IIT Kanpur (IITK) scientists have predicted that a fourth COVID wave may emerge in India around June 22 and linger till October 24 (TOI, Feb. 27, 2022). According to them, the severity of this wave will depend on emergence of new variants and the vaccination status of individuals. These predictions have been published on a preprint server (MedRxiv, Feb. 24, 2022). The new wave, if it comes indeed, will peak during August 15-31 and decline thereafter. India must take this fourth Covid prediction by IIT Kanpur (IITK) scientists seriously, as their prediction about the third wave was nearly accurate.
However, other experts have cast doubts on this prediction (Business Standard, Mar. 5, 2022). The report says that most people in India have had two vaccine doses and one natural infection. It, therefore, asserts that the impacts in terms of hospitalizations and deaths would be minimal unless a new variant emerges. Prof Sitabhra Sinha, Institute of Mathematical Sciences (IMSc), Chennai, opined that active cases are declining very fast and it's too simplistic to predict a fourth wave at this stage, given the large number of uncertainties involved.
COVID and the Heart
According to a report in the leading journal 'Nature' (Feb. 10, 2022), the risk of heart disease increased tremendously after COVID, even with a mild disease. It says that the risk of 20 diseases of the heart and blood vessels remains high for at least a year after a COVID-19 infection. Even a mild case can increase an individual's risk of cardiovascular complications. The rates of heart failure and stroke was much higher in people who recovered from COVID-19 than those who hadn't contracted the disease. The risk was elevated even in people who were under 65 years of age and who lacked other precipitating factors such as obesity or diabetes.
"It doesn't matter if you are young or old...", says Dr Ziyad Al-Ali of Washington University, St Louis, US.
Need for fourth dose of Covid vaccine
Emergence of Omicron necessitated the administration of booster shots to combat waning immunity and provide stronger protection against severe disease and death. A third dose if essential for protection against severe disease or hospitalization (Medical News Today, Mar. 2, 2022). However, a fourth dose (2nd booster) may not be needed for everyone but experts recommend it for people most at risk for severe disease, hospitalization, and possible death. Though there is no consensus about the timing of booster shots, the minimum recommended interval is about 3-4 months.
Following Israel, some countries including Chile, Denmark, Spain, and Sweden are offering fourth doses to high-risk groups.
Super-Vaccines
The race is on to develop a super-jab to prevent future pandemics by giving just a single shot (Money Control, Feb. 8, 2022).
New COVID Drugs
Eli Lilly's arthritis drug, baricitinib, has been shown to reduce the risk of COVID deaths in a large trial done in UK (CTV News, Mar. 3, 2022). It was found to reduce the risk of deaths in hospitalized people by about 13 per cent, regardless of which other treatments they were given. The study was led by scientists based at the University of Oxford, UK.
COVID and Blood Groups
A new UK study has linked COVID with blood proteins (The Print, Mar. 4, 2022). It analyzed over 3,000 proteins to identify which of them are linked to severity of COVID infections. The study was led by the National Institute of Health Research (NIHR) and was published in the leading journal "PLOS Genetics." It identified six proteins associated with an increased risk of severe COVID and eight that could help protect against severe disease.
One significant finding was that blood group A was higher in COVID-19 positive individuals; and this calls for detailed follow-on studies.
Will COVID end anytime soon?
"The thing about the pandemics is that they don't have an official endpoint", says William Hanage, Harvard University (El Pais, Feb. 9, 2022). The only way to reach a clean end to the pandemic is when you completely eradicate the virus. According to the leading scientist, the best-case scenario is that the immunity elicited by Omicron and the rate of vaccination administered so far means that we may no longer see serious waves of infection. The worst-case scenario is that a new variant arises and it is capable of causing either severe infections or capable of triggering a severe strain in the healthcare system due to the massive number of people it infects. This healthcare load may not just be due to the number of people that the variant infects but also due to the doctors and nurses it infects, compromising the healthcare capacity needed for hospitalized patients.
Omicron most probably may not be the last variant of SARS-CoV-2 that we will see. This view has also been publicly shared by Dr Leana Wen, George Washington University, USA (Deseret News, Feb. 4, 2022). She further adds that the BA.2 subvariant of Omicron will not be the last COVID-19 variant.
Mutating, and evolving new variants is the nature (dharma/karma) of a virus. Whether a new variant is concerning depends on if it's more contagious, more virulent, or if it can escape prior immunity from infections or vaccinations. That's why increasing the level of vaccination globally is of utmost importance. The more population immunity we have, the less number of viruses will spread and mutate, and less will be the chance of new variants emerging. That's how the world can rapidly emerge from the clutches of the pandemic.
According to Paul Duprex, University of Pittsburgh, USA the pandemic may end via various scenarios (Boston Herald, Jan. 16, 2022):
1. A vaccine or treatment is developed and ends the pandemic just as polio was eradicated by the polio vaccine (the mRNA vaccine seems to be working in that manner but it could not be jabbed worldwide) (pharmaceutical ending).
2. The wildfire burns itself out: (that's how the Spanish flu of 1918 ended) all those infected either die or develop immunity (medical ending).
3. People ultimately get tired of the virus and learn to live with the disease (social ending).
Dr Anthony Fauci, Director, NIAID, USA has just released a pandemic preparedness plan for America. The crux of the plan is what is called "Prototype Pathogen Approach." The plan is to take about 20 families of potential pathogens (5 of them are of highest priority) and establish certain commonalities within each family and work out diagnostic tests, vaccine platforms, multiplex diagnostics and therapies. You need not immediately develop vaccines against all 7 families, but you make take a few initial steps such as developing a prototype vaccine, and putting it through phase 1 clinical trials. When you get an outbreak within that particular family, you don't have to start from scratch. The potential pathogen families that can trigger global outbreaks include rhinovirus, flavivirus, alpha virus, and coronavirus etc.
The other arm of the plan include development of small molecule antiviral drugs that can be used across all lines of certain viruses such as flavivirus, arenavirus or alpha virus etc.
COVID Scenario in India
According to Dr Anurag Agrawal, Director, IGIB, Delhi the Covid situation is stabilizing in metro cities such as Delhi and Mumbai (News18, Feb.1, 2022). However, it is still a problem in Tier 2 cities such as Lucknow, Kanpur, Patna, Vadodara, Surat and others. The spread across India isn't uniform; therefore, different regions must adopt different strategies to contain the pandemic. However, the elections in five states may lead to a completely changed scenario.
What Manipur should do
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). 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.
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.
We must all remain vigilant, take care of standard protocols, and must not let our guards down.
