In Search for An End(Demic)

In Search for An End(Demic)

The Coming of End(Demic)?

I have been speaking with cross section of folks over the last few days. Covid Command Center Officials, Health Ministry Officials, Our Doctors, some experts across the world to understand what we are calling the ‘Second-Wave’ of Covid. Many social media posts, new reports are completely confusing the masses now that a few places have now imposed the so called ‘Second-Wave of lockdown to manage the situation. Let me dissect the situation and ally some of the misconceptions and fake news going around. So here are the issues I am hearing

  • With increased vaccination rate, there is increased covid infection rate
  • Are the spikes in coronavirus cases due to more coronavirus testing?
  • There is very high incidence in Maharashtra and Delhi and will spread across the country after the Kumbh Mela
  • There is shortage of beds, medicines, vaccines to meet the current wave
  • What should I do?

So is there an End(Demic) in sight to this Covid?

With increased vaccination rate, there is increased covid infection rate

This is totally incorrect. India had administered 111 million doses of vaccine and covered about 7% of the population with one dose. So there is no correlation between vaccination rate and the spike in the Covid Cases in this wave which is due to the following reasons:

A new double mutated strain of SARS CoV2 has been detected in second wave. This is in addition to Brazilian, South African and UK strain. This new mutated virus has the potential to skip the immunity and even vaccine. This is the reason for re-infection cases & cases among vaccinated people.

  • It is more infectious & affecting younger population of 18 to 45 years group and this group is “super preader”.
  • By passing RT-PCR – new COVID cases may not be detected by routine RT-PCR test.
  • R- value is increasing. This is reproductive value which tells one positive person will infect how many others.
  • Public carelessness & lack of adherence to COVID appropriate behavior (mask, hand sanitization, social distancing & vaccination).
  • Pandemic Fatigue

Are the spikes in coronavirus cases due to more coronavirus testing?

No. During a surge, the actual number of people getting sick with the coronavirus is increasing. We know this because in addition to people testing Covid positive, the number of symptomatic people, hospitalizations and later, deaths, follows the same pattern. Therefore there is a correlation.

There is very high incidence in Maharashtra and Delhi and will spread across the country after the Kumbh Mela

It is true that Maharashtra has the highest number of Covid positive cases in India at the moment. However other cities and states are quickly catching up with newer cases showing up with a lag effect. The latest map show the spread. (see the map below)

Covid Wave 2 Clusters and Lockdowns and Restrictions
Covid Wave 2 Clusters and Lockdowns and Restrictions Imposed

There is shortage of beds, medicines, vaccines to meet the current wave

Yes there is a lag in the capacity creation and supply with this sudden surge in this wave. Many of the temporary facilities which were lying vacant as the Covid cases went down were utilized for Covid Vaccine Centers. They have now been been used for the treatment and isolation of Covid patients in this wave. On the supply of the injections, many of the manufacturers had now produced these medicines as the demand for them had reduced since October 2020. They are now ramping up production of Remdesivir and this should be available by next week. On the vaccination front, the politics still continues, while a third vaccine from Russia is being given emergency use approval and should also be available by the end of this month.

What Should I do?

Authorities, doctors, clinics and hospitals recognize that more waves are likely to occur. Here’s what you can do now:

  • Continue to practice COVID-19 precautions, such as physical distancing, hand-washing and mask-wearing.
  • Stay in touch with local health authorities, who can provide information if COVID-19 cases begin to increase in your city or town.
  • Make sure your household maintains two weeks’ worth of food, prescription medicines and supplies.
  • Work with your doctor to ensure that everyone in your household, especially children, is up to date on vaccines, including your Covid Jab

So is there an End(Demic) in sight to this Covid?

So how will these Covid Waves End? Do we see any endemic in sight? Throughout the pandemic, health experts have tended to set the magic number for herd immunity between 50% and 70%. Some of the data coming in shows that

Presumed ‘herd immunity’ is ‘the combined value of infections + vaccinations as % population > 60%

Let me explain the above formula:

Herd immunity is a public health term that refers to the fact that, when enough people in a community have immunity from a disease, the community is protected from outbreaks of that disease. More than 60% of the population needs to be immune to the coronavirus before herd immunity can work. People might be immune from the coronavirus, at least for a while, if they have already had it, but we don’t know this yet. Researchers are currently trying to determine if, and for how long, people are immune from the coronavirus after recovering from Covid. If it turns out that immunity only lasts for a while, people could get Covid again, resulting in even more death and disability. This is the lesson from this wave.

Our country needs to speed up the immunization rate which may take months before we see an end!

The Second Chinese Virus Wave – Trade Off Between Vaccine Strategy and Vaccine Diplomacy

Vaccine Strategy

The Second Chinese Virus Wave – Trade Off Between Vaccine Strategy and Vaccine Diplomacy

There is a second impending Chinese Wuhan Virus Wave in India. Last few days have seen a huge spike in the number of Covid Cases. States like Maharashtra are contributing to over 50% of th cases in the second wave of this pandemic. There are hints of a lockdown while the immunisation drive is now open to second age cohorts of upto 45 years age. Let’s understand, a lockdown is like celebrating an Easter after the economic crusification of the masses when we have proven our vaccines and immunisation drive should be accelerated to cover maximum population which is at risk. Being a student of epidemiology, it begs to reason out the strategy that needs to be followed for immunisation to win over the Chinese Virus in India and sacrifice the wider world’s do good by supplying the vaccines to other countries when our own country is a a peril. In this blog, I discuss on the various options for India.

Where do Indian Covid Vaccines stand in the World Vaccine Race?

India’s CoviShield (rebranded as Vaxzevria on rest of the world) has received the largest purchase orders by the Governments around the world with over one-fourth of the total are going to be supplied by AstraZeneca/Serum Institute. This is on the backdrop of certain adverse event in certain populations of blood clotting. The next in the race are Pfizer/Moderna which has around one-fifth of the commitments. India’s Covaxine from Bharat Biotech is still lagging behind on the 6th spot.

India’s Vaccine Diplomacy

Although India is the world’s largest vaccine manufacturer, it has won the race against China’s vaccine silk route strategy to dominate the world Covid vaccine supply very early on. From unconfirmed news sources, around 70 million doses have been supplied by India to the world as part of various initiatives to aggressively outwit Chinese Vaccine Silk Route Strategy. India must aggressively meet its commitment for its country and the world to combat the Chinese Wuhan Virus and its various mutants emerging in the world. India’s success in being transparent in the trials of the vaccine and its efficacy is India’s strength in leading the vaccine diplomacy and emerge as a leader. However, India cannot let its own population face the second wave of the pandemic by short supplying the vaccines in India to its 1.35 billion population meet world’s requirements of over 7 billion population. It needs to secure its own borders from the Chinese Wuhan Virus before it can free the world from the invasion of the virus. This means, India need to repriortise its Vaccine Diplomacy strategy. New emerging is that India has slowed down or halted the supply of the vaccines to the world’s after around 65 million doses supplied already.

India’s Vaccination Strategy

India has already used around 65 million doses for covering around 65 million people (around 2% of India’s population) since the launch of the program in January 2021. The phased roll out of the immunization program is on the basis of age cohorts. After the front-line medical workers, the senior citizens were the first to be covered under the program. The second phase is underway covering population above the age of 45 years. The for India is to immunize over 250 million of its citizens by July 2021. Let’s analyse this scenario in the face of the second wave emerging.

Optimum Population Immunisation Coverage

It is believed that over 50% of the population immunized is the much comfortable situation for any country to manage and control the Covid pandemic. While no country has reached this so far, around 20 countries has performed better in their population immunization drive so far. UAE, UK, Chile, and the US have immunized over 20% of their population. The rest of the 16 countries faring better than India also are accelerating their vaccination strategy by ramping up the procurement and supply of vaccines. India has to also do the same.

Revised Vaccination Strategy in the Face of the Second Wave in India

While India may take some time to reach the 250 million population coverage by July 2021, it must rethink the vaccination coverage strategy. Here are a few suggested ones which obviously do not meet the cannons of vaccination in the face of a global pandemic never faced by the world before.

Total Vaccination of Population in States with the highest Covid outbreak:

In this scenario, India accelerates the immunization and opens it to all the age cohorts in the top-5 states which are contributing to over 80% of the current second wave of cases. These states include Mahrashtra, Kerala, Delhi, Karnataka, Andhra Pradesh, Tamil Nadu. This is going to be politically sensitive as other states which have better managed their Covid situation may let the current situation slip to demand total immunization coverage of their states

Total Vaccination of Population in States with the highest Covid outbreak:

Like the earlier strategy, the top 20-cities are contributing to over 50% of the second wave of the Covid cases. This may also be difficult and politically sensitive.

Open up the double bell curve of the Indian age cohorts at Risk:

At a median age of 27 years, its our 50% of the younger population which has to also be opened up for the inoculation strategy as newer mutations attack this population which is our country’s future productive resource.

While the above vaccine strategy would lead to some amount discrimination and political horse trading. Its time to our review and acceleration of the vaccine strategy. The vaccine strategy adopted by other countries as a benchmark would be another blog for another time. The priority of the immunisation strategy is to avoid another impending lockdown to control the spread of the Chinese Wuhan Virus infections!