Mangalore: After India experienced the devastating effects of the pandemic during the first and second waves of Covid-19, there has been much speculation on India witnessing a third wave. While medical experts had predicted its onset anywhere between July-August 2021 and speculated that it would peak in October, Dr Patrick J.C. D’Souza, who was working at Kulur hospital in Mangalore during March 2020 when the country was grappling with the pandemic, says that the sudden increase in Daily Death Toll (DDT) numbers in the country is the result of the second wave of Covid-19 and “we cannot attribute it to the beginning of a third wave in the country”. He says that the third wave might not be severe if a greater number of people get vaccinated and if Covid appropriate protocols and behavior are followed. He says individuals who have not received their vaccinations so far, might face complications during the third wave if they test positive. ‘Since the virus mutates very fast, the new variants might be cause of concern if they’re aggressive in nature,” he says. He further adds that the population density, lack of doctors, nurses, medical staff and hospitals in few districts were the reasons behind the crumbling healthcare system during the second wave of the pandemic. He states that the situation was the same even in countries like Spain and Italy.
Asked on his opinion about reopening of schools in the country, he feels it should be done taking into account the Covid situation area-wise. According to him, if one district or state has a higher rate of positivity, the same might not hold true for other districts or states. If there is any way to prevent the onset of the third wave in the country, he says it’s only through following Covid-appropriate behavior like wearing mask, hand-wash and getting vaccinated. If 90% of the population gets vaccinated, then Covid-19 will become just another common flu virus.
Dr. Srinivas Kakkilaya, a senior doctor, says that things like the third wave are arbitrary numbers given to increasing cases. He says similar respiratory infection was found in 2009 in the form of H1N1 and similar overreaction was experienced for which the WHO apologized nine months later. “We didn’t number the waves during H1N1, why are we giving them numbers now?’ he asks. He says the point is, whoever has not been infected so far will be infected. He says there are a lot of studies done to support the claim, including that of Siren and Vivaldi in the UK, which shows that reinfection is extremely uncommon. “This is the first time we are using a RT-PCR test to make a diagnosis. There is a huge difference between finding RNF particle in throat and real infection and merely finding RT-PCR positivity does not mean that the person is carrying the infection,” he says.
Dr. Kakkilaya says that most of the virus that affects humans and animals keep changing their RNA and DNA and mutations are very common. By now, since one-and-a-half years, there would be thousands, if not lakhs, of variants of the coronavirus. He says that out of all these variants, only four are named as “variants of concern”; they are: Alpha, Beta, Gamma and Delta. Seven are named as “variants of interest” which means they’re not of concern, but we are watching them. He says that children and young adults below the age of 20 do not have any issue with Covid-19 as they recover on their own. Very few children like the ones suffering from obesity, type 1 diabetes, blood cancer, kidney and liver disease are at risk from developing serious complications, but in their case also, the mortality is low.
He says its not proven anywhere that children are “super spreaders” of coronavirus nor that they’re “carriers” of the virus. “WHO, European CDC have categorically stated that children are not at risk from severe Covid and there is much harm done by keeping schools closed than open especially in a country like India where children lag behind in the learning curve.” He says there is no point in administering children vaccination when they’re not affected by coronavirus at all and administering them vaccines that are not tested on children could put their lives at risk.
Dr. Sanjeev Bagai, chairman of Nephron Clinic, says that day-to-day active cases are fluctuating and the main hotspots are states like Kerala, Maharashtra and a few southern states. He says this could be the ignition for the third surge. Dr Sanjeev anticipates the third wave to be milder as the vaccination during the second surge in India covered 10-15 crore of people, but now has crossed over 53 crore. There are a lot of articles published to ascertain that increase in vaccination will suppress the surge and mutations of the virus. He says: “We are better prepared this time with state-wise restrictions being on focus and major hotspots like schools and colleges remaining closed.”
He says genomic sequence of the second wave completely tilted in 18 major surges worldwide towards Delta variant. Delta variant which initially began with two mutations now has 38 mutations and is responsible for the second, third, fourth and the fifth wave internationally. “Delta variant will be responsible for the third wave, there is no doubt in that,” he states.
Asked if the present vaccines will protect people from the Delta variant, he says that the phase three trials of Cowaxin shows a good protective rate even for Delta strain up to 65% and protective rate up to 68% for Covishield. But he says the aim of the vaccine is not to eradicate infection all of a sudden, but to decrease the load of the virus in the community. Asked about his opinion on the statement made by ICMR that the mixing of the vaccines elicits better immune response, Dr.Sanjeev states that mix and match which is also known as combo vac primarily with AstraZeneca vaccine first and then followed by Pfizer or Moderna, or Pfizer, Moderna first followed by AstraZeneca, have shown 2 to 3 fold increase in immunogenicity enhancing better B cells and T cell response. He says there has been no adverse effect of mix and match vaccine but as a result, different points of the immune cycle are stimulated.
However, he says it is very premature and risky to open schools knowing that children carry a different immunophenotype and carry a large number of naive and immature B and T cells which can not carry the load of Covid infection. He says their body immune system is not fully equipped and that the data from UK and 23 or 24 provinces in the US showed 400% increase in pediatric age group and adolescence age group in Covid cases. “Hence, schools should not open till end of this year and online classes should continue,” he says.