‘We need to look at where the second wave was descending since an increase will almost definitely be noticed from there that may be regarded as an early sign of the third wave. However, this necessitates a thorough examination of state-specific data,” claims top scientist of the Indian Council for Medical Research (ICMR), Dr Samiran Panda.
In an interview with Medically Speaking, Dr Panda talked about the possible threats of the third wave and an increasing number of daily cases in India amid the festive season. Excerpts:
Q. Everyone wants to know whether the third wave is going to hit or not? And if it does, what does it mean for the common people and when will it arrive or is it already here?
A. Short answer to this is that there is a possibility of the third wave hitting us. The question, however, can be broken down into smaller parts and should be asked at the state level because India does not have a uniform state-wise vulnerability. The pandemic didn’t impact many states in India as severely as Maharashtra, Kerala or Delhi. 80% of the recorded infections were recorded by only 10 states and people there developed good immunity against the infection. Thus, the possibility of the third wave hitting strong in these states is lower compared to other states. These states also had quick vaccination that boosted their immunity fairly. State-level data should be analysed in terms of the intensity of the first and second wave and the vaccination.
Q. We are seeing 60% to 70% of daily cases coming from Kerala. Would you say that the third wave has arrived there already?
A. We realised that around 44% of the individuals in Kerala, particularly from the areas participating in the 4th round of the Sero-survey had the presence of antibodies in them which means that they were also exposed to the infection. Looking at the other side of this, 56% of the people were not infected which means that Kerala was successful in containing the infection. Hence, we are not surprised by the fact that Kerala is experiencing a surge of infection.
We need to look at where the second wave was descending since an increase will almost definitely be noticed from there that may be regarded as an early sign of the third wave. However, this necessitates a thorough examination of state-specific data.
Q. Which states are at a higher risk of entering the third wave?
A. Infections might happen to anyone even after the vaccination but will not push us to the severe stage of the disease. In a particular state, vaccination has good coverage even then people can still get infected if they do not observe Covid appropriate behaviour. Vaccines against Covid-19 in India are not infection preventing vaccines, they are disease-modifying vaccines. Hospitalisation, need for oxygen or even unfortunate events of deaths will be less in those states where 50-60% of the people have been vaccinated.
Q. Would you say there is a tentative timeline for the upcoming third wave or it is not inevitable?
A. Virus needs an opportunity where suspectable people come in contact with infected individuals and in the situation where the population density is very high.
Q. We saw a surge in cases last time after the festivals like Holi and people went out to places like Kullu-Manali. Would you say that this time too the third wave would be experienced after festivals like Ganesh Chaturthi?
A. If the height of the wave is in the question, I would still expect the height of this wave to be lower than the second because we did not have vaccinations happening back then.
If the population density increases during festivals with Covid appropriate behaviour not being followed, we can always expect a rise in cases. We must not forget our health is in our own hands.
The recorded number of infections and recorded number of symptomatic infections where more people are going to the hospital requiring oxygen are two different things. The second scenario where the number of advanced stages of the disease is at a large is a scenario that can be considered as a wave and we do not want that.
Q. Is it possible to avoid it?
A. Each state needs to look into the epidemiology of the infection. It is possible to avoid the rise in cases through state-specific data analysis.
Q. We have seen a new variant emerge known as “C.1.2 and Mu” which could be a variant of concern and as reports suggest, many vaccines may not be as effective on it. Is there any real danger of it spreading in India?
A. While Delta was spreading, we looked into the magnitude of its spread. We realised that all the variants were neutralised and collected by the vaccine recipient which is a good thing. Talking about the variants from other countries, we need to have surveillance that could happen at three levels: at the airports, at the state level and at the district level.
As yet we have not recorded this new variant. Any new variant is identified as a variant of interest or variant under investigation. As far as India is concerned, C.1.2 has not made an entry into the nation. If it results in a large number of cases and deaths are being reported due to the new variant, it will be identified as a variant of concern.
NCDC is the focal institution that will conduct this genomic surveillance that sees whether the new variants are appearing or not.
Q. There are certain variants like the Delta Plus on which the vaccines are not effective. What does this mean for our country?
A. Any variant that gets identified as the variant of concern must be tested against the serum collected from a vaccine recipient and see if the serum is able to neutralise the new variant. Many laboratory experiments have shown that the vaccines made in India have been able to handle the variants called Delta or Delta Plus.
Q. Since we are talking about the various mutations of Covid, the possible third wave is stressing people. If it comes, will it be as effective as the second wave or will it not be considering the number of cases in the second wave, immunity building etc.?
A. If the third wave occurs, then, according to the models which we studied at ICMR, the third wave should not reach the heights as we had seen in the second wave, which is a good thing but we should not let our guard down because post-vaccination, it’s possible for us to get infected. We won’t get to the severe point of the disease but others can get infected which is not good.
Q. Is there any fear regarding an increase in Covid cases as children have better immunity but can be carriers?
A. Although children got infected, it is not clear whether they got it from school or not. And according to a National Sero-survey, we saw that 55% of the children were already exposed and infected because they had the presence of antibodies during the survey. So what can be done to avoid further spread is that before or during the opening of schools the parents and the school staff should get fully vaccinated and all the required precautions should be taken. Moreover, people should know that preventing children from going to school is like robbing their life opportunities because they are the future of the country.
Q. There are few reports about the booster shots, many countries started it already. What are your views on whether India needs a booster shot or not?
A. In India, we turned out to be lucky to have Covaxin and Covishield and many people have achieved natural immunity through natural infection. It does not make any sense to talk about booster dose as many eligible and prioritised groups of Indians are receiving vaccines and preferably two doses.
In the case of these present variants, it is all dependent on discussion related to neutralising antibodies. But we must not forget that it’s just not about neutralising antibodies after vaccination or post-infection which matters, there is another arm of immunity called cell-mediated immunity and we are not measuring them.
Let’s not panic and get fully vaccinated and then see what the scientific data is telling us. For India, a booster dose should not be the centre of discussion.
Q. What would you tell to the people about the safety measures they should take as we are also approaching the festive season?
A. If we celebrate a little low-key, maybe we can celebrate better in the coming years. So my appeal to everyone is to get vaccinated, keep following Covid appropriate behaviour and by doing this, we can win this war against Covid-19 in India. So all of this is in your hands. Stay home and stay safe.
In a particular state, vaccination has good coverage, even then people can still get infected if they do not observe Covid appropriate behaviour. Vaccines against Covid-19 in India are not infection preventing vaccines, they are disease-modifying vaccines.