5 top experts weigh in on the possibility of a Third Wave, COVID-inappropriate behaviour and vaccination

Microbes with an upward arrow symbolize increasing numbers of COVID infections (Source: ShutterStock)

The issue of a third COVID wave in India hinges not on its near inevitability now, but on the question of government ability and preparedness of agencies to tackle the onslaught.

The All India Institute of Medical Sciences (AIIMS) Director Dr Randeep Guleria’s assertion that a Third Wave can be expected in a few weeks time, has set the cat amongst the pigeons.

Given the background, a recent IIT Delhi study, which reflects on the worst case scenario and of 60 percent higher cases in a Third Wave, as compared to the Second, is a serious wakeup call not only for tying up oxygen supplies, but for all COVID critical medical supplies.

Last month, IIT-Delhi warned the national capital to be prepared for a worst-case scenario where 45,000 Coronavirus infections might be reported daily with 9,000 patients needing hospitalization in the Third COVID wave.

The report named ‘IITD Review and Recommendations for Management of Oxygen during Covid-19 Crisis for GNCTD’ has recommended a series of steps to brave a likely Third Wave, which could be worse than the first two waves.

Data received till June 18 reported a total of 3.87 lakh deaths, but there are some who claim that this official figure is highly conservative, given the lack of data collection infrastructure and vastness of the country.

During the Delhi High Court hearing Professor Sanjay Dhir from IIT-Delhi listed some of the challenges that lie ahead to improve the oxygen infrastructure in Delhi alone.

Among other measures, he said ramping up of storage capacity, improving supply lines from outside Delhi, more Pressure Swing Adsorption (PSA) plants, and removing shortage of cryogenic oxygen tankers were some of the immediate measures which the city must undertake for efficient handling of the Third COVID wave, which is anticipated to be more severe than the previous two.

I am not sure if there is going to be a Third wave. There could be seasonal variations

- Microbiologist and Virologist, Gagandeep Kang

Prabhat Jha, Leading epidemiologist, University Professor and Chair in Global Health and Epidemiology, Dalla Lana School of Public Health Professor, Toronto, Canada. 

`A Third Wave is almost inevitable. Other similar countries have had at least three viral waves.’

` Despite the vastness of India, as well its incredible complexities, not to mention diversities, it is very possible to measure disease and health outcomes. The National Sample Registration System records deaths in rural areas, and assigns causes of death. ‘

So how does an epidemiologist compare risk among two or more exposure groups and what are measures of association? ``We examine relative risk- the relative difference in rates of disease between those exposed and unexposed (this is how vaccine efficacy is determined) as well as absolute differences between the two.’’

``As for how far can the COVID-19 (CoronaVirus) particle travel by air, indoor unventilated places suggest several metres."

``The disease rates of COVID-19 of 2020 and 2021 suggest that the 2021 viral wave is far worse."

``As for studies conducted on COVID in India, what is needed are basics: serological studies to establish how many were infected, good quality death data, and regular reporting of cases with key details on who/when/where infected to enable public tracking of the pandemic. This need not include personal information.’’

Gagandeep Kang: Microbiologist and virologist, Professor in the Department of Gastrointestinal Sciences at the Christian Medical College, Vellore. She is the first Indian woman scientist to be elected Fellow of the Royal Society in 359-year-history of this scientific academy 

``I am not sure if there is going to be a Third wave. There could be seasonal variations. Obviously, vaccine coverage of the population is a critical issue, but in India, the numbers are so huge that a mere 30-40 percent of the population being covered may not be enough to contain the virus. Earlier, it was thought that 60-70 percent population coverage would work, but now it seems, 85-90 percent of the population needs to be covered! So we have a long way to go.''

``There are many variants of the virus in India at the moment and they are quite deadly. Of how many more may mutate, it is difficult to say, given that a large section of the population is not vaccinated so far.’’

``Also much will depend on public’s COVID-appropriate behaviour’’

Vineeta Bal: Indian Institute of Science Education and Research (IISER), Pune. IISER is an autonomous public research university established in 2006, established by the Government of India’s Ministry of Education.

``There is sure to be a further surge. I don’t know when, I am not an astrologer. But the fact is that there are serious question marks over vaccination policy. Even if one were to believe the media that 13.5 crore will be vaccinated by next month end etc, it is still a small section of the population.’’

Coming of Third Wave will depend on 2 interlinked things: low rate of vaccination and very short public memory – AHPI National President, Dr Alex Thomas Philip

``As long as there are large sections of the population that are not vaccinated, vulnerability will continue to remain very high. And there is not much that we can do. ‘’

Dr Alex Thomas Philip, National President, Association of Healthcare Providers India (AHPI) 

``The coming of the Third Wave will depend on two interlinked things: the low rate of vaccination and a very short public memory. The government is planning to vaccinate 50 lakh people a day beginning this week. I believe it can be done. The combined strength of India’s public and private health care system has very deep roots. Even the smallest hospital in the country’s hinterland has a cold chain to store vaccines. So if it is treated like a national cause, mass vaccination, even despite India’s huge numbers, is possible. Our record in polio and smallpox inoculations are proof of how durable the Indian health system is.’’

`The other thing is public memory, which is very short.  Look at Mumbai and Delhi; all social distancing has been dropped, people are careless about wearing masks and crowds are milling around each other. The horrors of the second wave have been forgotten, all too easily.’’

Dr M C Misra, Former Director AIIMS

`Indians believe in the philosophy of `All or None’! As long as there was a lockdown, people observed rules and the number of cases came down. Now that the process of unlocking has begun, you can see the crowd milling around the thoroughfares. The chances of the toll going up are also high if COVID-appropriate behaviour is not observed. ‘’

`The Third Wave is a real prospect if we don’t keep super spreader events at bay. We have to avoid marriages and parties and stay at home as much as possible. Today, all resorts are packed to capacity. Try getting reservations anywhere – there are no bookings available anywhere."

``Peoples' behaviour since the unlocking process would have us believe that COVID is over – the same was the outlook in February and March when caution was thrown to the winds with such disastrous results.''

`My idea is that a Third Wave could be 30 percent higher in its impact than the Second wave. We have vaccinated about 28 crore people once – about 8 percent have been given the second dose, which makes them somewhat safe. Even one dose offers some protection, but reports from the rural areas suggest a lot of hesitancy; people have all kinds of notions about taking a jab. I am afraid, all these are bad signs. A Third Wave could be much worse."