According to a recent report, about 15,000 potential pandemics may emerge in the next 50 years amid climate change. This was highlighted in The Mint, April 30, 2022, issue. This is the likely result of mammals transmitting viruses to other mammals. Such events of viruses (or other pathogens) jumping the species barrier are known as spillover events or simply spillovers. And diseases resulting from such spillovers are known as zoonotic diseases. Increased virus spillovers will trigger more viral outbreaks like COVID-19.
The causes for spillover are quite complex. But one major triggering factor is climate change. The worsening climate change and global warming will cause shifts in wildlife habitats leading to close encounters between species capable of exchanging pathogens.
Studies of relationship between global warming and zoonotic diseases have been published in a recent issue of the leading journal Nature.
How can climate change affect the probability of zoonotic diseases? Some likely reasons include:
As temperature rises, many animal species will move to cooler regions where they will meet several other new species leading to new spillover events.
Increased virus spillovers will trigger more viral outbreaks like COVID-19.
Hotpots of viral spillovers will be regions that are rich in biodiversity which are also densely populated (parts of Africa and Asia).
This process has probably begun and will continue unless we concertedly take initiatives to mitigate carbon emissions.
Bats are considered to be major reservoirs of viruses and will continue to be main agents of viral transmission irrespective of climate change.
If we have to ensure the survival of humankind, we must act in concert to drastically cut down carbon emissions, stop deforestation, carry out urgent afforestation projects and conserve other carbon sinks.
Colin Carlson, the study's co-author said, "Climate change is creating innumerable hotspots of future zoonotic risk-or present day zoonotic risk."
New Covid Sub-Variants
The Omicron sub-variant BA.2.12, often known simply as BA.12, has now been detected in Patna (One India, April 28, 2022). It was first detected in the United States. And a few cases have previously been reported from Delhi.
BA.12 is considered 10 times more deadly than the original Omicron variant. However, more studies are needed to establish this definitively. According to some reports, the current surge in Delhi and parts of India is triggered by this sub-lineage of SARS-CoV-2.
Covid Surge and Possible New COVID Waves
On April 30, 2022, India reported 3,688 fresh COVID-19 cases and 50 deaths in a span of 24 hours.
China is currently facing a scary wave of Covid infections; with the country logging 20,000 cases on Friday (TOI, April 29, 2022).
Meanwhile, South Africa faces an imminent threat of a fifth wave that could begin in May or June (HT, April 29, 2022). The rise in infections seems to be driven by BA.4 and BA.5 Omicron sub-variants. There is another fear that the new sub-lineages are likely to evade vaccines as well as natural immunity.
The R number for India has increased to more than 1 for the first time since January (TOI, April 20, 2022). It was 1.07 during April 12-18, and the R value was just 0.93 during April 5-11, according to Sitabhra Sinha, a scientist in the Institute of Mathematical Sciences (IMS), Chennai.
To avoid or mitigate the possible fourth wave, we have two powerful tools: masking and vaccination.
Meanwhile, the World Health Organisation has warned that the next variant of cOVID-19 could be a serious cause of concern. WHO's Maria Van Kerkhove said that the global body is tracking sub-lineages and sister lineages of Omicron such as BA.4, BA.5, and BA.2.12.1 etc. (The Mint, April 27, 2022).
The agency has also warned that the declining case numbers globally could partly be due to the drop in the number of COVID tests.
The WHO chief said that "This virus won't go away just because countries stop looking for it", and he said that "it is still spreading, it is still changing, and it is still killing."
WHO had earlier warned that several deadly mutants may soon emerge (Daily Mail, April 15, 2022). The global health body also hinted about another COVID wave (The Mint, April 14, 2022). It says that with winter approaching in the Southern Hemisphere, the chances of another wave remains very high.
With the virus still circulating in significant numbers in parts of the world, the risk of more virulent strains emerging remains high.
WHO asserts that, as winter draws near in the southern hemisphere, the risk of another wave of coronavirus infections is rather high. The virus spreads more easily in cooler temperatures. And, this risk is aggravated by people congregating indoors in large numbers as the temperature goes down.
WHO has recently strongly recommended Paxlovid for high-risk populations in countries across the world. This Pfizer pill has been shown to prevent more hospitalizations than competing drugs. The drug is a combination of medicines: nirmatrelvir and ritonavir; and is meant for administration to unvaccinated, elderly or immunocompromised patients.
The global health agency says that Paxlovid pill may prevent more hospitalizations than its alternatives, has fewer side effects than Molnupiravir and is easier to administer compared to the IV route for drugs like remdesivir and antibody cocktails.
The drug is not effective for people who have reached the severe stage of the disease.
The WHO panel observed that antiviral drugs such as Paxlovid must be administered as early as possible in the course of COVID.
A worrisome report says that Long Covid is more severe in women than in men. Breathlessness was the most common symptom in COVID long-haulers, followed by fatigue. It was found that post-Covid complications induce more symptoms in women than in men. This study has been published in the Journal of Women's Health.
Women were more likely to experience long COVID symptoms such as difficulty in swallowing, fatigue, chest pain, and palpitations as compared to men. They were also more likely to report dyspnea, weakness, thoracic pain, and sleep disturbance, according to the study.
It has also been observed that severe diseases resulting from long COVID can be significantly reduced through COVID vaccination.
Scenarios of COVID pandemic ending
There may be three scenarios for a possible COVID ending: medical, political, and social (Business Standard, Mar. 10, 2022). Nobody knows for sure how COVID-19 will end. But past epidemics can provide some clues. According to Dr Erica Charters, University of Oxford, there could be different types of endings that may not all occur at the same time.
A medical end may happen when the disease retreats. A political end will take place when the government stops preventive protocols. A social end will occur when the people (society) move on despite the pandemic. There is ample reason to believe that the end is near in the US-65% Americans are fully vaccinated, and about 29% are both vaccinated as well as administered booster doses.
We may look at the trajectories of some past pandemics. The 1918 Spanish flu killed about 500 million people globally and came in three waves. Another flu pandemic of 1957 killed about 116,000 Americans and another pandemic in 1968 killed 100,000 more. Another flu pandemic in 2009 didn't turn out to be as serious as it was anticipated; it fizzled out quite soon and quite unexpectedly.
WHO declared COVID-19 as a pandemic on March 11, 2020 and it has raged across the glove for 2 years now. The global health agency will monitor the global decline in cases, hospitalizations and deaths before deciding if the international health emergency is over. Covid cases are waning in US and dropped globally by 5% in the past week. However, cases are seen rising in some other places such as the UK, Hong Kong, and New Zealand.
Poor people in many countries still are in dire need for vaccines and medications. In Latin America and the Caribbean alone, over 248 million people have not had their first vaccine dose. Countries will low vaccination rates will still see surges in illnesses, hospitalizations and deaths. Dr Ciro Ugarte, Director of health emergencies, PAHO says that we're still not out of the pandemic and we still need to tackle this raging pandemic with a great lot of caution!
Possible Measures for Manipur
The state need to assume that there may be a fourth wave in Manipur too. Even if that may turn out to be a wrong anticipation, it's better to err on the side of caution. Accordingly, we must initiate measures to squarely face a possible 4th wave in the state. These may include:
Stockpiling of Paxlovid drugs in hospitals and pharmacies in Manipur for use in unvaccinated, elderly, and immunocompromised at-risk people in Manipur, as and when required.
Vigilant monitoring of arrival of XE and other sub-variants in Manipur, testing and tracking it meticulously, and administering booster shots to all eligible people aged 18 and above.
Death audits, genomic tracking combined with tweaking of treatment protocol (as deaths due to COVID remain high in Manipur, logging an average of 1 or more daily deaths, for the past few weeks of Jan-Feb 2022); we need to ascertain if deaths are due to Delta, Omicron or both; or, is there a need to fine-tune the COVID treatment procedures; regular genomic surveillance, death audits, and tweaking of hospital admission, treatment and monitoring procedures will be helpful in mitigating deaths.
Preparations for administering vaccines to kids in Manipur & booster shots to high-risk people (elderly, healthcare workers and people with weak immune systems).
Conducting immediate seroprevalence studies to understand what percent of population in Manipur and in its different districts are still susceptible to the coronavirus.
Speeding up vaccinations in a big way; aggressive vaccinations with monthly targets to cover all eligible populations with first doses in the next few weeks (4-6 weeks); and targeted vaccinations of all adult population with second doses in the next 2-3 months.
Regular & repeated COVID testing in hotspots.
Enhancing the ratio of RT-PCT to Rapid Antigen Testing (RAT).
Weekly "awareness messaging" about the pandemic to the public by a designated healthcare official.
Genomic sequencing of a subset of positive cases and surveillance of the variants including the delta and omicron variants: which COVID strains are there in Manipur, where are they, and where are they moving towards; and whether any new variants are emerging.
Contact tracing and government-monitored isolation of positive cases, wherever feasible.
Boosting up healthcare provisions such as medical oxygen plants, tankers and cylinders; steroids, antifungal drugs, oxygen concentrators, ventilators, oximeters, masks, PPEs, sanitizers etc.
Strengthening of healthcare infrastructure such as construction of new COVID hospitals.
Provision of more COVID care centres (CCCs), more Covid beds and ICUs in existing hospitals
Constitution of a special taskforce for the third wave; a separate taskforce for pediatric COVID is also highly recommended.
Special provisions for kids such as pediatric hospitals, wards, and ICUs, pediatric oximeters, concentrators, and ventilators and strengthening of staff such as pediatricians and pediatric nurses and paramedical workers etc.
Conducting, at least, part of the election campaign in the online mode, limiting crowds in public spaces, and minimizing crowds in offline cultural, political, and political events; as far as feasible.
We all owe it to the common people of Manipur to religiously adhere to the standard SOPS to help prevent/mitigate a possible new COVID wave in Manipur; and, help save our people from possible hospitalizations and deaths.