Coronavirus waves inevitable without appropriate protocol: experts

Recurring waves of coronavirus infections are inevitable if existing practices such as expanding India’s vaccination drive and following COVID protocol are not adhered to, say experts.

Earlier last week, Principal Scientific Advisor K. VijayRaghavan had said, “A phase three is inevitable, given the higher levels of circulating virus.”

“There is, however, no clear time-line on when this third phase will occur. We should be prepared for new waves and COVID appropriate behaviour and vaccine upgrades are the way forward,” he added.

On Friday, however, he qualified his statement saying that such a wave wasn’t a foregone conclusion. “If we take strong measures, the third COVID wave may not happen in all the places or indeed anywhere,” Dr. Vijay Raghavan said.

After cases peaked and registered a steady decline since September and well into early March, life in India had gone back to normal with the inevitable crowds. While multiple serology surveys by the Indian Council of Medical Research (ICMR) had suggested that at most 21% of India had been exposed to the coronavirus, the subsequent decisions to have a staggered vaccine rollout that would cover only the most at-risk populations and to be entirely dependent on locally produced vaccines reflected the government’s calculation that a devastating second wave was unlikely.

‘Unprepared’

“I am angry,” said Dr Samiran Panda, who heads ICMR’s epidemiology division. “Not counting healthcare workers, effectively 75% of the country continued to be vulnerable in January. Social distancing, infrequent mask use and vaccine hesitancy have all played a role. I wouldn’t hesitate to say that a third and fourth wave is inevitable if these conditions continue.”

Unlike in January and February when the limited vaccine rollout was yet to accelerate, there is currently a shortage in vaccine supply, with less than 2 million doses being administered a day, and supplies of both Covishield and Covaxin unlikely to significantly pick up before July.

Dr. Panda adds that vaccines ought to be preventive and be administered before infections ravage a community and not after.

“In future, we should consider a cut-off, say a 10% test positivity, and through a smart combination vaccinate people in districts with low infection spread as well as high spread. That’s the essential lesson from our previous experience with HIV epidemic.” Test positivity refers to the number of samples that test positive for the coronavirus and a percentage above 15% indicates high prevalence of the infection in a community.

Policy response

The Lancet Commission Task Force that has a range of public health and policy experts spanning the state universities and even those with the ICMR, has in two reports, in April and May, pointed out that there was no unique policy response to rein-in the pandemic.

The group presented a “checklist” that highlights a range of actions needed for different places with varying disease burden.

These include “credible and regular projections” of the trajectory of the pandemic that would help policy makers to evaluate the relative success of different approaches, putting in place a system to share anonymised microdata with a larger pool of researchers to understand more nuanced trends of hospitalizations, disease severity, long COVID-19 characteristics. This would help to better prepare the health system and the administration with the consequences of the surge and, ramping up genome sequencing to 5% of all tests on a monthly basis and ensure that the data on variants of concern (VoCs) from genomic surveillance was shared across to the districts.

‘Not inevitable’

Gautam Menon, modeller and Professor, Ashoka University said he believed a ‘third wave’ wasn’t inevitable.

“Hopefully the powerful lessons of what is happening now will not be forgotten in a hurry. Social factors, more than even the biology of the virus, govern how epidemics proceed. Provided we can reconfigure our lives so that physical distancing, mask wearing, working from home where possible, reducing crowding in public places and paying careful attention to ventilation becomes a part of our daily life, we can be spared another wave. To do this until a substantial proportion of our population can be vaccinated, that is what should be our priority,” he told The Hindu. In the long run, dominant strains of the coronavirus would tend to be more transmissible and less virulent but when that would happen couldn’t be calculated at present.

Shahid Jameel, virologist and advisor to the Indian Scientists SARS-COV2 Genome Consortium (INSACOG), however, said waves would keep happening until actions were taken. “We know some variants are more transmissible. We should be testing the India variants against vaccines, in labs and in real world settings.”