A simple way to explain the emergence of multiple COVID-19 waves is by using the analogy of a road with several speed bumps. When we accelerate along that road and approach an obstacle (or wave), our instinct is to slow down (or be more cautious). But we step on the gas soon after (or become careless again), until we reach the next bump on the road. Even as most places in India emerged from the second wave, we must prepare for the next and its potential impact on children.
Ahead of the anticipated third wave of Corona in India, we brought together an expert panel in our latest Practo Connect webinar to guide us forward. Hosted exclusively for doctors, by doctors, it was led by Prof V Ravi, former Head of Neurovirology at the National Institute of Mental Health and Neurosciences (NIMHANS) and COVID-19 Task Force member, Karnataka, and Prof Santosh Soans, Head of Pediatrics at AJ Institute of Medical Sciences and former President at Indian Academy of Pediatrics.
According to them, even though accurately predicting the development trend of the third wave is difficult, we must prepare ourselves for the worst and plan accordingly.
“Will there be a third wave of COVID-19 in India? Yes. This is primarily because the majority of the population is not immune to the virus,” says Prof Ravi. “Unless a significant proportion of people is immunized or infected, there will certainly be another wave,” he adds.
Although SARS-CoV-2 is different from the influenza pandemics of the 20th century, the Spanish flu of 1918-1919 has set a precedent for the development of some of these outbreaks. Much like COVID-19 in India, its first wave was mild, followed by an intense second wave and then a third.
Graph showcasing the successive waves of the 1918-1919 Spanish Flu
“We experienced a second wave because of our unpreparedness, coupled with the emergence of deadlier variants of the virus, which increased the rate of infection among a largely unvaccinated population,” says Prof Santosh, adding, “In fact, children, whose COVID-19 vaccination drive is yet to start in India, are likely to be impacted in the next wave.”
Pediatric guidelines for COVID-19
COVID-19 cases among children can be classified into three categories: mild, moderate, and severe. While mild cases largely warrant home isolation and care only, moderate cases may demand level two care, with some children even requiring supplemental oxygen and anticoagulation therapy. On the other hand, severe cases are handled in pediatric intensive care units if children experience rapid respiratory rates, pulse oximeter reading of less than 94%, pneumonia, seizures, or even bluish discoloration of the body.
“In such cases, patients should not be discharged unless they are comfortable on room air without oxygen therapy for at least three days, and can tolerate enteral feeds,” says Prof Soans. “Given that ICU facilities for children in India are almost negligible, this may be a good time to start building a separate infrastructure for pediatric cases, especially in district hospitals in India,” he adds.
Even though the vast majority of COVID-19 cases among children have been largely reported as mild, this number can be further reduced by following basic preventive measures. Since the majority get infected when coming in contact with a family member, they should isolate themselves if they suspect they could be carriers.
“It is also important to train parents for home care, including teaching them how to correctly measure body temperature, use oximeters, and evaluate respiratory distress,” adds Prof Soans.
Minimizing the impact of the third wave of Corona
Coronavirus has certain enzymes that make mistakes while copying itself, and these mistakes accumulate to produce a mutation, resulting in different (and potent) variants. Since we cannot stop existing viruses from mutating, we need to be vigilant until we have achieved immunity from them.
When is the third wave of COVID expected in India? Typically, COVID-19 waves are spaced three to five months apart based on prevailing human behaviour, where they tend to behave more responsibly during periods of peak pandemic, followed by a complacent attitude until the next peak.
According to Prof V Ravi, we need to take 10 important steps to minimize the impact of the third wave:
- Collect, share, and use data to drive interventions, especially at a district level
- Continue COVID-19 testing, and sustained surveillance
- Accelerate vaccination efforts, especially in rural areas
- Step up non-pharmacologic interventions, including wearing masks and maintaining social distancing
- Emphasize on the importance of both lives and livelihoods
- Allocate and manage resources well, and build up healthcare infrastructure
- Boost communication and amplify efforts to create more awareness
- Leverage technology to handle COVID-19 cases remotely
- Manage mental health issues, and alleviate stress and anxiety through targeted intervention
- Focus on post COVID-19 care continuum, and rehabilitation
Correcting mistakes made during the previous two waves, and working towards building a fair and equitable healthcare system which works for all people may be the only solution to minimize the impact of the third wave of Corona in India.
“Simply put, whenever there is an increase in the number of cases, we must carefully monitor the situation, and impose certain restrictions on human activity to minimize the impact,” says Prof V Ravi. “This includes continuing to reinforce COVID appropriate behaviour of wearing masks, maintaining social distancing, and avoiding crowded areas at an individual level, and increasing hospital bed strength, recruiting and training medical staff, and ensuring adequate stock of essential medicines and oxygen cylinders at a systemic level,” he adds.
Join us every month as we partner with leading industry and doctor associations for our educational webinar series, Practo Connect. Watch this, as well as previous webinars, here.