CHENNAI: Tamil Nadu is on road to recovery from the devastating COVID-19 second wave with cases and positivity rate showing a decline. There is, however, heated debate on a possible third wave and the rising number of cases in a few clusters.
In an interview with The New Indian Express, Dr Prabhdeep Kaur, Senior Scientist and Deputy Director, Indian Council of Medical Research-National Institute of Epidemiology, Chennai, discusses the preparations to be done and issues to be addressed. Excerpts.
The second wave appears to be weakening, but what are the possibilities for a third one?
We need to look at the data very carefully. The decline is not uniform across the State. Once we start opening up, there might be a resurgence of cases in several districts.Lockdown is only a short-term measure to prepare and improve the capacity of the health system. A third wave is technically possible as we have a virus that mutates fast.
The current variant is more infectious and can keep mutating further. We still have a high percentage of the population in non-metros who have not been exposed to the virus. We also know that as we start opening up, we will find it much more difficult to identify hotspots and contain them. We need to prepare for the third wave and also resurgence within second wave.
In the first wave, the State had a peak of just close to 7,000 daily cases. But in the second wave, during mid-May, the State was recording more than 30,000 cases daily. What went wrong in this period, and must the State follow a proactive approach as opposed to a reactive one in the future?
In the second wave, per day cases were much higher for every State in India. This is a pattern in the virus' behaviour. What we missed was when the new mutant took over the other variant in our population.
If we had done genomic surveillance, we could have detected it. We missed the shift and the only option was lockdown. We cannot stop the virus from changing its behaviour. We need a system in place to identify when it happens and act fast.
In the second wave, there was a lack of beds, oxygen, and increased waiting time for admissions to hospitals. Could these have been avoided if we had appropriate infrastructure in place? How can the infrastructure be prepared for the upcoming waves?
If you look at last year and this year, there has been a lot of development in infrastructure in terms of oxygen beds and the ability to supply oxygen. The challenge was faced even by developed countries. Every state or country can prepare its health system to a certain level but if the health system gets overwhelmed above that, it will be very difficult.
We should monitor the bed occupancy. If it exceeds 70 or 75 per cent, that’s when you start putting restrictions. As long as the health system handles it, we can allow economic activities. We definitely need to up our infrastructure.
We need a trained workforce, infection control, and many other clinical practices to be established. We also need to strengthen and institutionalise our processes such as triaging abilities, especially in the districts.
Lack of manpower in the medical system has been an issue even in the past, but the State never faced a health crisis of this magnitude. Has the COVID-19 pandemic scenario exposed the dire shortage of doctors and nurses in our government machinery? How crucial it is to address this issue?
The importance of manpower in the healthcare sector has been emphasized globally during the pandemic. Tamil Nadu is doing better in human resources but obviously, we need to add manpower as Covid has added several new activities to the health sector.
Addition has indeed been done in medical colleges, but, if we look at the field situation, there is not enough manpower. For instance, health inspectors and nurses in the peripheral level.Vaccination will go on for a long time and we must have dedicated manpower for it.
In secondary care hospitals, there is not as much manpower as in bigger hospitals. They need to be strengthened. We also need to add anaesthetists, physicians, and those trained in critical care and ICU care in smaller districts.
Newer variants such as the B1617 are being discussed globally and it is said to have a more rapid transmission rate and infectivity. How the public health surveillance system, research, and development, can equip itself to monitor newer variants entering the State?
Every State must have genomic surveillance in place and a fixed number of samples from every district must be tested to understand if there is a change. All mutations are not important but we need to know if variants of concern are increasing in the population.
The only way to do that is by testing a fixed number of samples every week or every 14 days from every part of the State. We must strengthen our ability to do genomic surveillance on an ongoing basis.
In the second wave, more youth were infected, and several in their mid and late 20s and without comorbidities died. How crucial is it to fast-track vaccination for the 18-44 age group?
We have to vaccinate everyone and that’s the only way to come out of the pandemic. There is still a large proportion of the elderly and the comorbid, who are not vaccinated. If the third wave comes, all the deaths likely to happen will be from these two groups.
We have to prioritise the elderly and those with comorbidities for vaccination. Within 18 to 44, again there are people with comorbidities.
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With the possibilities of schools opening in the coming months, is vaccinating children and teens critical?
In India, Covaxin has already initiated trials for younger age group. We hope that at least one indigenous vaccine is available to us quickly. Now that India has come up with a more open vaccination policy, other manufacturers will be willing to manufacture here. Or, we will have many more vaccines available here.
A few of those might be approved for the younger age group as well. But, I am concerned that it may take some time. Within the next six months or so, we may have options for children and teenagers.
Risk of pregnant women contracting COVID has been high in the country. How critical is it for them to get vaccinated?
There is a national-level committee that makes these decisions and they are reviewing the data for the two vaccines available in India. Even gynaecologists have recommended that pregnant women be vaccinated. The public health community feels the same. There are maternal deaths in the antenatal and postnatal phases.
Coming back to field-level containment strategies, the government took many measures like closing down streets and door-step triaging. How can there be a proactive surveillance strategy at the field level?
Strategy to reduce spread must be strengthened. The strategies are surveillance, testing, tracing, and isolation. While the government sector facilities have been good, a large chunk of people have been using the private sector and that’s a weak link in the surveillance system.
We must get the private sector on board by building systems so that they can report early on people coming with Covid-like symptoms. People with symptoms sometimes do not get tested over fear or other reasons, and take up paracetamol.
Pharmacies must be brought to the surveillance system and this must be replicated everywhere, just like it was done in Chennai.
Surveillance in CT scan centres too must be strengthened. We also need to strengthen surveillance in industries and we have to find ways to detect those clusters early. Employees must be taken into confidence so that they report the symptoms early.The employer must also provide paid sick leave, which will empower staff to come forward to report symptoms.
In clusters, we should do Rapid Antigen testing. Contact tracing must be done at workplaces and households. Systems must be in place to monitor isolation. In Chennai, we had FOCUS volunteers and similar people in districts could be roped in for supporting this kind of activities.