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A third wave of coronavirus in India is said to be ‘inevitable’ and according to a recent study by IIT Kanpur, it is set to strike by October 2021.
In the past couple of weeks, top scientists and epidemiologists, as well as public servants have made an active attempt to warn the masses.
There is an urgent need to empirically identify the current trends of vaccine supply and immune profiles. It is imperative to add more nuances to the clamour around the third wave for both public consumption and policy action.
Even though the 68-day hard lockdown in the first wave appeared to be a control measure, it is unlikely that the empowered groups will recommend such a nationwide step again. Thus, state governments have a critical role to play—they need to gauge basic needs and impose restrictions accordingly. A full unlock may lead to a repeat of the disaster that we witnessed after the first wave. Another proactive measure is to prioritise vaccinations for the people working in critical supply chains. Given that the vaccination drive has opened up for those in the 18-to-45-year age group, some relief could be felt, but with only 3.2% citizens fully inoculated, the pace is still a concern. Thirdly, with rich pharma sector companies and drug and equipment manufacturers in the country, product innovation and R&D should be leveraged for self-testing of infections.
We should learn and adopt best practices from countries that have reported almost nil infections. For example, to support businesses and workers, the government of Australia provided subsidies to firms to keep people employed. Another example is South Korea that learned from its mistakes during the MERS pandemic outbreak of 2015. After an outcry, the country built a new public health system that snapped into action in early 2020 and successfully contained Covid-19. We can also learn from the UK that detected different variants of Covid-19 entering the nation, imposed a ban on visitors and conducted technology-led awareness campaigns on the importance of vaccination.
Policymakers and healthcare leaders must focus on driving awareness and creating infrastructure towards promoting citizen-driven responsiveness. While the states and the Centre have an extensive vital role to play to contain the pandemic, the general public needs to cooperate and abide by the rules. Responsible implementation of protocols of pandemic control such as social distancing, constrained citizen mobility, hand washing, in-house toileting and avoiding spitting in open areas requires far more than merely investing in traditional public health systems. Governments, socially responsible corporate giants and NGOs should consider investing in building awareness in citizen communities towards improving their state of living. Without cooperation from the general public, state responsiveness alone will not effectively control the third wave around the corner.
The third wave currently under discussion refers to a possible surge in cases at the national level. The national curve seems to have entered a declining phase now, after having peaked on May 6. In the last two weeks, the daily case count has dropped to about 2.6 lakh from the peak of 4.14 lakh, while the active cases have come down to 32.25 lakh, after touching a high of 37.45 lakh. If current trends continue, it is expected that by July, India would reach the same level of case counts as in February.
If there is a fresh surge after that, and continues for a few weeks or months, it would get classified as the third wave.
In the meantime, states could continue to experience local surges. Like it is happening in Tamil Nadu and Andhra Pradesh right now. Or, at a more local level, in the districts of Amravati, Sangli and a few others in Maharashtra. But as long as they are not powerful enough to change the direction of the national curve, they would not be described as the third wave. Also, the more localised the surge, the quicker it is likely to get over, although cities like Mumbai and Pune have gone through prolonged surges.
There has been some speculation about the third wave being even stronger than the second. However, this is not something that can be predicted. Usually, it is expected that every fresh wave would be weaker than the previous one. That is because the virus, when it emerges, has a relatively free run, considering that the entire population is susceptible. During its subsequent runs, there would be far lower number of susceptible people because some of them would have gained immunity.
This logic, however, has been turned on its head in India’s case. When the number of cases began declining in India after mid-September last year, only a very small fraction of the population had got infected. There was no reason for the disease spread to have slowed down, considering that such a large proportion of the population was still susceptible. The reasons for the five-month continuous decline in cases in India is still not very well understood.
And since the second wave was expected to be weaker than the first, many were fooled into believing that the pandemic was nearing its end. With the lessons learnt in a very painful manner, there are now suggestions that the third wave might be even stronger.
But that might not be the case. A far greater number of people have been infected during the second wave than the first. With the positivity rate almost four times that of the first wave, the unconfirmed infections — those who were never tested — is also expected to be large. In addition, vaccination would also induce immunity in a large proportion of the population. So, there would be a significantly lower number of susceptible people in the population after the second wave.
However, gene mutations in the virus can alter these calculations. The virus can mutate in ways that make it escape the immune responses developed in the already infected people, or those vaccinated.
The outcome of the third wave also depends on what level of immunity India’s population has – both from prior infections and from vaccines. The country averaged 3.25 million doses every day between 9 and 22 June. But it needs to reach 8.5-9 million doses daily to meet its target of vaccinating the eligible population by the end of 2021.
Just over 4% of Indians are fully vaccinated and about 18% have received one dose so far.
Dr Lahariya says if the speed doesn’t pick up, millions will still be vulnerable, although immunity from past Covid infections can protect people.
But it’s hard to establish the number of Indians who were infected and may have developed natural antibodies to fight the virus. Many in cities, towns and villages struggled to get tested and have no way of knowing if they had the infection. Even the number of Covid deaths has been under-reported. Dr Lahariya says that the number of people who have immunity from a prior infection could be between 55-60%.
The third wave is a distinct possibility. It is likely to come, although the scale or timing is not something that can be predicted. But it is not inevitable. As mentioned, VijayRaghavan, the Principal Scientific Advisor, also modified his remarks, clarifying that it could possibly be avoided if people continue to take strong measures. It’s also possible that this time, the fresh wave will be indeed much smaller than the previous one, so that it inflicts much less pain and can be managed more efficiently.
A lot would depend on how people heed these warnings. They can become paranoid about an incoming disaster, or get numb to repeated warnings. The second wave has taught us that it is far better to remain paranoid and cautious than be hopeful in a situation like this.
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