Just when we thought the worst was over after the gloom and doom of 2020, a fresh wave of the Covid-19 pandemic roared back in India, as all of us were caught unawares.
Hope has turned into despair in no time. Worse, children largely unaffected in the first wave have not been spared this time, as the mutants worked their way. Newer symptoms such as headache, stomach pain, redness in eyes, which generally go unattended, are a cause for massive concern.
Thinking that the pandemic was “over”, a vast population, which was under a strict lockdown for months last year, rushed to reclaim their normal lives by as early as end-December. Without masks and throwing social distancing caution to the wind, guards were lowered while the virus was still raging and mutating.
Sadly, we were mistaken.
What did not help the cause was the mixed messaging. Immunologist Vineeta Bal, who lives in the worst-hit Pune, explained the surge, “Slow and steady relaxation in restrictions on the public’s movement, resumption of public transport, opening of offices and restaurants, lowering of guard by the people, holding of major religious events such as the Kumbh Mela, election rallies, having limited vaccination opportunities, in addition to virus variants have all contributed to the spread.”
The result is an all-round devastation playing out in front of our eyes. Overburdening of hospitals and crematoria in urban sprawls amid widespread panic become a common scene. Not just Maharashtra, Gujarat, MP, the national capital region of Delhi is reporting an acute shortage of hospital beds and life-saving Covid-19 medicines. Even oxygen is in short supply in some States. Patient’s kin in Delhi are running from pillar to post to get admission to hospitals. Social media is full of desperate pleas seeking medicines.
The Delhi government, which boasted of its mohalla clinics that provided equitable healthcare, is battling its gravest health crisis yet. The near total collapse of the healthcare system is beyond the realm of our imagination. Fear is the key in large parts of the country.
New York-based Dr Shuvendu Sen said, “I may disappoint you. We’re probably seeing the tip of an iceberg.”
It is clear both the Centre and the State governments are not keen yet to take the countrywide lockdown route this time. They cannot be faulted as the economy is still in repair after the devastating consequences of last year’s lockdown. Doctors say there is no other way out. Night and weekend curfews have only limited impact.
Sen said India needs an instant ban on all social gatherings, mandatory mask and mass vaccination drive. “India must act very aggressively before it becomes Brazil.”
Dr Shamsher Dwivedee of VIMHANS, New Delhi, said, unlike the West, it’s impossible to maintain social distancing in a country like India both because of dense population challenges and ingrained behavioural issues. “It’s easier in Canberra but not in Karol Bagh or Chowpatty.”
Benchmarks must be set to impose what he called “localised lockdown”. Otherwise, it will be impossible to contain the surge, he said.
Infections came down in the West with the mixed strategy of vaccination and lockdown. India launched its vaccination drive in January but it was known for months that vaccination alone won’t eradicate SARS-CoV-2, like it was in the case of polio or smallpox. But good news is despite the slow pace of inoculation and vaccine hesitancy before and after reports of blood clot, doctors maintain vaccines still remain our biggest hope. The data showed that vaccines prevent hospitalisation and death – the most important outcomes. Those clotting events are exceedingly rare.As far as treatment is concerned, Dr Randeep Guleria, director of the All India Institute of Medical Sciences (AIIMS), New Delhi, told CNN-News18 that there has been no new learning in treatment. “Covid-19 appropriate behaviour and mass vaccination remain the most important strategies,” he added.
Sen makes a strong case for administering remdesvir and dexamethasone at the slightest hint of hypoxia or drop in oxygen level in positive patients.
But India has been ambivalent in using remdesivir. Guleria insisted remdesivir is not that effective a drug in decreasing mortality. It’s effective only when oxygen saturation is falling, he says, and hence timely use is the key. But many other Indian doctors admit privately that remdesivir has been instrumental in saving lives.
Dr Rajesh Gandhi, a top American infectious diseases expert said, “Dexamethasone is standard of care for hospitalised patients who require oxygen. In the US, we recommend combining dexamethasone with remdesivir for hospitalized patients who require oxygen but are not yet on a ventilator. We also recommend combining tocilizumab (another drug that decreases inflammation) with dexamethasone for people who have rapid worsening of Covid-19 – particularly if requiring high amounts of oxygen or intensive care unit (ICU) care — and have evidence of inflammation. We are also using anti-SARS-CoV-2 monoclonal antibodies in high risk outpatients with mild to moderate Covid-19 to prevent hospitalisation and death.’’
He said, people with mild infections can be treated at home “but need to be closely monitored and in the US we use monoclonal antibodies in high risk outpatients”. He said the data for ivermectin, commonly used as a Covid-19 treatment for mild infections in India, are inconclusive.
Gandhi added, “There are medicines that provide benefit but we need better medicines than the ones we have. For example, we need an oral agent to treat outpatients with mild-to-moderate disease.” That’s a work in progress.
Herd immunity or not, the virus is not going away anytime soon. Dwivedee said epidemiologists held out hope last year that a “good” mutant that is infectious but much less lethal will soon enter as it often happens after a pandemic to allow us to live with the virus with treatment and vaccination. “But we are still waiting.”
Vineeta Bal said, “It will be a long haul, certainly till 2022. Once a large number of people become immune either through infection or through vaccination the pandemic will recede and we will live in endemic disease state.”
Infections are surging more than recoveries, and hospitals that are bursting at the seams are finding it increasingly tough to take the heavy load. How we overcome the virus will depend on how we strengthen our combat strategy. To be sure, a piecemeal approach will be a recipe for more disaster. Most important, there should be absolutely no room for complacency and hubris. We don’t want India to become another Brazil. We have already paid a heavy price.