Right approach to ride the ‘inevitable’ third COVID-19 wave

The COVID-19 had continued relentlessly for the last one and a half years. There have been periods of surge that have been followed by a relative fall or lull in India. So far, there have been two very distinct periods- a surge separated by a prolonged lull period. So, the National curve seems to be in a declining phase right now.

Inevitable third wave

The third wave of COVID-19 pandemic in India is inevitable because a majority of the population is still susceptible and unvaccinated as the unlocking of COVID-19 related restrictions has started already across the country. The second reason for the third wave is antibody-escape mutant viruses. Antibodies produced by the immune cells called plasma serve as the first line of defence against infections. So, they are secreted into the human body especially into the bloodstream when they recognise the antigens and the toxins and then it inactivates these viruses. So, this is called neutralisation. When the COVID-19 virus mutates, the protein encoded is altered and is different from the non-mutated form. So, people get infected with COVID-19 even if they have enough amount of antibody. This is called escape antibody. This is another main reason for the third wave. We can expect a third wave within two to three months of the second wave.

Measures to prevent the third wave

Some states and union territories have decided to ease the lockdown. So depending upon the total positivity rate the plans and deadlines have to be announced. We have to closely monitor and decide on whether to ease the lockdown or give some restrictions. The second important thing is to keep pushing ahead with the vaccination programme. We have to move forward in approving more vaccines with the aim of covering at least 40% of the Indian eligible population as soon as possible. Priority should be given to those people who can be superspreaders and second priority should be given to people with comorbidities in the 18 to 45 age group so that we can reduce the number of deaths. The third thing is to enhance the surveillance including the sequencing and of viral genomes to identify the potential threats from new variants. Ultimately the public has to understand that these waves are not coming to us, but rather they are originating from us because we are not following covid appropriate behaviour. So, disease transmission can be halted by changes in human behaviour. So, the antidote to the third wave is a combination of social distancing, proper masking and avoiding the crowds as much as possible.

Treating covid patients

Healthcare professionals have to divide the patients into asymptomatic (those who do not have an infection), mild symptoms (having mild fever, cold cough, or loss of smell), moderate symptoms (patients who are having breathing difficulty and their saturation is low) and severe (saturation below 90 per cent). And treat them accordingly. For example, if the asymptomatic and mild COVID-19 patients have upper respiratory tract infection or slight fever without complications (like shortness of breath or hypoxia), the patient should be asked to remain in home isolation and follow physical distancing, indoor masking and hand hygiene. And if the patient is suffering from diarrhoea, multivitamins can be tried and the patient should stay in contact with the treating physician. He/she should monitor the temperature and the oxygen saturation by applying the pulse oximeter probe to the fingers. Seek immediate medical help if the patient is developing, breathing difficulty or if there is a saturation going below 94%.

Natural antibody or vaccine-induced antibody?

The natural immunity from the Coronavirus is fortunately quite strong if the infection is very high, for example, if the patient needs a ventilator when the patient is very sick, the antibodies are very, very strong and it will fight against the infection. But most people are only mildly ill or have immune protection, in those patients natural antibodies can provide mild protection. Those people can be benefited more from the vaccine than natural antibodies.


Note: The article is based on inputs from Dr Danish Salim, Kerala State Secretary: Society for Emergency Medicine India, National Innovation Head Society for Emergency Medicine India, Vice President Indian Medical Association Kovalam, HOD & Academic Director PRS Hospital, Trivandrum Senior Specialist Abudhabi Health Authority.

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