The Second Coming

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          “Of all sad words of tongue or pen

            The saddest are these, it might have been”

As a nation, poised as we are at a crucial juncture of the Coronavirus pandemic which has been raging for the past year, we are very much in the midst of a second wave. This, in spite of the fact, that India performed remarkably well during the first wave given its vast population, dismal health care infrastructure, lack of knowledge about the causative virus, poor testing facilities, a general tendency to flout rules and everyone claiming to be an expert on management of the pandemic in general and government policy in particular.

With a strict nationwide lockdown imposed when cases barely numbered from five to seven hundred, India managed to prove all the dismal predictions wrong by limiting the number of cases to around ninety thousand a day as the peak of the first wave hit the country in September 2020, when crores of infections and deaths had been predicted.

The total number of cases stood at 1,13,08,846 and deaths at 1,58,326 at the beginning of March 2021. The steady decline of cases through January and February made everyone heave a rather gusty sigh of relief. But the complacency cost us dear and now that we are at the beginning of April, we seem to be fast losing the ground that we had gained. With more than 1,00,000 new cases being reported each day in the past few days, with no signs of abating we stand in danger of being swamped by the second wave after successfully riding out the first.

While much of the Western hemisphere had been hit by the second wave as early as December 2020 and January 2021, it seemed that India had been more successful at flattening the curve and the second wave would be far milder if it rose at all. But the present picture is the exact antithesis of this scenario, begging the question, what caused this second wave to arise so suddenly and with such ferocity despite a vaccine now being available. 

Several factors have been put forth by experts as possible causes for the sudden spike in cases and may be discussed as follows:

Variations In Viral Strains

INSACOG, the Indian SARS COV Consortium on genomics, has been carrying out gene sequencing on the novel Coronavirus and has detected more than 7000 variants across the country. A recently discovered indigenous double mutant strain involving L452R and E484Q mutations have been detected in Maharashtra and Punjab. These variations lead to a change in the spike protein of the virus resulting in increased infectivity and a rise in new caseload. This is plausible since the abovementioned states have the highest caseload in the country.

In addition, several imported strains like the UK strain, Brazil strain and the South African strain have also played a role, being detected in almost eighteen states across the country. While establishing a definite correlation between the new variants and caseload is still a work in progress, there is no doubt that the new variants are more prone to immune escape.

Covid Fatigue

Image Source: https://www.peoplematters.in/blog/life-at-work/compassion-fatigue-in-times-of-covid-19-25616

According to Dr Mala Kaneria of the BYL Nair hospital Mumbai, “Pandemic fatigue and inappropriate behaviour of the people” have led to the current crises. After months of lockdown and isolation, people have become remarkably blasé` about contracting the virus. This has resulted in rule flouting, especially in public with fewer people wearing masks, indulging in hand hygiene and social distancing. People now indulge in social gatherings like weddings, vacations, election rallies, the celebration of festivals and collective prayers,  many a time flouting the rules laid down by the authorities with impunity.

After the norms of the lockdown were relaxed, people also indulged in travelling across the country for various reasons, resulting in transporting the virus to far-flung areas. Improper travel norms and inadequate checking of reports on the part of the authorities also led to a rise in the caseload. 

Rapid Relaxation Of Lockdown Norms

Image Source: Image by Please Don’t sell My Artwork AS IS from Pixabay

With the economy taking a downturn, rapid relaxation of lockdown norms were implemented. The business and economic sectors saw a rapid influx of workers returning. Ill-equipped offices and factories which were not conditioned to social distancing or working in shifts resulted in a surge. In addition, with public transport being normalized, overcrowding of the means of public transport, especially in urban areas led to the spike in cases.

Vaccination Policy

While the advent of the vaccine for the coronavirus was greeted with unbridled enthusiasm, the vaccination drive left a lot to be desired. With a population as large as India, vaccination needs to be carried out at a much more rapid pace. In addition, dissemination of misinformation, scepticism about the indigenously developed vaccines and technical issues resulted in a hobbled vaccination program with only 2.6 doses of the vaccine being administered per 100 population. Technical issues like training personnel for proper vaccine administration and maintenance of the cold chain is necessary or else the vaccine is rendered futile, especially in the Indian summer.

With a change in the directives for the interval between the first and second doses being increased to 45 days, rapid vaccination is difficult. While it cannot be said for sure whether the vaccine protects against the new strains, it does reduce the severity of the disease and must be administered to as large a fraction of the population as possible.

Under-Reporting

With inadequate testing facilities being available, the danger of under-reporting has been very real since day 1 of the pandemic which was true both for the caseload as well as the fatality rate.  This has led to unknown clusters and super spreaders which has resulted in a sudden spike in cases. In addition, deaths in the rural set up are largely unreported unless the person has visited the hospital first which led to many fatal cases going unreported but causing infection within the community.

 Now that some probable causes of the second wave have been discussed, it is worthwhile to mull upon them and take action wherever possible for us as worthy citizens so that the pandemic curve is not only flattened but completely wiped out in the not so distant future.

Remembering the old adage “Don’t count your chickens unless they hatch”, we have to remember to use common sense in dealing with the pandemic and also that it is better to be safe than sorry!

Featured Image Source: Image by Alexandra_Koch from Pixabay
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About the author

Describing herself as a 'surgeon who would rather wield a pen', Dr Sumedha Rege is an ENT specialist by profession but a writer by choice. After completing post-graduation in ENT in 2003, she has also worked as a post-graduate trainer in a popular institute in Mumbai. Obtaining an advanced diploma in creative writing with distinction in 2010, she has written on myriad topics for quite a few online publications. She currently has a private practice in Thane and is specially interested in nasal allergies.

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