HOW PREPARED IS INDIA FOR THE THIRD WAVE OF COVID-19?

As of 3 January 2022, India has recorded 1,892 cases of the “very high risk” Omicron variant amongst a surge in COVID-19 cases in the country. The second wave of the pandemic ravaged the health system as daily caseloads topped at around 4,00,000 in April and May 2021. After the peak of the second wave, cases declined substantially, and as vaccinations picked up speed, the national tally of cases remained under the 10,000 daily mark for several weeks in November 2021. However, since mid-December, driven by a surge caused by the Omicron variant, cases have been on the rise. There is a renewed call for caution and action across the globe as countries have recorded a severe uptick in cases driven by the new variant. The Omicron variant of COVID-19 has been called a variant of concern by the World Health Organization (WHO) based on the evidence that it has several mutations that may have an impact on how it behaves. This suggests that Omicron may be able to evade some of the immune protection afforded by vaccines, many of which are based on the original spike protein and past infections. Scientists at the University of Hong Kong noted that the Omicron variant multiplies about 70 times faster inside human respiratory tract tissue than the Delta variant does.

India’s official COVID-19 death count by the end of June 2021 was 4,00,000; however, experts suggest the actual figures were significantly higher than official estimates. As daily cases across states continue to climb, the healthcare community and individuals alike are expressing growing concern about the possibility of a third wave in the country. According to scientific projections and medical experts, India will see a rise in COVID-19 cases, which may be termed as the third wave, but its impact will not be as severe as that of the first and the second waves. According to experts, the wave is also likely to be short-lived. The surge is predicted to take place at the beginning of 2022. States have already begun to introduce restrictions, including the closure of schools, colleges, and non-essential businesses, and the implementation of night curfews in several states.

IS THE INDIAN HEALTHCARE SYSTEM READY?

The third wave of the pandemic— driven by the new variant of concern omicron — is projected to peak on 3 February 2022, according to a study by the Indian Institute of Technology (IIT), Kanpur. During the second wave of the pandemic in 2021, states around the country experienced an acute shortage of hospital beds, essential medications, ventilators, and oxygen tanks. Since then, both state and central governments have taken steps to strengthen the healthcare system of the country. This started with the vaccination drive in the country, which has been provided free of cost for the eligible population across the country. To improve the COVID-19 vaccination rate, the ‘Har Ghar Dastak’ campaign was also launched in November. States have been supported with the supply of oxygen cylinders and concentrators and the Centre has also helped in the installation of oxygen concentrator plants / PSA (Pressure Swing Adsorption) plants. During 2020-21, funds of around Rs 8,257.88 crore were released to states and Union Territories towards the India COVID-19 Emergency Response and Health System Preparedness Package. The central government has also approved Corbevax and Covovax COVID-19 vaccines and antiviral drug Molnupiravir for restricted use on adults in emergency situations, as cases continue to rise.

Overall, India’s medical oxygen capacity, essential for serious COVID-19 patients, has increased nearly 28% between October 2020 and November 2021. During the second wave, there was also a massive shortage of hospital beds across the country, as those with more serious symptoms of COVID-19 required ventilators and round the clock medical care. As part of the final plan of the package, six states will get 60% of 75,218 beds that will be set up to augment the three-tier healthcare systems up to the village level. The six states are Uttar Pradesh (11,770), Bihar (9,920), Andhra Pradesh (9,596), Odisha (8,206), Assam (7,320), and Jharkhand (5,798). Apart from this, states are individually working on their own preparedness and interventions, including the setting of additional hospital beds, ICU beds, supply of oxygen cylinders, concentrators, and cryogenic tankers in order to prepare for the third wave of the pandemic. However, experts still suggest that given the highly transmissible nature of the new variant, government decisions must be taken with caution as the increasing load of cases could strain even a ramped up healthcare system.

BOOSTER SHOT DRIVE

On 25 December 2021, Prime Minister Narendra Modi announced vaccinations for children in the age group of 15-18 years, along with a “precautionary” third or booster dose for frontline workers and those above the age of 60 with co-morbidities. The “precautionary” dose vaccination drive will begin from 10 January 2022, and the gap between the last dose and the precautionary dose is 39 weeks (nine months) for both frontline workers and senior citizens. The announcement for the booster dose comes as a relief to those most vulnerable to COVID-19, although countries such as the United States and the United Kingdom have announced booster shots for the general public since November last year.

Although both doses of the COVID-19 vaccination are effective in preventing the severe impact of the disease, medical experts and studies suggest that the vaccination could become less effective over time, especially for those above the age group of 65. With the emergence of highly contagious variants such as the Omicron variant, many fully vaccinated individuals are at the risk of getting infected again. This is why boosters of the vaccine are recommended especially for the elderly and those with low antibody levels – to be able to increase the level of protection by increasing the antibodies by taking another shot of the COVID-19 vaccine. The WHO has maintained that the introduction of booster doses should be “firmly evidence-driven” and “targeted” at population groups at highest risk of serious disease, and frontline healthcare workers.

While booster shots may offer additional protection, it is important to keep in mind that roughly only 44% of all adults have received both doses of the COVID-19 vaccination so far in India. Some healthcare experts have pointed out that given supply constraints, the focus of the government will be to vaccinate those eligible adults first, before moving on to providing booster shots to the rest of the adult population. Out of the roughly 146 crore doses administered, about 85.45 crore doses are first doses; and 61.29 crores are second doses. This implies that India will need 21 crore additional doses to fully vaccinate 90% of the eligible population. Add to this the burden of providing booster doses to senior citizens, frontline workers and those between 15-18 years of age, which would signal that it would be a while before a booster vaccine for those in other age groups is announced. While states such as Maharashtra, Rajasthan, Karnataka, Delhi, and West Bengal have been rallying for booster doses, states like Punjab, Uttar Pradesh, and Bihar are lagging behind other states in providing even the first two doses of the vaccine to their population. Due to this, some healthcare experts have raised concerns about vaccine equity in the country and suggested focusing on states which have been lagging.

As a result of daily cases reaching six-month highs in various states, state governments have announced night curfews to prohibit non-essential travel and some have also announced the closure of schools, colleges, gyms, cinemas, and non-essential shops. In light of the new variant, government advisories and health experts have urged people to follow all COVID-19 prevention protocols such as washing hands regularly, wearing face masks, and maintaining social distance. As per health and medical experts, the key to beating the third wave will be such COVID-19 appropriate behaviour along with a calibrated approach to boosters and additional vaccine doses for the vulnerable population.

Contributing reports by Damini Mehta, Junior Research Associate at Polstrat and Ananya Sood, Madhav Chadha, Megha Pande, Interns at Polstrat.