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| EDIRORIAL |
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| Year : 2021 | Volume
: 69
| Issue : 3 | Page : 545-546 |
How can India be Prepared for the Third Wave?
V Ravi
Nodal Officer for Genomic Confirmation of SARS-CoV-2, Government of Karnataka, Retired Professor and Head, Department of Neurovirology, NIMHANS, Bengaluru, Karnataka, India
| Date of Submission | 02-Jun-2021 |
| Date of Decision | 02-Jun-2021 |
| Date of Acceptance | 02-Jun-2021 |
| Date of Web Publication | 24-Jun-2021 |
Correspondence Address:
Dr. V Ravi
Nodal Officer for Genomic Confirmation of SARS-CoV-2, Government of Karnataka, Retired Professor and Head, Department of Neurovirology, NIMHANS, Bengaluru, Karnataka 5600029
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.319259
How to cite this article:
Ravi V. How can India be Prepared for the Third Wave?. Neurol India 2021;69:545-6 |
Mankind has been repeatedly endangered by infectious disease outbreaks and each time so far has won the fight. Over the past year and a half, we have been battling the pandemic Corona Virus-Induced Virus Disease 2019 (COVID-19) caused by the Severe Acute Respiratory Syndrome Coronavirus type 2 virus (SARS-CoV-2). Indeed, the COVID-19 pandemic had many lessons to offer. As George Santayana (1863–1952), a philosopher, essayist, poet, and novelist, said “Those who cannot remember the past are condemned to repeat it,” and learning lessons from the first two waves of the pandemic will ensure that we are well prepared for the future waves. While some people are still debating if there will be the third wave, it is not whether there will be the next wave; it is only the question of when. Almost every country in Europe, the United States of America, and many of the countries in the East as well have experienced three waves of COVID-19.[1] In all likelihood, the next wave in India might be in late November or December 2021. Despite the quantum of cases in the next wave, it is essential to plan and prepare to tackle the next wave. It is therefore an opportune time at present to take stock of some of the salient lessons learnt from the COVID-19 pandemic as well as the previous pandemics. While making our preparations, we should take a 360° view that encompasses health in all its dimensions – physical, mental, social, and economic well-being. The following 10 themes are crucial to tackling the next wave of COVID-19 in the country.
Theme 1 – Collect, share, and use data to drive interventions: As stated by John Barry, the most important lesson from the 1918 influenza is to “tell the truth.” Whenever accurate figures are suppressed during a pandemic time, the data gets skewed resulting in unreliable projections made by modelers and formulation of wrong policies and programs. Hence, data should be made freely available to experts. Systematic collection, compilation, and analysis of clinical, epidemiological, and laboratory data are paramount to decision making.[2],[3] A core group expert comprising clinicians, epidemiologists, and laboratory personnel should be constituted at every level (district, state, and national) and entrusted with the responsibility of suggesting appropriate interventions to the concerned authority. Data and data alone should drive interventions.
Theme 2 – Sustained surveillance: We only wake up to disease threats when there is a large outbreak. In the intervening periods, we have selective amnesia to health-related issues and quickly get back to “normal” activities. However, it is the intervening period between waves/outbreaks that are the important ones. It is in this period, surveillance needs to be meticulous. One of the critical aspects of surveillance[4] is to sustain aggressive testing especially in symptomatic individuals and keep a close watch on the 7-day moving average of the test positivity rate (TPR). A TPR of less than 5% indicates that the disease is under control. Another important facet of surveillance should include genomic sequencing to keep a watch on the emergence of new variants of SARS-CoV-2.
Theme 3 – Accelerate vaccination: Vaccines are the best defense against COVID-19.[5] Although the current pace of vaccination has increased steadily from the time it was introduced in India, it is still insufficient to mitigate the onset of the next wave. Bolstering the local production and distribution of COVID-19 vaccines is critical to reducing severe health outcomes and preventing the third COVID-19 wave. Therefore, accelerating the vaccination rate should be a top public health priority for averting the expected surge in COVID-19 hospitalizations and deaths.
Theme 4 – Stepping up NPIs: The COVID-19 pandemic has been associated with a high attack rate among household contacts. Therefore, nonpharmacological interventions including avoidance of mass gatherings, school closings, case isolation, contact tracing, and implementing infection prevention strategies in healthcare settings represent the cornerstone to halting transmission.[6] Therefore, they are critical to achieving a 50% reduction in transmission, which correlates with a basic reproductive number lower or equal to one (R0 ≤ 1).
Theme 5 – Lives and livelihoods are both important: Very often, control measures adopted during pandemics can be highly damaging to vulnerable populations. The lockdown and quarantine measures adopted in India during the first wave of COVID-19 laid emphasis on saving lives. This adversely impacted the livelihoods of the poor and marginal groups (migrants) that were the worst hit by disease control efforts. However, after the first wave subsided and cases started rising sharply in March, 2021 indicating that there would be a second wave, the country continued to lay emphasis on livelihoods and did not impose any restrictions until it resulted in a huge surge. Rather than take polarized positions, it is important to emphasize that balancing both lives and livelihoods are important. Whenever the TPR starts rising, it is important to impose restrictions on activities in smaller geographic zones and avoid lockdown which is an extreme step.
Theme 6 – Allocation and management of resources: Allocation of resources for health is meager in most nations across the world. Pandemics when they occur are akin to any war. Indeed, they are wars of a different kind, “biological wars,” wherein we fight an unseen enemy, loose hundreds, thousand, and millions of lives. All governments pledge to allocate resources for health during a pandemic, but soon after it is over, our priorities go back to other sectors. Unless there is sustained investment in health budgets, we will again face a crisis in the next pandemic. Managing bed capacity at hospitals to treat severe cases, ensuring the availability of oxygen and essential drug in hospitals across secondary and tertiary healthcare facilities are some of the key learnings. Above all, the COVID 19 pandemic has also taught us several lessons in the management of the human resource. Work from home, and rotation of workforce especially in key sectors, such as healthcare, are some of the lessons that should not be forgotten. Looking ahead, we need to sustain all these activities we undertook during the second wave as all adults are unlikely to be immunized before the onset of the next wave. In addition, we need to prepare for a possible surgeon infections in children.
Theme 7 – Communication: A critical determinant that ensures the success of any intervention be it vaccination or NPIs is appropriate communication. While there is an overload of information from various print, electronic, visual, and social media during the current pandemic, a large part of it is not credible. All communication during a pandemic should be well balanced with facts and primarily directed at behavior change. It is therefore imperative that a robust communication strategy is developed that is directed at behavior change for subverting the third wave.
Theme 8 – Leveraging technology: Digital technology was harnessed reasonably well during the past one and half year of the COVID-19 pandemic.[7] A wide range of applications it was used for included testing, tracing, tracking, teleconsultation, training of work force, bed allocation, etc., While these should continue to be exploited, we need to use technology and expertise from other sectors for forecasting trends and managing procurement and supply chains for delivering essential drugs and vaccines.
Theme 9 – Managing mental health: Even under normal circumstances, good mental health is crucial to the functioning of society. During a pandemic, however, it can affect how we respond and recover.[8] Healthcare workers are essential to the COVID-19 response but may have to leave the workforce if their mental health is not protected. Mental ill health may also affect uptake of a vaccine and adherence to NPIs, with some evidence suggesting that poor mental health could increase susceptibility to infection and transmission of the virus.
Theme 10 – Post COVID care continuum and rehabilitation: Many patients who have recovered from an active COVID-19 infection are experiencing long-term residual effects of the disease both physically and mentally. There are innumerable examples of respiratory (lung fibrosis), cardiac (heart attacks), neurological (strokes), autoimmune (MISC in children), psychological (PTSD), and infectious (mucormycosis) complications that occur days or weeks after a COVID-19 patients. In order to systematically address these issues, all hospitals should counsel patients about the likelihood of complications post discharge, establish a post-COVID-19 care clinic and or services to address these needs comprehensively.
The SARS-CoV-2 has not run its full course as yet. Also, whenever it is done, a chief takeaway could be keeping the collective memory of it alive. How well a country will fare in tackling future COVID-19 waves or newer pandemics will depend a lot on how well they weave and integrate the 10 themes mentioned here into the fabric of their work culture.
| » References | |  |
| 1. | Cacciapaglia G, Cot C, Sannino F. Multiwave pandemic dynamics explained: How to tame the next wave of infectious diseases. Sci Rep 2021;11:6638.  |
| 2. | Bertsimas D, Boussioux L, Cory-Wright R, Delarue A, Digalakis V, Jacquillat A, et al. From predictions to prescriptions: A data-driven response to COVID-19. Health Care Manag Sci 2021:1-20. doi: 10.1007/s10729-020-09542-0. |
| 3. | Shirin A, Lin YT, Sorrentino F. Data-driven optimized control of the COVID-19 epidemics. Sci Rep 2021;11:6525. |
| 4. | World Health Organization. Public Health Surveillance for COVID-19: Interim Guidance, 7 August 2020. World Health Organization; 2020. |
| 5. | Sah P, Vilches TM, Moghadas SM, Fitzpatrick MC, Singer BH, Hotez PJ, et al. Accelerated vaccine rollout is imperative to mitigate highly transmissible COVID-19 variants. EClinicalMedicine 2021;35:100865. |
| 6. | Moore S, Hill EM, Tildesley MJ, Dyson L, Keeling MJ. Vaccination and non-pharmaceutical interventions for COVID-19: A mathematical modelling study. Lancet Infect Dis 2021;21:793-802. |
| 7. | Budd J, Miller BS, Manning EM, Lampos V, Zhuang M, Michael Edelstein M, et al. Digital technologies in the public-health response to COVID-19. Nat Med 2020;26:1183-92. |
| 8. | The Lancet Infectious Diseases. The intersection of COVID-19 and mental health. Lancet Infect Dis 2020;20:1217. |
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