Experts call for caution in unlock, warn: Third wave in 3-4 months

AIIMS chief Randeep Guleria told The Sunday Express that the next three months will be crucial for India and the emergence of cases in the UK is a “red flag”.

With cities unlocking across the country and a highly infectious Delta variant still around, top health experts and Health Ministry officials are underlining the need to calibrate the reopening while adopting an aggressive vaccination strategy and Covid-appropriate behaviour, failing which India could well see a third Covid wave in three-four months.

AIIMS chief Randeep Guleria told The Sunday Express that the next three months will be crucial for India and the emergence of cases in the UK is a “red flag”.

And in a meeting held in the last week of May, a top Union government official informed the Delhi Disaster Management Authority (DDMA) that he expects the third wave to hit the national capital in February-March 2022.

Dr P Ravindran, who is Additional DDG, Directorate General of Health Services, conveyed this during a meeting of the DDMA attended among others by Dr Guleria, Delhi Chief Minister Arvind Kejriwal, Lt Governor Anil Baijal, NITI Aayog member Dr VK Paul and ICMR DG Balram Bhargava.

During the May 28 meeting, Dr Guleria, Prof Bhargava and Dr Paul suggested a very cautious approach in lifting the lockdown restrictions, saying that unlocking will lead to rise in cases.

On Saturday, Dr Guleria said: “Why everyone should be concerned is that in the UK, with the Delta variant, there is already a rise in cases that we are seeing, despite the fact that they had a long lockdown. The emergence of cases from the UK is a red flag for two reasons: one is the fact that this is the variant which is in India; second, this is despite the fact that they have a large number of people vaccinated. We still don’t have that kind of vaccination coverage and we have the same strain in India, which is highly infectious.”

He said the timeline for a probable next wave will depend on two factors: Covid-appropriate behaviour and the transmissibility of the strain.

“The timeline of the probable third wave depends on two factors. One is our own behaviour and how we move ahead. In normal circumstances, (the next) wave usually takes 5-6 months. But in case you don’t have Covid-19 appropriate behaviour, and you have a strain that is more infectious, it may be even three months or four months. It seems that despite the huge mortality and suffering, some people have gone back to crowding and no masking.”

“The next three few months are very crucial. Because if we are able to prevent a spike, we will be able to push vaccination and increase coverage. Also, we have to understand that our healthcare system is finite. Therefore, if you have to decrease the strain on the healthcare system, you have to work on the strategy of decreasing the number of cases. And for that you have to have aggressive Covid-19 appropriate behaviour and surveillance,” he said.

Guleria underlined that “surveillance with genome sequencing and linking that clinical and epidemiological data” will be crucial in stopping the next wave. During the May 28 meeting, Dr Paul had also observed that an “immediate” sero survey linked to genome sequencing be undertaken.

Guleria said there are three metrics that indicate India cannot lower its guard despite the drop in the cumulative number of cases: “One is the number of cases and the fact that they are still significantly high, and the virus is still there in our community and multiplying. Second is the fact that our data suggests the number of people who are protected by vaccines is still small, and unless we are able to build that up, it will have an effect not only on mortality but the chain of transmission will continue and we will not be able to break it. Third is that in some areas, positivity continues to be a concern and therefore, these areas need to be under proper control. Because if you allow travel and allow everything, then people will travel and infection will also spread. Therefore, along with this, you need very good surveillance because you have to be able to pick up hotspots or where admission in hospitals is increasing.”

At the May 28 meeting, which focused on the national capital, this is what was discussed: “Dr Ravindran, Addl DDG (DGHS) & Director, EMR, MoHFW, Gol emphasised that containment zones should be strengthened… do not allow any coming up of hotspots and micro level analysis should be carried out through NCDC. On the third wave, he mentioned that he expected that it would come in February/March next year and we have seven to eight months to improve our preparedness level.”

Dr Paul mentioned that “restrictive actions were taken somewhat belatedly. This allowed patient load to increase on the health infrastructure in Delhi”.

At the meeting, Dr Guleria “suggested only a gradual unlocking of activities”. “He stressed that maximum surveillance and aggressive testing in hotspots areas. He also referred to the higher mortality rate in Delhi during the current surge of Covid-19 cases and suggested that Death Audit may be carried out so as to ascertain possible causes for so many deaths”.

Prof Bhargava cited the example of London in making a case for a slow unlock: “He suggested that unlock activity should be gradual and staggered over a period of time… Lockdown measures have proved to be effective. He reminded that London had a lockdown of three months, therefore, we still have some window to continue it for some more time.”

Director NCDC Sujit Kumar Singh also advocated a cautious approach in unlocking the economy, underlining that the “mutant virus was 50% more transmissible”, causing the rapid surge in cases in Delhi.

National Disaster Management Authority member Krishna Vatsa told the meeting that “an honest assessment of Covid-19 cases” to help understand the reasons for a rapid rise in cases and the large number of deaths was required: “He suggested that this initiative should come from the government itself and information should be shared with the general public.”

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