The second wave of COVID pandemic that India is experiencing right now is more virulent, but less fatal though the number of per day deaths may rise to 2,320 by the first week of June on account of increased infection rate, says a report of the Lancet Covid-19 Commission.
The report, titled “Managing India’s second Covid-19 wave: Urgent steps”, gives a clearer picture of how the second wave has progressed so far while suggesting ways to contain the spread of infection.
COVID cases restricted this time in geographical area
The report states that the spread of infection this time has been more geographically clustered. During August-September 2020, the number of districts contributing to 75% of COVID-19 cases was roughly between 60 and 100, but this time only 20 to 40 districts are contributing that many cases.
The Lancet report states: “While the pandemic has spread, the geographic contours of the second wave closely mirror those of the first wave, though with a deeper penetration into tier 2, tier 3 cities”. The number of districts comprising the top 50% has dropped from over 40 at the time of the first peak to less than 20 at present.
Rapid rise this time
There are two main differences between the first and the second wave.
Firstly, it took just about 40 days for cases to increase from 10,000 to 40,000 from February to April this year. In September last year, which was when cases reached its peak, this rate was about 80 days. This means the rate of increase in cases is significantly higher during the second wave.
Secondly, a good number of cases this time around are asymptomatic or mildly symptomatic, which has caused less hospitalisation and deaths, in proportion. The Lancet report, however, does not clarify if detection of more asymptomatic cases can be attributed to better contact tracing.
Number of deaths may still rise
India’s Case Fatality Ratio (percentage of people dying in proportion to infections) since March 2020 is approximately 1.3%. However, the Case Fatality Ratio (CFR) since the beginning of year 2021 is just 0.87%. In conclusion, the Lancet report states that death rate is less though the absolute number may look big due to increased infection.
The country has been recording 664 deaths per day across the country (seven day moving average a/o April 10th, 2021).
Economy under strain
India will spend more than $7.8 billion on testing and $1.7 billion on healthcare utilisation due to COVID-19 infections till September this year.
The pandemic has caused badly impacted health services like routine immunisation and delivery care, thus having devastating effect on maternal and child survival.
Solutions to contain second wave
1. Increase vaccination: The Lancet report suggests all adults (including those below 45) with severe co-morbidities should be vaccinated. As of April 11, 2021, 29.6% of those above 45 years have received one or both doses of a vaccine.
2. India needs more vaccine options: Besides Covishield and Covaxin, the two vaccines being administered in India right now, the country needs more options. Sputnik V got the government’s emergency use nod just a few days back. Johnson and Johnson, Pfizer-BioNTech and Moderna are the other candidates lined up, which should be approved at the earliest, the report suggests.
3. Increase vaccine production: Right now, Serum (Covishield) and Bharat Biotech (Covaxin) are together producing about 70-80 million doses of vaccines a month. “Even if 100% of this supply was for domestic use, at a target of 5 million doses a day, the monthly supplies would fall short by half,” the report stated.
Completely indigenous vaccine manuacturer, Hyderabad-based Bharat Biotech has set an ambitious target to hike manufacturing to 150 million doses a year, which will reduce the supply gap to an extent.
4. Increase acceptance for vaccine: Though India leads the world in vaccination, only 57% people surveyed said they are willing to take the jab. The India Task Force of Lancet suggests this acceptance percentage should go up significantly.
5. Against complete lockdown: The Lancer report is against complete lockdown, either at the national level or at the state level, because of the high economic cost, mostly suffered by the poor and underprivileged. The Lancet report suggests taking a middle path, which includes restrictions at the local level and phase-wise closures, if absolutely required, besides maintaining containment zones.
6. Emphasise on Genome Sequencing: The percentage of genome sequencing in India has always been poor. The Lancet task force suggests more genome sequencing of the virus to know how prevalent are the mutants during a particular wave, like the current one.
7. Strict travel restrictions: People arriving from foreign countries should be mandatorily told to undergo seven-day institutional quarantine with a compulsory RT-PCR test on Day 8. Even if the test turns out to be negative, they be made to isolate themselves at home for a week.
8. No public gatherings: The Lancet report suggests a ban on gatherings of more than 10 people, at least for the next two months.