India faces second wave of COVID-19

India is squarely in its second wave of COVID-19. Will he be able to handle it better compared to the first wave? Much will depend on the lessons he draws from these experiences.

The second wave

The number of new cases recorded daily has more than increased tenfold, from less than 9,000 on February 1, 2021 to more than 103,000 in the first week of April. During the first wave, the peak was in mid-September when India passed 97,000 people. This time, despite much more extensive diagnostic and monitoring capabilities, the rate of increase was much faster.

The number of linked deaths has risen steadily, from less than 90 in early February to more than 440, but there is invariably a lag between the rise in cases and the associated death figures. These numbers are expected to increase further in the coming weeks. Medical facilities, especially intensive care unit (ICU) beds, are under increasing strain in Maharashtra, where the second wave hit the hardest.

Mutated variants of the virus with higher infection rate, pandemic fatigue and increased COVID inappropriate behavior are cited as reasons for the second wave. The start of the vaccination program on January 16, 2021 gave a feeling of complacency. The government’s message not to let our guard down is diluted by the huge election rallies in recent weeks with no one wearing a mask and the Mahakumbh in Haridwar drawing 30 million visitors a day, confident their faith will protect them from the virus.

Locking is not an option

The first wave took place during a period of complete uncertainty about the virus. The central government quickly took control. Although health is a state matter, decisions were centralized and often announced without adequate consultation with states. On March 24, 2020, a nationwide lockdown was announced as India had 525 cases and suffered 11 deaths. The lockdown was lifted on May 31, after 68 days, with the number of cases rising to 190,606 and the death toll to 5,408. The spread of the pandemic slowed, but then accelerated rapidly, reaching a peak in the second half of September, before numbers start to drop from November.

However, even with a faster second wave, no one is talking about a repeat of the nationwide lockdown. This Brahmastra has been used and the belated realization of its economic drawbacks means that there is no appetite for such measures. Delhi prefers to let individual states take this call and deal with the fallout. In fact, the central government is desperate to get the economy back on track.

The only solution is a rapid increase in vaccinations. In January, before the launch of the vaccination program, the goal was to complete the vaccination of Indians in the priority category of 300 million (composed of 10 million health workers, 20 million frontline workers, 140 million over 45 years with co-morbidities and 130 million people). million over 60 years) by (subsequently extended to August) 2021. Since vaccines require two doses, this means 600 million vaccines in five months, in addition to normal vaccination campaigns covering children, pregnant women and other infectious diseases.

India has an extensive immunization program which has led to its emergence as the world’s largest vaccine producer. Annual vaccination against nearly a dozen infectious diseases and natal and neonatal vaccinations amount to 400 million doses per year covering about 60 million people. That means nearly 34 million monthly doses and the COVID-19 reader would add. However, this objective must be reviewed in the face of the second wave.

Speed ​​up vaccination

It is clear that the COVID-19 vaccination rate is far too slow. In the first phase, from January 16 for healthcare and frontline workers, the sample was lukewarm. Confusion has been generated by statements about the use of Covaxin (developed and produced by Bharat Biotech) in “clinical trial mode” even as data from phase III trials were awaited, while Covishield (developed by Astra-Zeneca and Oxford and produced by the Serum Institute) has been donated. emergency use authorization ”. In Europe, it has been reported that Covishield is not given at age 60 due to suspicious blood clot developments. On March 1, the government opened vaccinations for people over 60 as well as those over 45 with co-morbidities and on April 1, for all over 45.

Demographics indicate that the above 45-year-old cohort represents only 22 percent of the population. While it is true that this age group accounts for 60 percent of infection cases and 88 percent of COVID deaths, the second wave is also hitting younger age groups hard because they are back in the world. work, in fields, stores, factories and offices.

To date, 80 million vaccines have been administered; the current rate is approx. 3 million a day. At this rate, the target of 600 million doses for the priority population by July or August cannot be reached. Assuming that for the 800 million Indians over 18 who need 1.6 billion doses, at the current rate, vaccinations would continue until November 2022!

Currently, there are around 50,000 with a target of 100 vaccinations each. However, due to reluctance and the lack of effective communication strategies, the harvest is much lower in many centers. There is a certain waste inherent in such a large-scale exercise, but in a war situation every vaccine must be used. This has added to the anxieties, especially among the most affected states. It is therefore hardly surprising that Maharashtra,

It is clear that the second wave is moving faster and according to preliminary calculations 1.7 times faster than the first wave. At that rate, it could exceed 150,000 daily cases before peaking. Second, the idea that the case fatality rate (CFR) is lower this time turns out to be a mistake because the delayed CFR (using an 18 day lag) indicates that it is as deadly as the first wave. . This means that we may soon see rates surpassing the peak of 1,200 deaths per day in the first wave.

Policy changes

The first requirement is to open the vaccination and speed up the vaccinations to 10 million doses per day; in a way that retains priority for people over 45 but under 45 would also be accepted for vaccination, depending on the local situation and appropriate guidelines. This requires delegating power to states to establish vaccination points and to open up vaccinations to age groups under 45. Guidelines for monitoring vaccinations would continue to be prescribed by the Indian Council for Medical Research (ICMR).

At over three million vaccines per day, the government’s monthly demand for 100 million doses already exceeds the current production capacity of the Serum Institute (SII) and Bharat Biotech (BB) which currently stands at 65 million and 4 million doses per month respectively. According to a report filed by Rajya Sabha’s biotechnology department on March 8, 2021, SII’s capacity is to increase to 100 million and that of BB to 10 million by mid-2021. Beyond that, the two companies asked the central government for financial assistance to undertake an increase in production.

The central government has no choice in this matter. Last year, he created a national working group to expand vaccine production under the aegis of the Department of Biotechnology, which has contributed to the development of diagnostics and encouraged R&D for vaccine development. But the requirement is now different. The first priority is to finance an immediate expansion of the production of the two approved vaccines, Covishield and Covaxin.

The second priority is to advance approvals of the Russian vaccine Sputnik V for which the Russian company, Russian Direct Investment Fund (RDIF), has partnered with five Indian vaccine makers to produce a total of 850 million doses in 2021. There are at least five other vaccines in the Indian pipeline, under development by Biological E, Zydus Cadila, Gennova Biopharmaceuticals, SII and the nasal BB vaccine.

Meanwhile, the Johnson and Johnson single shot should also be considered for early use, especially if Biological E is going to produce it in India. If the government. Large companies will be happy to take responsibility for their workers and families if they can be sure their schedules will be spared the disruption of the COVID epidemic.

National levels of wastage are estimated at 7 percent, with considerable variation between states. Opening the vaccination will put an end to this preventable waste.

Current test levels need to increase rapidly. The current level of 1.1 million tests per day is lower than the 1.5 million tests performed daily in September-October. With the prices much lower now, there is no reason the test numbers should not rise to 2 million or even more.

Finally, India has undertaken the sequencing of only 11,000 genomes, or a fraction of 900,000 sequenced genomes, of which almost half in the United States and the United Kingdom. Large-scale sequencing helps in early tracking of variants so that mutations can be analyzed. The ICMR laboratories are best placed to remedy this shortcoming. It will also help Indian vaccine developers.

Finally, the most important lesson of the first wave is the need to change the mindset – from centralizing control to delegating responsibility. In order to have a whole-of-government approach, the central government needs to focus only on what it can do and rely on state governments to manage the situation on the ground. Local authorities are also better able to tailor communication strategies specific to demographic groups to ensure higher vaccination rates.