India is going through a terrible phase of the recent explosive COVID19 wave, now infamously called the 2nd wave, and it is terrifying! Here are some observations from recent news and reports from India for benefit of public health and research: 1) I did not observe any COVID related significant morbidities and fatalities/mortalities report among healthcare workers, or senior citizen who were vaccinated earlier – that’s very encouraging, as I believe > 80% of the healthcare workforce is vaccinated (at 60% by 16th Feb 2021[1]). If absence of morbidity and mortality in healthcare staff is true during this current explosive COVID19 wave then the current vaccines in India – Covishield® and Covaxin® – both are working and very effective in preventing serious COVID19 related health issues; 2) during last two month (March 1st – April 30th, 2021) cases grown from about 15,000 to ~400,000 [2] cases per day with >1% to 35% test positivity rate, in perspective, during 1st wave, in 2 months (June 20 – August 20th, 2020), the cases grown from 15,000 to ~55,000 cases per day[2], means, the 2nd wave have ~8X infection rate than the 1st wave; 3) this wave is affecting mostly middle class with possible low sero-prevalence of COVID antibodies but not the poor ones, as during 1st wave, the middle class could afford work-from-home, masks, and mostly stayed home due to nationwide lockdown, but poor could not afford any of that and were exposed during the 1st wave and now are protected during this 2nd explosive wave – this needs to be proven with sero-prevalence data; 4) higher serious health condition and mortality – this is again in middle class having usual less physical active and unhealthy life style and lead high morbidity and need hospitalization and intensive care with high Oxygen need; 5) Kumbh Mela and election-rallies are blame games and 3rd wave discussions at this time are to hide incompetency and to distract the focus. Now let’s discuss some more details of these observations.
Why this virus is causing enormous infection resulting in the explosive growth of infections? One of the reasons for this explosive growth could be explained by the new COVID19 variant with high transmission and morbidity rates (more than African, Brazilian, and Britain variant) and rapid growth of variant with a high viral load that may be the reason behind this explosive wave and serious health conditions, of course, this needs to be proven with sequencing analysis and virus growth rate. As the new COVID variant seems to grow rapidly among infected people creating lots of viral particles in the air resulting in a high virus load in the atmosphere. Because of the rapid multiplication of this new variant virus, the infected person could be producing high viral particles (viral load) even before any symptom develops, and later on the reason for serious health conditions in the infected person. The variant may not be traveling too far by being air-born, but it seems to infect many people nearby to an infected one as more viral particles in the environment can infect more people in close proximity with higher viral load/dose than the variant being air-born. Since people get infected with high viral doses, they will develop severe symptoms and will require oxygen and hospitalization.
Why this time the virus is spreading among the middle class? This wave is affecting mostly the middle class with possible low seroprevalence of COVID antibodies but not the poor ones. The poor ones during 1st wave could not afford work-from-home, or masks, and could not stay home even during the nationwide lockdown and were exposed during the 1st wave, and now are protected during this 2nd explosive wave. The middle class could afford work-from-home, wear masks, and stayed home during the nationwide lockdown and were protected during the 1st wave and could have lower seroprevalence and could be a reason for explosive growth among the middle class. The middle class could also be lesser physical activities and have an unhealthy lifestyle than the poor ones and could be a reason behind serious health conditions with higher demand for hospitalization and intensive care with high Oxygen need.
Are Kumbh Mela and Elections rally just blame game? It is very irresponsible to blame elections rallies or the “Kumbh Mela” – the greatest gathering of “Sadhus” (the saints) and the public for a holy dip in the sacred river. These are just targets to blame and hide incompetency than to really understand the cause. The “Kumbh Mela” should not blame, why? If “Kumbh Mela” was the reason then by this time there would be higher explosive growth of infections and fatalities among participating “Sadhus” than the general public, as the “Sadhus” were the earliest and in the greatest number who participated in the Kumbh Mela and these Sadhus did not wear any masks, in fact, some sects did not wear any clothes – the Naga Sadhus. But this did not happen yet, though there were reports of infections and mortality among Sadhus, but not higher than the general public. In fact, infection and mortality rates could be probably lower among participating Sadhus than the general public. Similarly, election rallies should not be blamed when the infection and mortalities rate was much higher in non-election states – such as Maharashtra, Punjab, Madhya Pradesh, and Chhattisgarh. In fact, some of these states – Maharashtra, Punjab, Chhattisgarh had and still have much higher infections and mortality rates than most of the other states or compared with the election states, such as Bengal, Assam, and Tamil Nadu.
Could the explosive growth have stopped? In hindsight, yes, the explosive growth could have been stopped, and this new variant may not be developed if the “experts” and leading policymakers were vigilant about ongoing infection growth in Maharashtra, Kerala, and Punjab, and strict restrictions/lock-down were in –place in these three states to restrict the movement of infected people. In these three states, the pandemic was never under control and COVID cases were still growing in February 2021 by when every other state has controlled the virus infections. The unchecked spread/growth of infected people in the three states might have resulted in mutation creating a new variant which might be the reason behind this explosive growth rate. As it is known if virus infections are not checked, there would be a higher chance of developing a new mutation leading to a new variant that may more infectious and deadly. This could be the reason as the people from these three states, without any restrictions in place, might have spread the variant in the Kumbh Mela, and but could also be true for ongoing farmers’ protest in Capital – Delhi that was originated in Punjab, one of active pandemic state. If the Public health leadership – the “experts” and leading policymakers – were vigilant and proactive in controlling the spread from these three states, possibly the variant would not have developed and no this 2nd wave. Also, if they have focused on aggressively vaccinating all before exporting to other countries. But the Public Health leadership failed and now has been making an irresponsible statement of 3rd wave.
3rd wave “talk” is the media publicity and distraction catch-phrase: Recently, media is ablaze about prediction statements of the “experts” and leading policymakers about an eventual 3rd wave. The statements are irresponsible and causing more harm than any good. Also, it is not clear the logic behind these statements – do the “experts” know when and how this 2nd wave will end? If not, then how these “experts” could predict the 3rd wave and based on what? Also if they ever predicted this 2nd wave before? So, basically, these statements may provide more sound bites and publicity in media for the “experts” making the statements, but it will distract the current focus and may cause more harm in controlling the current wave. The experts should investigate the reasons behind the explosive growth – if this new variant really has a high multiplication/growth rate. At this crucial time, there is no basis for discussing the “third” wave when the focus of the “leading policymakers” or “experts” should be on controlling and raining in the current ravaging 2nd wave. They should mobilize all resources to provide proper medical care to the COVID patients, conduct aggressive vaccinations, and investigate the variant. The Public Health leadership and “experts” should explain to the public the reasons for explosive growth and about the dangers of exposure to high doses to increase awareness, and should educate the people to eliminate and to reduce exposures by wearing double masks, even indoors and with greater physical distancing.
The main takeaways so far from India’s recent explosive COVID19 wave are – 1) the explosive growth could be due to new COVID19 mutation/variant which more infectious with faster viral growth, which leads to more viral particles in the environment; 2) both vaccines are very effective in India to prevent COVID related serious health issues; 3) stop the blame game of the “Kumbh Mela” or “election-rallies” but own the mistakes of being non-vigilant and not pro-active to stop the growth in three states; 4) do not distract the focus of combating this ravaging wave by talking about 3rd wave; 5) educate the public about the danger on new variant and to reduce viral load exposure by strictly adhering to social-distance and wearing double face-masks even indoors; 6) very aggressive vaccination strategy to vaccinate all quickly.
Cited Sources:
2. https://www.worldometers.info/coronavirus/country/india/#graph-cases-daily
(C) Bhagwan D Aggarwal
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