MAGAZINE Voices Devapriya Roy Sheila Kumar Gautam Chintamani Shinie Antony Madhulika Liddle Mata Amritanandamayi Buffet People Wellness Books Food Art & Culture Entertainment NEW DELHI April 18 2021 SUNDAY PAGES 12 Making Waves India is headed towards the fourth wave of the coronavirus, which could cause irreparable damage to its population and economy. It can only be stopped by public awareness, sacrifice and cooperation. By Anu Jain Rohatgi T he frightening truth is that we do not know. We do not know why after over 13 crore recorded Covid-19 infections, 30 lakh deaths, nearly 700 million vaccine doses given worldwide, including in India, the waves of death and destruction keep coming, crashing on the rocks of fear and speculation, threatening to drown humanity in its worst nightmare. We do not know why vaccinated people are getting infected or re-infected. We do not know how long antibodies last in our body . We do not know which mutation is next and which can bust the vaccine, like the South African variant, B.1.351, which has eluded the Pfizer shot. We do not know about the scope, duration and efficacy of vaccines available in the world. We do not know which vaccine is the best either. Trapped in the middle of such apprehensions, India has plunged into a second wave, which is projected to get worse in the coming weeks. Experts say that Delhi, Mumbai, Pune along with many towns and cities in Maharashtra, Chhattisgarh, Kerala and Madhya Pradesh are in 3rd and 4th stages. Stage One is the first stage of individual infections without a local spread, moving to Stage Two that begins with local transmission, followed by Stage Three when health professionals cannot trace the source of the infection on to Stage Four where the pandemic becomes uncontrollable with major clusters blooming all across the country Currently China is the . only country to have reached that stage. Europe is in its third stage. Simultaneously we are , facing a big challenge of continuous mutations of the Covid-19 virus. “Repeated mutation of the coronavirus is a matter of concern since it isn’t easy to predict for how long the pandemic will last or even slow down,” worries Dr Om Shrivastav, infectious disease specialist and consultant at Sir HN Reliance Foundation Hospital and Research Centre, Mumbai. THE UNRELENTING WAVE What we do know is that India has the world’s highest number of Covid-19 cases after Brazil. The tally was 1.39 crore cases, with a record spike of 1,84,372 cases by last Wednesday , according to the Union Health Ministry—the lowest number of active cases was 1,35,926 on February 12 or 1.25 percent of the total caseload in India. We also know that complacency and carelessness have pushed SHOTS OF PROMISE mRNA-1273 us into the Stage Two spiral, with mass gatherings like elections and the Kumbh Mela certain to become super spreaders, which would ravage India’s villages and small towns that have seen relatively low levels of contagion. Currently on an average, there are more than 1.5 lakh cases arising daily . AIIMS Director Dr Randeep Guleria has warned that India is fast approaching Stage Three. Should this trend continue, we are ultimately heading towards Stage Four, which the country is ill prepared for. Estimating a daily number of 100,000 cases, India would need 5,000-10,000 beds every day for critical care. A PricewaterhouseCoopers survey found that India has only 1.3 hospital beds per 1,000 patients while the WHO mandate is 3.5 beds per 1,000 people. A conservative estimate of researchers at CDDEP India and Princeton University puts the current number of critical medical facilities at 1.9 million Moderna/National Institutes of Health Efficacy: Approx. 92 percent (WHO). Protection kicks in 14 days after the first dose. The new variants of SARS-CoV-2 do not alter the effectiveness. BNT162b2 Pfizer/BioNTech/Fosun Pharma Efficacy: 94.8 percent (The New England Journal of Medicine) The protection circle begins 14 days from the first dose. It has a high efficacy—92.1 percent—right from the first dose hospital beds, 95,000 ICU beds, and 48,000 ventilators. Most of these are in Uttar Pradesh (14.8 percent), Karnataka (13.8 percent), Maharashtra (12.2 percent), Tamil Nadu (8.1 percent), West Bengal (5.9 percent), Telangana (5.2 percent) and Kerala (5.2 percent). However, India’s vaccination drive is in full swing. Its staggering population is the biggest detriment to a successful vaccine drive, even as efforts picked up following Prime Minister Modi’s call for ‘Tikka Utsav’—so far only 7 percent of the population has got at least one dose. The Washington Post reports that over three million Indians are being vaccinated daily A senior . health official stated that the Serum Institute that produces the Oxford-AstraZeneca Covishield vaccine manufactures about 60 million doses a month and Bharat Biotech 10 million doses of Covaxin. Scientists of IIT-Kanpur predict that the second wave will peak around April 15 to 20 and start receding within two weeks. They are hopeful of a sharp reduction in cases by May-end. The required social distance used to be three to four feet but the new norm suggests five to six feet. Unless people take it upon themselves to overcome Covid fatigue and stop relaxation of pandemic protocols like wearing masks and social distancing, and effectively implement containment measures at the field level, the Convidecia CanSinoBIO Efficacy: 90.07 percent (BioSpectrum Asia magazine). It prevents the disease 28 days after single-dose vaccination. It can be accessible by under-developed regions. wave is certain to reach tsunami levels. There is good and bad news. The bad news is that the Health Ministry figures indicate that the current caseload is spiking at more than last year’s rate when coronavirus cases were at their peak. The good news is that the mortality ratio shows a downward trend. But viruses are unpredictable. Experts, however, advise caution, warning unanimously that future casualty rates might go up due to unexpected viral behaviour and human response. Ageing, obesity chronic renal , failure, smoking and some genetic traits are responsible for a patient’s low immunity . Hence, sometimes the vaccine does not respond to its full extent. Two to 10 percent of vaccinated people fail to generate adequate antibodies, leading to inadequate immunity . Hepatitis B vaccine failure is noted as high as 10 percent, among the highest failure rates. A SERIOUS MISUNDERSTANDING After proving to be a world success story in Covid containment, how did the virus and its variants rise again as India’s fatal scourge? Associated Press reported that scientists have discovered a new Indian variant, which has two mutations in its spiky protein that it uses to stick to host cells. These variations can reportedly encourage faster and easier virus spread, and bypass the Sputnik V Gamaleya Research Institute Efficacy: 91.6 percent (BMJ). Full dosage requires 21 days. Janssen Johnson & Johnson Efficacy: 85.4 percent (WHO). It comes into effect 28 days after inoculation. The vaccine works against new variants of SARS-CoV-2 virus. immune system. Take the case of Aarti (name changed), a 40 year-old banker in Delhi who contracted the coronavirus in October last year. She was admitted in Delhi’s Moolchand Hospital for 15 days. But after recovering, she was careless, was not particular about social distancing, went mask-less and partied as before—all in the mistaken belief that she had developed sufficient antibodies against the coronavirus. Soon she developed mild fever, diarrhoea and had sneezing bouts. She took a test immediately and found to her dismay that she was Covid positive again. Her physician Dr Srikant Sharma, Consultant, Internal Medicine, at Moolchand Hospital diagnosed that the possibility of Aarti having been infected by a new strain of virus is high, although the symptoms she developed were mild. She has also infected seven of her family members and three friends. “If one member of a family is diagnosed Covid positive, the chances of every family member getting infected within a short period of time is high, since the new strains are spreading fast. Of 100 patients, almost 60 to 70 percent show a new set of symptoms,” adds Dr Sharma. Experts put the ratio between patients infected with old strains and freshly infected patients at around 40 to 60. Points out Dr A Sreenivas Kumar, senior cardiologist, Apollo Health City Jubilee Hills, Covishield AstraZeneca/ University of Oxford Efficacy: 63.09 percent (WHO). The longer the dose interval—8 to 12 weeks range—the greater the efficacy of the vaccine. Hyderabad, “Till now the mortality rate has been comparatively low, thanks to timely diagnosis and immediate treatment. But patients taking their infection lightly are landing up in hospital with serious complications.” At the start of the second wave, the new strains were showing milder symptoms. It is also being observed over a period of time that not only are they more contagious than during the previous stage, they are proving more dangerous too. “ After invading the chest and the lungs, the virus spreads very quickly says Dr Sharma. ,” The double-mutated virus is showing serious and unusual symptoms among non-vaccinated patients. “More and more people are being put on oxygen support and quite many of them urgently need ICU facilities,” says Dr Ashesh Bhumkar, ENT Specialist at Bhumkar Hospital, Mumbai. Doctors do not deny the theory that every mutation makes the virus weaker and milder. But it has become more cunning, too. “Viruses act very intelligently , change their behaviour to survive longer by staying undetected. HIV and Hepatitis are examples where the viruses do not kill people within a short period of time; instead they stay in the body for years and years, damaging it slowly and gradually We are noticing . the same pattern in the NVX-CoV2373 Novavax Efficacy: 96.3 percent (Claims the parent company). Additional efficacy: 86.3 percent, against the B.1.1.7 variant first discovered in the UK. Turn to page 2 COVAXIN Bharat Biotech/ICMR/Indian National Institute of Virology Efficacy: 81 percent (Claims the company's official statement). It has a 28-day open vial policy as a unique product characteristic, thus reducing vaccine wastage.
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