The third wave has arrived. We now know that no two waves are identical and that each wave is unique. Each variant of the virus has its own clinical symptoms, course and death rate and therefore requires a different course of management. The age and gender predilections also vary significantly, but what has remained constant is probably the fear, fatigue and foremost question — When will it end?
The first wave in India between March 2020 and December 2020, caused by the Alpha and Beta variants, typically involved all age groups. However, the older individuals and people with co-morbidities were more severely affected and unfortunately succumbed to the disease in large numbers. This wave was characterised by uncertainty and a gamut of therapeutic options lacking evidence, ranging from former President of the United States Donald Trump’s scientifically unfounded endorsement of hydroxychloroquine to the much-fancied convalescent plasma therapy. There was global confusion and chaos about the disease, its pathology and treatment.
Following a falsely reassuring period of relative stability, the second wave arrived with an onslaught of cases, involving a larger proportion of the younger age group. The villains of the second wave — the deadly Delta and Delta Plus variants — predominantly involved the lungs resulting in varying degrees of hypoxia necessitating oxygen therapy.
It was during the midst of this crisis that the results of clinical research trials became available and established treatment protocols were formulated and followed. Convalescent plasma therapy and remdesivir were unceremoniously tossed off their high pedestal. Heparin and steroids continued to be promising and effective. However, the heroes of this wave were the COVID-19 vaccines which were given EUA (Emergency Use Authorization) and administered to the vast majority of the adult population, which shielded many lives.
As the third wave is gathering momentum, it is evident that it is going to spread rapidly, given its innate nature of high transmissibility. Regardless of our vaccination status, most of us are prone to getting infected but the real challenge we may be facing in a few weeks from now is that clinically severe COVID-19 that may be affecting the vulnerable, inclusive of the unvaccinated elderly, elderly with co-morbidities, pregnant and lactating mothers and probably extending to children, overwhelming our health care facilities.
As we stand at the shore looking at the tsunami approaching, armed with the knowledge and wisdom gained, we now arrive at the question — Is there anything we can do? As socially aware and active citizens of this nation, it is incumbent upon us to adopt ideal strategies, whether old or new, to overcome the possible catastrophe heading our way.
At the present doubling capacity of 48 hours, there is going to be an overwhelmingly large number of COVID cases. We need to remind ourselves and our public not to panic.
Enough evidence is there that it is a mild form. Clinically not all positive patients need to be driven in herds to health facilities, least of all to a COVID designated higher centre. Remember, COVID does not replace non-COVID ailments, we need to keep the facilities open for timely management of non-COVID priorities too!
Thankfully, Tamil Nadu’s infrastructure has been built up admirably during the second wave. This infrastructure has to be reactivated and ramped up wherever possible.
The vaccine is our proven saviour and so we need to ensure an unabated vaccination drive, including administration of an early ‘booster’ or ‘precautionary dose’, as it is called now, to the high-risk and vulnerable population. This has to be started right away. Adolescent vaccination has to be parallelly maintained in full swing.
An out-of-the-box thinking approach would be to consider “Reverse Quarantine” instead of exhausting all available resources and precious healthcare facilities with asymptomatic/mildly symptomatic individuals. It will be prudent to identify the following categories for reverse quarantining in facilities
• Unvaccinated elderlies above 60 years of age
• Unvaccinated with moderate to serious comorbidities.
Identify them, drive them into the safety net/cocoon of CCC (COVID care center) or CHC (COVID health centre), vaccinate them and optimally control the co-morbid conditions. Through this strategy we can prevent the loss of many lives.
Our state encompasses about 1.04 crore of elderly population and about 62% of them have received at least one dose of the vaccine. Bringing the remaining unvaccinated elderly and those with comorbid and multi-morbidities under the safety net may not be practical and viable, therefore a judicious use of clinical discretion with robust field activity becomes essential. COVID protocols and appropriate behaviour need to be followed diligently.
To summarise, lessons learnt and wisdom gained should make us tide over yet another tsunami of COVID rather than be swept off our feet.
(The author is Dean, Government Omandurar Medical College, Chennai)
