitals themselves became hotspots.

There was also a realization, especially among the poor and rural, that this was a pandemic for the rich and fearful who stayed indoors in their air-conditioned rooms, as it became evident that the virus was much less likely to spread in open spaces.

While the government increased it’s testing and counting of cases, the actual number of infections razed through the population by a factor of 50 times or more, as serological test results on a large-scale, sporadic sero-surveys, and mathematical modeling showed. So, when the number of cases reached over one crore, the actual infection numbers likely crossed 50 crore or more, perhaps 75 crores.

Thanks to the immunity brought on by nature, daily deaths related to COVID have come down in spite of the fact that there is no COVID specific cure as of now. Vaccines have just been started just a month back. Indians may have contracted the virus and developed natural antibodies. This means we are heading towards herd immunity very fast.

The western world including USA, UK, Spain, France Italy, Germany have seen a far more widespread COVID and far more serious mortality rates. It is the inability of our poor masses to follow the lockdown restrictions and social distancing norms that may have silently built India’s herd immunity to a large extent, even before the vaccines came in. All Indians get BCG vaccination routinely which probably has given additional protection against the disease.

The biggest question today is: when and how will Covid-19 pandemic end?

This is tough to answer. We’re at a tipping point. There are multiple, contradictory predictions. End of 2021 is a probable time limit! It all depends on how the vaccine delivery to the population at large is organized. India has enough and more vaccines for its population. It has become a hub for global distribution of vaccines. Some 120 countries are getting the vaccine from India.

The people should overcome Vaccine hesitancy and come forward to take the vaccine to be safe from COVID. India will have mass vaccination by late 2021 good enough for Herd Immunity. A word of caution! It is not just India getting vaccine cover but the whole world population should get the vaccination. Lurking infection anywhere is a threat to all. Find a cure for COVID! The UK is running the world’s largest clinical trial, called Recovery. So is WHO!

Future Strategy!

The first is that successfully managing viral pandemics requires a dedicated, mission-focused health organization. The second critical lesson of public health — one that we are painfully relearning in this pandemic — is that an outbreak anywhere threatens all of us. Be open about it and keep an open channel to communicate and deal with it earnestly!

A permanent shift to a ‘public health virus dept’ is what’s called for. They will provide both preparedness and rapid response. These vertical health organizations, acting quickly, thoroughly and vigorously will generate political support, public engagement and cooperation.

Former director of Sri Jayadeva Institute of Cardiology, Former VC of Bangalore University and former chairman of the Karnataka State Health Commission