Dynamics of Second Wave of COVID-19

The coronavirus (SARS-COV-2) is now a global concern because of its higher transmission capacity and associated adverse consequences including death.

Number of Cases

In 1^st wave (March, 2020), cases were less than 5,000. Only in September its peak at around one lakh. But in the 2^nd wave, by April only, there are close to 2 lakh cases a day and the current doubling time is 10 days. Therefore, India will reach ~3.1 million detected cases, spelling the peak of the second wave.

Inter-Regional and Intra-Regional Disparities in Health System:

There are inter-regional and intra-regional disparities in health system access and delivery. In Maharashtra, the distribution of hospitals and healthcare workers in Mumbai is different compared to other districts. That’s why those districts face a greater strain on their health system compared to Mumbai. In Uttar Pradesh and Bihar, there is a very poor distribution of health system capacity both in terms of infrastructure and human resources.

Reinfection Rate

According to a recent Indian Council of Medical Research report, the reinfection rate in India is 4.5% .

Reproduction Number

The reproductive number of coronavirus provides an estimate of the possible extent of the transmission. The R value of the initial ‘variant’ of the virus of the first wave was 2-3, meaning, one infected person would infect 2-3 others.
The variant(s) causing the second wave has a higher R value — it may have doubled, ≥ 4.

Herd Immunity Level

The herd immunity level required to bring the numbers down to the end of the second wave (herd immunity threshold) would be about 75%-80%, in contrast to 60% for the first.
This studies cite that the reproduction number almost nearing three (2.87), the States of UP and Bihar will probably have the highest number of cases. Even if 5% of these people reassumed to need hospitalisation, they have no beds- in the state, or even in the nearby States.

Vaccine Hesitancy

WHO defines Vaccine hesitancy as a delay in acceptance or refusal of vaccines despite the availability of vaccination services. Vaccine hesitancy has been reported in more than 90% of countries in the world.
The percentage of population willing to take the Covid-19 shot has gone up from 38% to 77% in 75 days, post the start of the vaccination drive in India. The decline accelerated further after the country started witnessing a surge of Covid cases and success of vaccine with only mild side effects.

Gaps in administration of Vaccine rollout

There are a complicated list of problems including lack of micro planning, lack of mobilisation, lack of better communication, and lack of a vaccination policy on how to go about vaccination in different phases. Most importantly, in every vaccination campaign, we have had a separate plan for social mobilisation of the minorities. We don’t have that yet for COVID-19. So, it’s incomplete preparation.
Early this February, the fear of the pandemic waned and people lowered their guard, allowing the virus to spread unchecked Example being the election rallies and allowing mass religious congregations. The second wave could have been smaller or even averted, had we stayed vigilant and achieved wide vaccination coverage then.
Vaccine hesitancy, policy hesitancy and fast-spreading virus mutants all added to the tempo of the second wave.
A larger number of symptomatic infections in youngsters in the second wave may be attributable to their higher mobility and premature opening up of schools and colleges in the face of highly infectious variants.

Public vs Private Health Sectors

For nearly four or five decades now, Public Health Sector has been the main player in vaccination programmes. Private health system, though is active in Covid-19 Vaccination now, it cannot outsmart the public health system. The private health system has a definite and clearly identified population that it caters to, but even that is changing both in terms of COVID-19 care and vaccination.
There are government health facilities reports citing even rich people using the Covid services. The kind of cold chain system in the government system is far superior.

Uneven Growth

The International Monetary Fund projected India’s GDP to grow at 12.5% this year. However, the growth during these times can hardly be described as inclusive. Many sectors, including the technological, pharmaceutical and healthcare sectors, saw record growth. The wealth of India billionaires increased by 35% even during COVID-19 times.
However, sectors including travel and tourism and wellness and hospitality, that form the bedrock of economies, receded to historic lows. The pandemic decimated the informal and MSME sector and pushed 75 million Indians into poverty.

Strategy Ahead

Golden rules of Universal Mask Use, Cough Etiquette, Maintaining Physical Distance, Hand-Hygiene and avoiding crowds and pursue an aggressive vaccination drive to contain the situation without imposing a lockdown, which will hurt the recovering economy and lead to untold public misery.
Vaccination can be made a pre-requisite for those who come in contact with large numbers of vulnerable people (for example, teachers). Vaccination at offices (started in Tamil Nadu) and persuading staff in the Indian Railways to get vaccinated quickly are innovative steps in the right direction.
Vaccination is a pre-requisite for any public assembly, fewer people will gather and more people will seek vaccination. Mobile vaccination vans can cover inaccessible rural pockets and reach people unable to reach vaccination centres.
The government’s decision to give emergency use authorisation to all World Health Organization-approved COVID-19 vaccines is likely to narrow the demand-supply gap. The mRNA vaccines, which appear to offer greater protection against new variants and other vaccines in the pipeline to cover variants of concern need to be mass produced, tested and commissioned quickly to benefit everyone.