BENGALURU: History seems to be repeating itself. A year after Covid-19 broke out, the country and the state are back in the same position and witnessing a ten-fold surge in the number of cases registered.
Just before the present spike, there was talk of herd immunity being gained and the pandemic almost reaching the endemic stage.
But proving those theories wrong, the country has seen a surge since the second week of March. Karnataka, which had fared well in containing the first wave, has started witnessing a steep increase in the number of cases and there is a fear that a second wave is forming. Not just second, there would be a third wave too if a majority of the population is not vaccinated and people continue to ignore Covid norms, warned experts.
“The more the virus is in circulation, the higher its capacity to mutate. The new variant could be more infectious and lead to third and fourth waves too. We have to contain the spread, now,” said Dr Giridhara R Babu, a senior epidemiologist and member of Covid’s Technical Advisory Committee.
What is a second wave?
Dr T Jacob John, a retired professor and head, departments of clinical virology and microbiology, Christian Medical College (Vellore), and former director of ICMR’s Centre of Advanced Research in Virology, said repeated Covid spikes could be like waves in the sea. “The wave simply means that the number of infections goes up and comes down again. Each cycle is a ‘wave’ of coronavirus,” he elaborated.
For a second wave to start, you need a sustained rise in infections. This is happening across the state and country now, he pointed out. While Karnataka is one of the six states contributing to a high number of cases, the rising second wave is bad and will get worse, warned epidemiologists.
During the first wave, the peak was in the first week of October when Karnataka saw 10,947 cases per day. But in the just last one week, the state has already reached around 7,000 cases. The situation is grim despite the availability of vaccines, oxygen, beds, knowledge of the virus, testing etc, said epidemiologists and public health experts. They believe that the state may see a peak again by the end of April or early May. “This time, despite extensive diagnostic and monitoring capabilities, the rate of increase in cases is much faster,” said Dr Giridhara Babu.
Reasons driving second wave
While experts believe that there are several reasons contributing to the surge, they stress that mutated variants of the virus with a higher infection rate should not be ruled out. “Though it is unfortunate that we still do not have evidence to say that the surge could be due to a new variant at play, we have to accept that in all possibility, the state may have the Variant of Concern’s presence. Also, pandemic fatigue, increased Covid-inappropriate behaviour and big elections and protest rallies with hundreds of people not wearing masks have added to the surge,” Dr Giridhara Babu said.
Agreeing, Dr John added that the health ministry may continue to deny it till it is red in the face -- just as it did when it came to community transmission during the first wave, but there is no denying the presence of new Variants of Concern in the state.
He said the second wave is peculiarly different in almost all states and across the country. “We have found new variants in many states and this time, there has been increased transmission. This second wave wouldn’t have happened if we had detected the variant early and people had not let their guard down,” he said.
“It is sad that there is big complacency in handling the present situation. Sector after sector is seeking concessions and most closed spaces continue to function to full capacity. The latest surge is due to people ignoring mask and social distancing norms,” said Dr Giridhara Babu. Even as Bengaluru Urban is leading the surge in the present wave, four other districts -- Mysuru, Kalaburagi, Bidar and Tumakuru too are big contributors.
How different is this wave?
The second wave is moving faster and, according to preliminary calculations, it is 1.7 times faster than the first wave. A TAC member said, “At this pace, it could go beyond 9,000 daily cases soon. As earlier believed, the case fatality rate (CFR) this time is not lower than the previous wave, with the delayed CFR (using an 18-day lag) indicating that it is as deadly as the first one. We may soon see CFR exceeding the peak of 179 deaths in September.”
Also, there are new symptoms in the second wave, including gastrointestinal issues, hearing loss and conjunctivitis. Experts now also warn about an increase in the number of clusters. “Apartment complexes, institutions, hostels, paying guest accommodations and others have formed clusters,” said Dr Ravindra Mehta, pulmonologist, Apollo Group of Hospitals.
Interestingly the R naught value of the state over the last few weeks has stayed above the national value. If the reproductive number for the country stands at 1.53, the state’s a R naught is 1.65 as on April 9. This means that 10 Covid-positive people can infect 16 others. The last time Karnataka had a similar R0 was on July 19, 2020 when the State had 59,625 cases.The second wave is also hitting the younger age
groups hard because they are back at work and out on the field. But most of them are asymptomatic.
Concerns and solutions
Experts are worried because people’s attitude about the pandemic has changed from absolute fear to total callousness. “I don’t think this government is serious in tackling the pandemic. If it was, it should have risk funded vaccination manufacturing companies, allowing them to roll out vaccines faster. Also, the infrastructure to conduct genome tests is needed immediately. Why is the government not doing anything,” asked Dr John.
On the increasing R0, Dr Ravi V, nodal officer for genomic confirmation of SARS-COV-2 in Karnataka and also a TAC member, said, “If it crosses one, the propensity of the infection spreading is very high.”
He said, “Pandemics of respiratory infections come in waves over two to five years. We had a second wave of Influenza ‘A’ H1N1 in 2012, three years after the first outbreak in 2009. The 1918 Spanish Flu also lasted for two years. This is a road with multiple speed-breakers and we have to be careful all along. We should expect repeated outbreaks in the next one to two years till we will reach herd immunity. It is possible only through repeated infections and/or vaccinations.”
Dr Giridhara Babu too suggested that the best solution to fight off the pandemic is to increase vaccinations rapidly and to ensure that people follow Covid norms. Dr John said that the government’s first priority should be to fund an immediate expansion of facilities for increased production of Covishield and Covaxin. Next would be to speed up approvals for the Russian vaccine Sputnik V, for which the Russian company, Russian Direct Investment Fund (RDIF) has tied up with five Indian vaccine manufacturers to produce 850 million doses this year. “There are at least five other vaccines in the Indian pipeline being developed by Biological E, Zydus Cadilla, Gennova Biopharmaceuticals, SII and Bharat Biotech which should be approved as soon as possible. Bharat Biotech’s nasal vaccine and a single-shot vaccine by Johnson and Johnson too should be considered,” he added.