Covid-19 second threat

Vaccination Drive
By Dr. S.Saraswathi
(Former Director, ICSSR, New Delhi)

Prime Minister Narendra Modi told Chief Ministers that rise in COVID cases in some States could “lead to a national outbreak of the disease and quick and decisive steps are needed to prevent an emerging second wave of the infection”. He pointed to the possibility of spread of the disease to villages from Tier II and III cities where it seemed to have spread, and said that controlling the disease in villages would pose a big challenge to health infrastructure.
Daily cases of COVID-19 crossed 40,000 for the first time after 111 days on 18 March. Active cases were over 19,000 that day raising rumours of return to lockdown regime and strict enforcement of official regulations.
The 7-day average rose by more than 5% for 6 days at a stretch, which was said to be the highest rise since the outbreak of the pandemic. In the week 15-21 March, the surge was still worse at 75% of the number recorded in the month of February which confirms the re-emergence of the virus and portends bad days ahead. The second wave is not confirmed yet directly, but often mentioned by concerned experts as imminent.
Five States – Maharashtra, Punjab, Kerala, Karnataka, and Gujarat are identified as the chief contributors to the threat of second wave of COVID-19 – not unbelievable as Europe is facing a third wave. According to data in the Union Health Ministry, 70 districts in 16 States registered over 150% increase in cases in the first fortnight of March and infection is increasing at 100-150% in 55 districts in 17 States. Maharashtra’s second COVID wave is reported to be mild, but spreading fast. It reported over 27,000 cases on 20 March. In 15 other States also, daily number which lessened in the last 3-4 months shows sudden increase. With approaching summer, chances of further spread of the virus is feared as people start using ACs and room coolers.
Indications of possible second wave despite timely precautionary measures point to inadequacies and lapses somewhere in the line. Neither the governments, nor the administration can be blamed as the pandemic is all powerful and unpredictable. Medical and health personnel are doing their best at great personal risks and need to be rewarded, not blamed.
The main reason for resurgence of the virus is suspected to be blatantly indifferent attitude of people in following norms. Most people do not wear masks despite announcement of spot fines and those who wear, also do not wear it properly. Social distancing is hardly followed and with the opening of temples, theatres, malls and restaurants in many places, cannot be enforced without stern action. Social gatherings in marriages and other celebrations go on as special occasions in one’s life. Less said about political meetings, the better.
Relaxations in lockdown are misunderstood as weakening of the virus. A Union Health Ministry team has reported that 10 to 20 pilgrims and equal number of locals test positive for Coronavirus in the ongoing Kumbh Mela in Uttarakhand. Still, the anxiety of the authorities seems to centre on conducting the festival allowing free movement of pilgrims and not on enforcing pandemic norms to prevent the second wave that is waiting at our doorsteps.
Vaccination is universally believed to be a powerful intervention in the present pandemic emergency to arrest its uncontrolled escalation, but not a remedy against the outbreak of the disease in future.
Both Vaccines used in India – Covaxin and Covishield – are said to be equally effective and no complaints have been received against their use. Emergency use of the two COVID-19 vaccines was authorized by the regulatory agency on 3 January and healthcare professionals were chosen as the top priority category for taking the vaccine followed by those in essential services. The second phase began on 1 March for the elderly.
Vaccination coverage is a technical issue and purposive, and does not adhere strictly to definite criteria like age, sex, etc. Questions of equality are irrelevant. From healthcare angle, vaccination aims at preventing mortality and severe attack of the virus causing serious health problems. From public health perspective, it is intended to put a break in the chain of the disease to control its spread which will help restoration and continuation of normal life and activities. Both objectives are equally important and the ultimate target is to cover the entire “eligible” population – eligible in the medical sense.
Therefore, vaccination programme needs a logical time schedule to be determined by administrative authority in consultation with medical and public health experts and not a matter for political debates and exchanges.
Further, it is repeated again and again that vaccination is not a final solution for anybody to permanently escape COVID-19. Not only does it take time to build immunity after the first and second doses of the vaccine, it is now said that the vaccine effect may stay for about 10 months which means that it is introduced as an immediate requirement to counter current emergency.
Under-utilisation of vaccination facilities is often mentioned as a problem in India, a reputed vaccine producer in the world, creating problems of vaccine wastage that world can ill-afford. India is able to supply vaccines to many countries, but at home has faced challenges in vaccination drive including positive opposition. Those who are vaccinated are repeatedly advised not to relax the essential precautions of wearing the mask, maintaining social distance, and washing hands frequently and avoiding touching one’s face. This perhaps acts as a disincentive in operation vaccination.
For, it raises a crucial question in everybody’s mind regarding the purpose of vaccination programme. The authorities have to come up with easily understandable explanation for the massive vaccination programme that will answer all doubts of people. Advice and stress on vaccination, assertion of the safety of the vaccines, expansion of vaccination centres, and concessions and incentives to get vaccinated are necessary, but must be accompanied with educational programmes to convince people of the purpose and effect of vaccination. The need for that education increases with increase in the propaganda made to take vaccination.
Several television channels are conducting interviews with medical experts to impart vaccination education that is very much needed in the country. But, how much of it is actually accessed by people is a big question. More official information directly addressing people is needed, but of course with no exaggerated claims. It is a difficult responsibility in view of the tendency growing in the country to politicise every issue.
Those likely to face problems in taking allopathic medicines and injections want more detailed information regarding possible reaction to the vaccine and facilities for treatment for them. It is partly the fear of side-effects and reaction of the body to the medicine that is hindering progress of the vaccination schedule. People who think that they can avoid catching and carrying COVID virus by scrupulously following COVID norms rather than subject themselves to the unknown reaction to the vaccine have to be addressed. In our country, such people are not a negligible section.—— INFA