Tuesday 11 May 2021
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Lancet projects grim ‘second wave’ scenario in India

The Lancet, however, points out that the second wave in India has been more geographically clustered so far, and suggests solutions

With India in the grip of a second Covid-19 wave, the country may see 1,750 coronavirus related deaths per day, rising to approximately 2,320 by the first week of June, a report of The Lancet Covid-19 Commission by India Task Force members said.

The Lancet report titled “Managing India’s second Covid-19 wave: Urgent steps” highlights the key points of the second wave of pandemic. The report recommends steps that should be taken now to help slow down the spread of infection.

The preliminary analysis of by The Lancet said that “while the pandemic has spread, the geographic contours of the second wave closely mirror those of the first wave, though with a deeper penetration into tier 2, tier 3 cities”.

The Lancet points out that the second wave has been more geographically clustered so far. The number of districts comprising the top 50% has dropped from over 40 at the time of the first peak to less than 20 currently.

At the time of the first surge of Covid-19 cases during August-September 2020, the number of districts contributing to 75% of Covid-19 cases was 60-100, while it has been around 20-40 districts during the second wave.

The second wave is different from the first in two important ways.

First, the rate of increase in new cases is significantly higher. The increase from 10,000 to 80,000 new cases per day from February to April has taken less than 40 days. In September, it was 83 days.

Second, more Covid-19 cases are asymptomatic or mildly symptomatic, resulting in relatively low rates of hospitalisation and mortality. It is not entirely clear if the higher proportions of asymptomatic cases are entirely due to better contact tracing (more family members, for example, being tested).

The overall Case Fatality Ratio (CFR) since the beginning of the pandemic in March 2020 has been reported to be around 1.3%. The CFR among patients who have contracted the virus since the beginning of 2021 is far less at 0.87%. Provisionally, it appears that CFR is lower in the second wave.

Yet, India is reporting 664 deaths per day across the country (seven day moving average a/o 10 April 2021).

Additionally, disruptions to regular health services, such as routine immunisation and delivery care, could have devastating consequences for maternal and child survival.

Fiscally, India may need to spend more than $ 7.8 billion on testing and $ 1.7 billion on healthcare utilisation due to Covid-19 infections leading to death by September 2021.

The report proposed following solutions to control the spread of the virus in India:

Vaccinate: Cover younger population based on supplies: As of 11 April 2021, 29.6% of those above 45 years have received one or both doses of a vaccine. The report recommended including all adults, including those below 45, with severe co-morbidities into the priority group.

More vaccines needed: Currently, India uses two vaccines- Covishield and Covaxin. As of 13 April 2021, the government has given nod for emergency approval of other vaccines that have met safety and efficacy standards and received regulatory green signal in other markets. These include Johnson and Johnson, Pfizer-BioNTech, Moderna.

Ramp up vaccine manufacturing: The Lancet says, “Today Indian manufacturers are producing approximately 70-80 million doses of vaccines per month. Even if 100% of this supply was for domestic use, at a target of 5 million doses a day, the monthly supplies would fall short by half.”

Bharat Biotech aims to increase production to 150 million doses per year, which will reduce the supply gap to some extent. But given India’s COVAX commitments, it is critical to ramp up production capacity.

Address vaccine hesitancy: Despite high rates of vaccinations, surveys show that even though acceptance is increasing, only 57% respondents said they are now ready to take the shot.

No branket lockdowns: The report does not recommend a blanket national or state lockdown. Pointing out that economic closures are most disruptive to the poorest sections of society, the report recommends a middle ground approach in India, including localised, phased restrictions or closures.

Increase genome sequencing: The report urges an expansion of genome sequencing of the coronavirus to understand if mutants or variants are responsible for the current surge, and if so, the nature and type of such variants.

Travel: The report recommends a mandatory seven-day institutional quarantine for all visitors arriving from other countries, with an RT-PCR test conducted on Day 8, and the option of completing another week in home isolation if the test is negative.

Ban on gathering of groups of more than 10: A temporary ban on gatherings of groups larger than 10 for the next two months has been recommended to control the spread of infection.

Inform if those testing for Covid were vaccinated or not: The report recommends that the Covid-19 test registration form be immediately amended to include information on whether the individual getting tested has received one or both doses of the vaccine (with details of the type of vaccine). This information can help track the spread of post vaccination infections, and the spread of potential variants.

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