Learn lessons to make system pandemic-ready

Umesh CS Yadav

Professor, Special Centre for Molecular Medicine, JNU

HISTORY tells us that pandemics come in the form of waves. The Spanish flu of the 20th century killed more people in the second wave than in the first one. If we had learnt lessons from the first wave of Covid-19, we would have been well prepared and responded quickly to make the second one much less devastating. We did not ramp up our health infrastructure by creating more hospitals and facilities to fight the second wave. Our population, especially the younger lot, became complacent and negligent, oblivious of the imminent danger.

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The resumption of economic activity and reduced number of infections by December 2020 started giving a false sense of normalcy. This feeling was reaffirmed by a series of political, religious and social activities. A wrong message reached the younger people that everything was under control and the coronavirus had left the country for good, even as discomforting news kept coming from Europe and other parts of the world that the virus had mutated and gained infectivity manifold and was also affecting the younger lot.

In India, the hospitals which were designated as Covid hospitals last year returned to their normal operations as soon as the first wave subsided and the cases dropped to three-digit figures at many places. This was done despite the fact that many countries in Europe were witnessing the second and third waves in early 2021 and virus variants were being reported in some countries. Initially, some cases were also reported in India in January and February, including the UK variant (B.1.1.7). By the end of March, 736 cases of the UK variant were reported from all across India, in addition to 34 of the South African variant and at least one case of the Brazilian variant. These variants were said to be highly contagious and therefore needed quick action to isolate, trace and treat in order to contain the wider spread. At this stage, swift measures were needed to contain the spread of the infection. But the system failed to recognise the looming danger. The cases started rising by leaps and bounds and the number crossed one lakh on April 4, two lakh on April 14, and three lakh on April 21. This sudden surge within a couple of weeks led to all-round panic, as the existing hospital facilities, which were functioning at a reduced strength, could not catch up with the number of patients that suddenly reached hospitals in many cities, especially in Mumbai and Delhi.

In the second wave, the patients include more people in the age group of 30-50 years. The probable reasons for this new trend, unlike the first wave, are the following: firstly, the younger people kept going to their workplace without adopting preventive measures; a majority of them avoided wearing a mask, and those who wore it slipped below the nose. Social distancing was not practised and washing or sanitising the hands was no longer a priority, unlike during the lockdown months of 2020. Secondly, the virus had got mutated, including a lately identified Indian strain (B.1.617) which had accumulated three mutations and become more contagious. Thirdly, the young population is still not vaccinated on account of priority given to the elderly and co-morbid population after the frontline workers. As a result, the mutant and highly contagious strains of the coronavirus found an unarmed and unvaccinated young population aged 25 or above, which accounts for more than 50 per cent of the nation’s population, as a favourable host to multiply.

In addition to the increasing incidence, a greater number of younger patients are needing hospitalisation, oxygen support and ICU admission, and are also succumbing to the disease. The reason behind this trend appears to be the negligence at the initial stage of the infection. People kept working and socialising despite having symptoms; as a result, their body became weak fighting the virus. As the virus grows in the lungs, it compromises the lungs’ function, and if the infected person keeps working and getting exhausted, the oxygen demand on the lungs increases. This double whammy leads to decreased oxygen level in the body, causing hypoxia and further damage to vital organs. By the time the patient becomes visibly weak and decides to go for testing, it is too late. The patients who show mild to moderate symptoms get scared upon learning that they are Covid-positive. In an HRCT (high-resolution computed tomography) scan the lungs show glassy patches in many cases; the severity score is more than 15/25 and oxygen saturation falls below normal. This leads to panic and the patients rush to hospitals.

The decline in cases being reported from a few places will be helpful in better management of patients and in bringing down the casualty rate, if not the severity. But it is likely that new hotspots may emerge due to the mistakes made at other places at the beginning of the second wave. Therefore, it is urgently needed that the pandemic is managed well by allocating and diverting resources wherever these are required on priority. For this, swift communication and transportation of resources without the restrictions of state boundaries are required. Further, an enhanced awareness drive is required to make people follow Covid-appropriate behaviour and help reduce the incidence.

More and more hospitals are needed to undertake studies simultaneously and perform analyses of the data well in time so that policies can be made quickly and altered in real time, wherever and whenever required. The clinical studies undertaken at the hospitals will help tackle the pandemic better in the current phase and also guide the preparation in future. We have a lot to learn from the pandemic’s second wave and apply those learnings in building a pandemic-ready health infrastructure and be prepared to handle the millions of cases without any hitch. This is extremely important looking at the demography of India and its projection for the coming decades as well as the likelihood of more disease outbreaks in future.

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