Why we must continue to remain vigilant against COVID-19?
It's advisable to continue wearing masks and to test all hospital-admitted patients, irrespective of whether they show typical symptoms of COVID or not.
ByDebananda S Ningthoujam
Updated 6 May 2022, 10:29 am
A few sub-variants have been detected in parts of India especially Bangalore and Delhi. Two new mutants-BA.2.10 and BA.2.12 have been found in Bangalore. However, as the data is too scanty so far, it's too early to say if these variants will be more transmissible or not. However, as more variants can emerge from clusters with low vaccination rates or immunocompromised individuals, we must remain very vigilant. It's now mandatory to conduct more testing, tracking, genomic surveillance and to enhance the vaccination rates on a war footing.
It's advisable to test all hospital-admitted patients, irrespective of whether they show typical symptoms of COVID or not.
Meanwhile, a new sub-variant, BA.2.12.1, also a sub-lineage of the Omicron variant, has been detected in Delhi. Dr Angelique Coetzee, a South African expert says that BA2.10 sublineage has also been found in South Africa. She opines that this sublineage possibly has the same clinical features as Omicron and so there's nothing to worry about.
In addition, there are the hybrid variants including XE, recombinant of BA.1 and BA.2; and XD and XF, which are recombinants of Delta and BA.1.
1,125 XE cases have been reported in the UK and this variant has also been found in India, Japan, Canada, Israel, and Thailand.
Covid Surge & Possible fourth Wave
On April 23, 2022, India logged 2,527 new COVID cases and the country's positivity rate now stands at 0.56 per cent. 33 deaths were also reported in the last 24 hours.
Due to the surge in cases, Delhi has again made wearing of masks mandatory.
The centre has advised some states, including UP, Maharashtra, Haryana, Delhi and Mizoram to track the spread of infections and take urgent measures to contain any likely surge.
Dr Gagandeep Kang, top virologist, said that we must prepare for the possibility of reinfections, in spite of vaccination and prior infection. She also warned against dropping our guards amid the changing scenario. Though there is no surety yet about a fourth wave, we must, nonetheless, be prepared for it.
The R number for India has increased to more than one 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 Institute of Mathematical Sciences (IMS), Chennai.
To avoid or mitigate the possible fourth wave, we have two powerful tools: masking and vaccination.
WHO has recently strongly recommended Paxlovid for high-risk populations. 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 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.
WHO has recently 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 assets 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.
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 with men. They were also more likely to report dyspnea, weakness, thoracic pain, and sleep disturbance.
It has also been observed that severe diseases resulting from long COVUD can be significantly reduced through vaccination.
Scenarios of COVID 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 per cent 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 two years now. The global health agency will monitor the global decline in cases, hospitalisations and deaths before deciding if the international health emergency is over. Covid cases are waning in US and dropped globally by five per cent 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!
Manipur must continue with measures to prevent resurgence of COVID and to squarely face a possible new wave. 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.
Othere possible measures are: 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. The is a need to conduct death audits, genomic tracking combined with tweaking of treatment protocol (as deaths due to COVID remain high in Manipur, logging an average of one 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.
There is also a need to conduct immediate seroprevalence studies to understand what percent of population in Manipur and in its different districts are still susceptible to the coronavirus.
The state must also continue to go aggressive on vaccinations with monthly targets to cover all eligible populations with first doses in the next few weeks (four-six weeks); and targeted vaccinations of all adult population with second doses in the next two-three months.
The state also must contunue regular and repeated COVID testing, contact tracing, isolation of positive cases, enhancing the ratio of RT-PCT to Rapid Antigen Testing (RAT) and ensure weekly "awareness messaging" about the pandemic to the public by a designated healthcare official.
It is also important to conduct genomic sequencing of a subset of positive cases and surveillance of the variants including the delta and omicron variants. The state should ensure healthcare provisions such as medical oxygen plants, tankers and cylinders; steroids, antifungal drugs, oxygen concentrators, ventilators, oximeters, masks, PPEs, sanitizers etc.
The state must prepare a special taskforce to face any possible new wave, and a separate taskforce for pediatric COVID. The state must have 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.
The state must continue limiting crowds in public spaces, and minimizing crowds in offline cultural, political, and political events; as far as feasible, and all must religiously adhere to the standard SOPS to help prevent/mitigate a possible new wave in Manipur.
(The views expressed are personal)
First published:23 Apr 2022, 7:00 pm
face masksvaccinationcovid-19 drugsxe variantcovid-19 fourth waveCOVID-19 variantsOmicron variant
Debananda S Ningthoujam
The author teaches and studies microbial biochemistry and biotechnology at Manipur University
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