THE new sunday express Voices Sheila Kumar S Vaidhyasubramaniam Anuja Chandramouli Shinie Antony Madhulika Liddle Mata Amritanandamayi MAGAZINE Buffet People Wellness Books Food Art & Culture Entertainment may 16 2021 SUNDAY PAGES 12 Shekhar yadav The Coming Wave A Covid-19 victim's body at Nigam Bodh Ghat crematorium in Delhi ...and how to brace for it The government warns of a third coronavirus wave. India is not ready. By Ravi Shankar L ong Bets is a philanthropic website built with funds from Amazon billionaire Jeff Bezos. Anyone can post a prediction and a challenge—the winner donates the money to charity. Lord Rees, the prominent British astronomer, placed a bet in 2017 that “bioterror or bioerror will lead to one million casualties in a single event within a six-month period starting no later than December 31, 2020.” His friend and Harvard psychologist Steven Pinker took up the wager and lost. All bets are off as the pandemic cuts widening fatal swathe in India because of no trials and many errors. In a podcast, Niall Ferguson, the author of The Ascent of Money: A Financial History of the World, scoffed at projections by investment banks and governments of a V-shaped recovery sometime in 2021: “If you believe that, I’ll sell you a bridge... because there’s no way this is going to be a V-shaped recovery The pandemic in .” India shows a bridge that will not be crossed anytime soon, thanks to government confusion, ignorance, lack of expertise, unscrupulous data fudging, slow vaccination drives and misplaced Vaccine Maitri. Experts warn of an imminent third Covid-19 wave even without before the nation has a chance to recover. Delhi Chief Minister Arvind Kejriwal has declared that national capital is in the grip of a fourth wave. Experts in the US are debating the existence of a fourth wave. The Washington Post saw a rise in cases that equalled the crest of 2020. Every day India is , breaking the previous day’s records. “We kept warning that the pandemic was not over but no one was listening,” Rakesh Mishra, senior principal scientist and director of the Hyderabad-based Centre for Cellular and Molecular Biology told National Geographic last month. What is a wave during a pandemic? It is the curve of any outbreak that reflects the rise and fall of the number of cases over a defined period. For example, the common cold crests in winter and drops in warm weather. A wave ends only when the virus has been contained and cases have fallen exponentially A sustained rise . in infections indicates a second wave, which is what has happened in India and is spreading to other countries. Research in the US and elsewhere shows that the common cold virus is usually active between December and March. Annual epidemics like influenza are accelerated by social factors like schools opening. Two Oxford University scholars who studied respiratory disease epidemics in the past 150 years found that the peaks of the waves differ. For example, the 1889-92 influenza epidemic had three waves with different degrees of virulence. Like with the second Covid wave in India, the second stage of the 19th century outbreak was worse for young adults. This was the case during the influenza pandemic in 1918 and 2009, the former being compared to the current contagion. Epidemics have maximum impact on a country’s future; reports suggest that the third wave puts children at the risk of a higher rate of infection. “Right now, we know that post the current wave the most vulnerable group would be the children. The adults are all being vaccinated on priority We . do not have the authorisation to vaccinate those under 18 years. This could pose a problem later,” says Upasana Kamineni, founder of URLife, a wellness platform, and Vice Chairman CSR, Apollo Hospital. Experts like Ferguson are predicting many more waves, though their magnitude is not certain. Dr Sanjay Rai, Principal Investigator of Vaccine Safety and Efficacy Trial at AIIMS, Delhi, is also a professor at its Centre for Community Medicine and part of the development team of Covaxin. Rai told The Leaflet, a news website—which has on its advisory board economist Kaushik Basu and Kalpana Kannabiran, Director, Council for Social Development, Hyderabad—that it is difficult to predict the number of Covid-19 waves in India with the available scientific evidence. Like Ferguson, Rai is of the opinion that the human race will have to live with the virus for a long time to come. “The Spanish Flu hit the world in three waves; it affected 2/3rd of the world’s population before it disappeared. But does this mean coronavirus will disappear after the third wave? No, there is no guarantee. We may see a few more and distinct waves in the coming years. After that, the virus will run out of evolutionary options and settle down as a more benign, A patient waits for his admission outside Delhi's Lok Nayak Hospital endemic pathogen,”explains Gauri Chaudhari, healthcare industry expert and author of The Perfect Pill. Why do these waves occur? The well-known reason for multiple waves is the mutation in the genetic code of the coronavirus. A slow vaccination pace gives it more time to mutate and find ways to evade or trick antibodies. This “accelerates the appearance of new variants as the continued spread of the virus allows it to get ‘trained’ to detect and bypass antibodies, since the immune system merely looks out for the original strain,” Brazilian virologist Renato Santana told the media. Fitch Ratings has warned that this delay would cause more epidemic waves in the future; the only silver lining is its prediction that the economic damage of Wave Two will not be as severe as in the first. Vaccinations in India dipped even as two-thirds of all districts reported a 20 percent climb in infection. “Scientists and public health experts believe that herd immunity is impossible because the virus is changing too quickly New . variants are spreading fast. We have to do mass vaccination as early as possible,” says Dr Varsha Phadke, Dean, KJ Somaiya Hospital and Research Centre, Mumbai. The Brazil variant is today considered its most dangerous form, which researchers confirm is a combination of 18 different mutations that includes Brazilian, British and South African variants. Deadlier and more infectious than the original coronavirus, this new scourge is a genetic combo of around two-dozen previously known mutations. “It is as if these variants were evolving,” Santana reportedly said. Three triple mutant viruses were found circulating in India last month. Of these, two were found in Maharashtra, Delhi, West Bengal and Chhattisgarh. Genome scientist Vinod Scaria in New Delhi had tweeted that one of the new mutants has specific genetic and immune escape variants and first appeared in West Bengal in October. But the government, flush with success over the first wave, did not act. What makes variants lethal? Variants can override vaccines and unleash severe diseases, according to the US Centers for Disease Control and Prevention. They are fast movers. The D614G mutant can spread more rapidly than the original coronavirus by infecting human respiratory epithelial cells. Death is common after infection. Moreover, the mutant can resist monoclonal antibodies effectively “For various mutant . strains, a booster shot of the vaccines will be required to protect against variants, yet the protocols are not yet in place,” says Phadke. According to the Institute for Health Metrics and Evaluation (IHME), an independent global health research centre at the University of Washington, daily deaths in India will peak at 5,600 in mid-May It has projected 665,000 . Covid deaths by August 1, 2021. “Without drastic measures to decrease social mixing and increase effective face mask use, the situation currently looks quite grim in India,” the briefing said. The institute estimates that universal mask coverage could prevent 70,000 deaths and that if the vaccination target for every Indian above 18 is met on schedule, another 85,600 lives would be Turn to page 2 Shekhar yadav
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