“We need to look at where the second wave was descending since an increase will almost definitely be noticed from there, which may be regarded an early sign of the third wave. However, this necessitates a thorough examination of state-specific data,” claims top scientist of the Indian Council for Medical Research (ICMR), Dr Samiran Panda.
In an interview with Medically Speaking, Dr Panda talked about the possible threats of the third wave and increasing number of daily cases in India amid the festive season.
Everyone wants to know whether the third wave is going to hit or not? And if it does, what does it mean for the common people and when will it arrive or is it already here?
Dr Samiran Panda: Short answer to this is that yes there is a possibility of the third wave hitting us. The question, however can be broken down to smaller parts and should be asked at state level because India does not have a uniform state-wise vulnerability. Many states in India did not get affected as severely as Maharashtra, Kerala or Delhi. 80% of the recorded infections were recorded by only 10 states and people there developed good immunity against the infection. Thus, the possibility of third wave hitting strong in these states is lower compared to other states. These states also had quick vaccination which boosted their immunity fairly. State-level data should be analyzed on the terms of the intensity of first and second wave and the vaccination.
We are seeing 60 % to 70 % of daily cases coming from Kerala. Would you say that third wave has arrived there already?
Dr Samiran Panda: We realized that around 44% of the individuals in Kerala, particularly from the areas participating in the 4th round of the Sero-survey had presence of antibodies in them which means that they were also exposed to the infection. Looking at the other side of this, 56% of the people were not infected which means that Kerala was successful in containing the infection. Hence, we are not surprised on the fact that Kerala is experiencing surge of infection.
We need to look at where the second wave was descending since an increase will almost definitely be noticed from there, which may be regarded an early sign of the third wave. However, this necessitates a thorough examination of state-specific data.
Which states are at a higher risk of entering the third wave?
Dr Samiran Panda : Infections might happen to anyone even after the vaccination but will not push us to the severe stage of the disease. In a particular state vaccination has again good coverage then people will still get infected if they do not observe covid appropriate behaviour. Vaccine against Covid-19 in India are not infection preventing vaccines, they are disease modifying vaccines. Hospitalization or need of oxygens or even unfortunate event of deaths will be less in those states where 50-60% of the people have been vaccinated.
Would you say there is a tentative time line for the upcoming third wave, or would you say that it is not inevitable?
Dr Samiran Panda : Virus needs an opportunity where suspectable people come in contact with infected individuals and in the situation that the population density is very high.
We saw a surge in cases last time after the festivals like Holi and people went out to places like Kullu-Manali. Would you say that this time too the third wave would be experienced after festivals like Ganesh Chaturthi?
Dr Samiran Panda: If the height of the wave is in the question, I would still expect the height of this wave to be lower than the second because we did not have vaccinations happening back then.
If the population density increases during festivals with Covid appropriate behavior not being followed, we can always expect rise in cases. We must not forget our health is in our own hands.
Recorded number of infections and recorded number of symptomatic infections where more people are going to hospital requiring oxygen are two different things. Second scenario where the number of advanced stages of disease are at a large, is a scenario which can be considered as a wave and we do not want that.
Is it possible to avoid it?
Dr Samiran Panda: Each state needs to look into the epidemiology of the infection. It is possible to avoid the rise in cases through the state-specific data analysis.
We have seen a new variant emerge known as “C.1.2 and MU” which could be a variant of concern and as reports suggest many vaccines may not be as effective on it. Is there any real danger of it spreading in India?
Dr Samiran Panda: while delta was spreading, we looked into the magnitude of its spread. We realized that all the variants were neutralized by the …… collected by the vaccine recipient which is a good thing. Talking about the variants from other countries, we need to have a surveillance which could happen at three levels: at the airports, at the state level and at the district level.
As yet we have not recorded this new variant. Any new variant is identified as variant of interest or variant under investigation. As far as India is concerned, C.1.2 has not made an entry into the nation. If it results in large number of cases and deaths are being reported due to the new variant, it will be identified as a variant of concern.
NCDC is the focal institution that will conduct this genomic surveillance which sees whether the new variants are appearing or not.
There are certain variants like the Delta Plus on which the vaccines are not effective. What does this mean for our country?
Dr Samiran Panda: Any variant that gets identified as the variant of concern must be tested against the serum collected from a vaccine recipient and see if the serum is able to neutralize the new variant. Many laboratory experiments have shown that the vaccines made in India have been able to handle the variants called Delta or Delta Plus.
Since we are talking about the various mutation of covid, the possible third wave is stressing people. If it comes, will it be as effective as second wave or will it not be considering the number of cases in the second wave, immunity building etc.?
Dr Samiran Panda: If the third wave occurs, then, according to the models which we studied at ICMR, the third wave should not reach the heights as we had seen in the second wave, which is a good thing, but we should not let our guard down because, post vaccination, it’s possible for us to get infected. We won’t get to the severe point of the disease, but others can get infected, which is not good.
Is there any fear regarding increase in covid cases as children have better immunity but the can be carriers?
Dr Samiran Panda: Although children got infected but it is not clear whether they got it from school or not. And according to a National Sero-survey we saw that 55 percent of the children were already exposed and infected because they had presence of antibodies during the survey. So what can be done to avoid further spread is that before or during the opening of schools the parents and the school staff should get fully vaccinated and all the required precautions should be taken. Moreover, people should know that preventing children going from school is like robbing their life opportunities from them because they are the future of the country.
There are few reports about the booster shots, many countries started it already. What do you think about it whether India needs a booster shot?
Dr Samiran Panda: In India, we turned out to be lucky to have Covaxin and Covishield and many people have achieved natural immunity through natural infection. It does not make any sense to talk about booster dose as many eligible and prioritised groups of Indians are receiving vaccines and preferably two doses.
In the case of these present variants, it is all dependent on discussion related to neutralizing antibodies. But we must not forget that it’s just not about neutralizing antibodies after vaccination or post infection which matters. There is another arm of immunity, which is called cell-mediated immunity, and we are not measuring them.
I would say let’s not panic, and let us get fully vaccinated and then see what is the scientific data is telling us. For India, booster dose should not be the centre of discussion.
What would you tell the audience about the safety majors one should take as we are also approaching the festive season?
Dr Samiran Panda: If we celebrate a little low key so may be can celebrate better in coming years. So my appeal to everyone is get vaccinated keep the covid appropriate behaviour and so by doing this we can win this war against Covid-19 in India. So all of this is in your hand. Stay home and stay safe.